成都市区1486名女性大、中学生进食障碍的 现况调查

目的 探讨女性大、中学生进食障碍的患病率及其相关因素.方法 采用最优分配分层整群随机抽样法从成都市区抽取大学6所、普通高中1所、普通中专1所、成人中专2所、职业高中1所、初中3所,共1486名女性大、中学生,采用进食障碍问卷、体像障碍量表、抑郁自评量表、贝克焦虑自评量表、自编调查问卷进行现场调查.采用t检验和logistic回归分析数据.结果 成都市女性大、中学生进食障碍估计患病率3.32%;各年龄组中17岁组估计患病率最高(7.16%);各学龄阶段中高中组最高(5.21%).进食障碍倾向组在认识偏差(P=0.009)、期望偏差(P=0.000)方面均比非进食障碍倾向组得分高.关注减肥相关媒体宣传、童年时父母关系紧张、童年时受虐待、进食障碍问卷的不满体型因子、内感受意识因子及焦虑是进食障碍倾向的相关危险因素.结论 进食障碍在女性大、中学生中估计患病率较高,应积极干预.     

Pattern of birth in restrictive and bulimic eating disorders

Objective: To determine whether different eating disorders are associated with being born at different points in the year. Based on previous research, it was hypothesised that being born during warm months (June–August) is likely to be associated with restrictive anorexia, rather than bulimic disorders (bulimia nervosa, binge-purge anorexia). Method: Case notes from 105 eating-disordered women were used to yield dates of birth and diagnosis. Associations were calculated between diagnostic group and birth period (month, quarter of year, high-risk quarter). Results: Restrictive anorexics were significantly more likely than the bulimics (42.6% vs. 24.1%) to be born during the warmest quarter (June–August) than during the remainder of the year. Conclusions: This preliminary study suggests that being born during warmer periods may form a small risk factor for the development of a restrictive eating disorder. Further research is suggested to test and extend the hypothesis.     

Prevalence of eating disorders and weight control practices in Germany in 1990 and 1997

OBJECTIVE: To investigate whether the prevalence of bulimic behaviors and weight control practices changed between 1990 and 1997. METHOD: In November 1997, we surveyed a representative sample of 2,130 adult subjects in West Germany and 2,155 subjects in East Germany. We asked subjects about binge eating, vomiting, use of laxatives, appetite suppressants and diuretics, and about dieting, weighing, and exercise. As the same questions had been used in a representative survey (N = 1,773) in autumn 1990 in West Germany, trend comparisons for prevalence between 1990 and 1997 are possible. RESULTS: The prevalence of severe eating binges twice a week dropped nonsignificantly between 1997 and 1990 from 3.1% to 2.4% in men and from 2.3% to 1.3% in women. In men, the prevalence of binge eating disorder dropped nonsignificantly from 2.4% to 1.5%, the prevalence of bulimia nervosa from 2.1% to 1.1%. In women, the prevalence of binge eating disorder dropped nonsignificantly from 1.5% to 0.7% and that of bulimia nervosa from 2.4% to 1.1%. CONCLUSION: The prevalence of bulimic behaviors decreased slightly during 1990 and 1997 in the West German population.     

The prevalence of eating disorders in female health care students

Previous research has suggested a raised prevalence of eating disorders amongst female medical students. This study aimed to test the belief, commonly held by occupational physicians, that there is also an increased prevalence of eating disorders amongst female applicants to nurse training. If correct, it implies the need for additional support and may predict increased failure to complete the course. Three groups of female students were compared: applicants to a university nurse training course, first-year medical students and a comparison group of first-year university students on courses not related to health care. Possible eating disorders were identified using two self-report instruments, the EAT-26 and the BITE questionnaires, and the body mass index. No significant statistical difference was found in the prevalence of eating disorders between the three groups, using the above measures. After controlling for age and ethnicity, 20% of the nurse applicants were found to have disordered eating patterns meriting further investigation, compared with 19% of medical students and 21% of arts students. The nursing students are being followed up to compare the progress of those with and without disordered eating patterns.     

The comparative utility of statistically derived eating disorder clusters and DSM-IV diagnoses: relationship to symptomatology and psychiatric comorbidity at intake and follow-up

INTRODUCTION: The classification of eating disorders has been a matter of considerable debate. The present paper extends previous work and aimed to compare the utility of statistically derived clusters of eating disorders and conventional diagnoses. METHODS: Adult female eating disorder patients who had previously been classified on the basis of cluster analysis of key diagnostic variables were examined on measures of eating disorder symptomatology and psychiatric comorbidity at intake (N=601) and subsequent follow-up after 6 and 36 months (N=349, N=322, respectively). RESULTS: Compared to DSM-IV diagnoses, clusters demonstrated greater utility in terms of more distinct between-group differences and higher effect sizes in relation to a wide range of variables. The greater utility of clusters was in important respects due to the reallocation of EDNOS patients to more relevant alternative categories and to a greater emphasis on psychological and behavioural features of eating disorders. CONCLUSIONS: In order to achieve a better classification of eating disorders, it will be important to place increased emphasis on common psychological features. There is a need to move away from increased use of subtypes and toward a definition of eating disorder per se.     

