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.     

Perception of hunger and satiety induced by 2-deoxy-D-glucose in anorexia nervosa and bulimia nervosa

The effect of intracellular glucopenia induced by 2-deoxy-D-glucose (2-DG) on changes in hunger ratings, blood glucose, plasms cortisol, and prolactin levels were examined in six female patients with primary anorexia nervosa, three patients with bulimia nervosa, and six age-and sex-matched volunteers. In the normal subjects, hunger ratings obtained by the linear visual analog technique increased significantly at 60 minutes after 2-DG infusion and remained elevated. In Patients with anorexia nervosa, however, hunger ratins paradoxically decreased significantly at 90 minutes. In normal subjects, the ingestion of a 20-minute lunch relieved hunger, but neither the anorexic patients nor bulimic patients felt satiety even after food intake. These results suggest that the perception of hunger induced by 2-DG in anorexia nervosa and that of satiety in anorexia nervosa and bulimia nervosa are disturbed.     

Attitudes and knowledge regarding bulimia and anorexia nervosa

The current study investigated general knowledge of the symptoms, causes, and treatment of bulimia and anorexia nervosa, as well as attitudes toward anorexics and bulimics. High school and college students, 15 to 25 years of age, were administered an anonymous questionnaire. Adequate definitions of bulimia and anorexia were provided by 44% and 71% of the subjects, respectively. Females demonstrated more knowledge than did males. Emotional problems were seen as the most likely cause of both disorders, and psychotherapy was considered the most effective treatment. The subjects were more rejecting of an anorexic female, an obese female, and an average weight vomiter than an average weight binger. Over 4 7 % of the males were rejecting of an anorexic, obese, or purger female as a dating partner.     

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.     

Gastric inhibitory polypeptide (GIP) in anorexia nervosa

Simultaneous glucose, insulin, and gastric inhibitory polypeptide (GIP) responses to meal stimulation were measured in five anorexia nervosa patients, eight bulimia patients with a past history of anorexia nervosa, and twenty-two healthy subjects. Although basal levels of GIP were similar, anorexia nervosa patients had an early and significantly higher (p <.05) mean peak GIP response than controls or bulimics with past anorexia nervosa. Mean peak insulin levels in anorexia nervosa patients did not differ significantly from those of control or bulimia/past anorexia nervosa patients, although anorexia nervosa patients had a nonsignificantly prolonged elevation of serum insulin. Glucose responses were not significantly different among the various groups. The exaggerated CIP response to meal stimulation with no significant difference in insulin levels suggests that the usual association between insulin and GIP is altered in anorexia nervosa. This is apparently a state-dependent abnormality since GIP responses in bulimia patients with a history of anorexia nervosa do not differ from healthy subjects. Altered GIP responses may contribute to the gastric hypomotility and acid secretion changes previously reported in low-weight anorexia nervosa patients.     

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.     

Premorbid onset of psychopathology in long-term recovered anorexia nervosa

It is recognized that patients with anorexia nervosa commonly have other psychiatric illnesses. No study, to our knowledge, has determined whether these other psychiatric disorders occur prior to the age of onset of anorexia nervosa. We obtained a retrospective history from 24 subjects who were long term (more than 1 year) recovered from anorexia nervosa. We found that 58% reported that they had the onset of one or more childhood anxiety disorder diagnoses at the age of 10 ± 5 years old. This was 5 years before the mean age of onset of anorexia nervosa. The onset of depression was about 1 year before the onset of anorexia nervosa in about one half the subjects. Alcohol and substance abuse/dependency tended to occur after the onset of anorexia nervosa and only occurred in anorexic subjects who binged and/or purged. The early and common onset of childhood anxiety disorders in a substantial percentage of anorexics raises the possibility that childhood anxiety disorders herald the first behavioral expression of a biologic vulnerability in some subjects who develop anorexia nervosa. © 1995 by John Wiley & Sons, Inc.     

Body size distortion in bulimia nervosa

Body size estimation was studied in normal weight women with bulimia nervosa and a matched group of normal controls in order to determine whether bulimia nervosa patients overestimate their body size and whether they do so to a greater degree than women who are not suffering from an eating disorder. Estimation of five body locations was measured objectively with adjustable markers. Percentage of over- or underestimation was determined by the ratio of estimated to actual body size. Relative to control subjects, bulimia nervosa subjects significantly overestimated the size of their bust, waist, hips, and abdomen. Both groups overestimated the size of their face. Compared with previous studies of body size estimation in anorexia patients, the present study suggests that body size distortion might be less extreme in patients with bulimia nervosa.     

The comparative psychopathology of anorexia nervosa: Obsessive-compulsive disorder or phobia?

The current study investigates the similarities and differences between anorexic restricters, anorexic bulimics, female obsessives, agoraphobics, social phobics, and specific phobics. Measures of psychopathology were self-ratings of adjustment, the IPAT, FSS, MPI, and LOI. Results indicated that persons suffering from anorexia nervosa and bulimia nervosa were more similar to obsessives than to phobics with respect to obsessional personality traits and neuroticism. Additional research is needed in the examination of the central preoccupation in order to understand the differentiation of the various disorders and to what extent anorexia nervosa is a nosological entity.     

Microcalorimetric study of muscle and platelet thermogenesis in anorexia nervosa and bulimia

Muscle and platelet thermogenesis was measured by direct microcalorimetry in patients with anorexia nervosa. The median heat production, as calculated per unit of tissue mass, was 0.35 mW/g in vastus lateralis muscle, which is significantly lower (p less than 0.001), by approximately 50% than that in matched healthy subjects, 0.74 mW/g. The average deficit in body weight was 35%. Platelet heat production was decreased to a lesser degree with median values being 51.3 fW per cell and 60.9 fW per cell, respectively (p less than 0.02). Patients with bulimia without concomitant anorexia nervosa had normal heat production values. In the control group a positive correlation appeared (rs = 0.75, p less than 0.02) between resting muscle heat production and body surface area whereas no such relationship