Attrition and outcome in self-help treatment for bulimia nervosa and binge eating disorder: a constructive replication

The aim of the study was to assess the efficacy of a 12-week CBT-based pure and guided self-help among 29 patients with full and subthreshold bulimia nervosa, and binge eating disorder. In the intention-to-treat analyses, self-help had a moderately positive and sustained effect on the patients' eating problems. The patients reduced their mean number of objective bulimic episodes and purging behavior by 26% and 22% over the course of treatment. The corresponding reduction levels for the treatment completers (n=21) were 41% and 34%, respectively. As in the previous study, there were no significant differences between the pure and guided self-help mode in terms of outcome, and the results were sustained 6 months after the end of the treatment. The findings are discussed in relation to the shorter duration of the self-help, the lower rate of attrition, and the characteristics of the sample compared to the earlier trial.     

Dyadic view of expressed emotion, stress, and eating disorder psychopathology

Prevailing models of the association between expressed emotion (EE) and relapse conceptualize EE as a form of stress for patients. In eating disorders (ED), there is no research addressed to evaluate the degree to which patients feel stress due to their relatives’ EE. It has been neither investigated how the EE and the subsequent stress relate to disordered behaviours and attitudes neither. Using a sample of 77 inpatients with ED, this study aimed to: (1) evaluate patients’ reported level of stress as it relates to their caregivers’ EE, particularly as associated with carer's criticism, emotional overinvolvement and warmth; (2) examine the associations of stress with the patients’ perceptions (self-reported) and the caregivers’ perspective (assessed by the Camberwell Family Interview) of the EE; and (3) study how the two views of EE (patients’ and caregivers’) and the stress due to EE relate to the ED symptoms. The findings indicate that patients judged their carers’ critical stance as the most stressful, followed by emotional overinvolvement. Secondly, patients’ perceptions of EE, whereas none of the interview indices focused on the caregivers’ perspective, were associated to the stress and to the ED symptomatology. Additionally, the patients’ stress due to criticism was positively related to the ED symptoms, while the stress associated with emotional overinvolvement and warmth was not. Clinical and research implications are discussed. Findings suggest attention to the ED patients’ view of their family environment and support the utility of assessing their appraisals of EE.     

The Minnesota Eating Behavior Survey: a brief measure of disordered eating attitudes and behaviors

This article describes details of the development and psychometric characteristics of a brief self-report inventory for assessing attitudes and behaviors symptomatic of eating disorders that is currently in use in a longitudinal study of over 700 families with 11-year-old or 17-year-old twin girls. The Minnesota Eating Behavior Survey (MEBS), formerly the Minnesota Eating Disorder Inventory, is a 30-item measure developed for use with children as young as 10 years as well as adults. An examination of the MEBS's psychometric properties in a large, community sample of girls, women, and men demonstrated good factor congruence, internal consistency reliability, three-year stability, as well as evidence of concurrent and criterion validity. This questionnaire has promise as a screening and assessment measure for eating disturbance in cross-sectional and longitudinal research involving individuals of a wide range of ages.     

Eating disorders in adolescent boys: a review of the adolescent and young adult literature

Although a number of studies have investigated eating disorders in adolescence and the topic has been thoroughly reviewed, these studies have typically focused on females, only to state that the approach and treatment should be similar in males. Recently, there have been a number of studies that have explored gender differences in eating disorders. In this article, we review the literature pertaining to two DSM-IV-defined disorders (anorexia nervosa and bulimia nervosa), a DSM-IV-defined research disorder (binge eating disorder), and two DSM-PC-defined disorders (dieting/body image and purging/binge-eating behaviors), highlighting those findings that pertain to disordered eating in adolescent boys.     

"Not all my fault": Genetics, stigma, and personal responsibility for women with eating disorders

Medical researchers and clinicians increasingly understand and present eating disorders (anorexia and bulimia nervosa) as biologically-based psychiatric disorders, with genetic risk factors established by high heritability estimates in twin studies. But there has been no research on interpretation of genetic involvement by people with eating disorders, who may hold other views. Their interpretations are particularly important given the frequent presumption that biogenetic framing will reduce stigma, and recent findings that it exacerbates stigma for other mental illnesses. To identify implications of genetic framing in eating disorders, I conducted semi-structured interviews with 50 US women with a history of eating disorders (half recovered, half in treatment; interviewed 2008-9 in the USA). Interviews introduced the topic of genetics, but not stigma per se. Analysis followed the general principles of grounded theory to identify perceived implications of genetic involvement; those relevant to stigma are reported here. Most anticipated that genetic reframing would help reduce stigma from personal responsibility (i.e., blame and guilt for eating disorder as ongoing choice). A third articulated ways it could add stigma, including novel forms of stigma related to genetic-essentialist effacing of social factors. Despite welcoming reductions in blame and guilt, half also worried genetic framing could hamper recovery, by encouraging fatalistic self-fulfilling prophecies and genetic excuses. This study is the first to elicit perceptions of genetic involvement by those with eating disorders, and contributes to an emerging literature on perceptions of psychiatric genetics by people with mental illness.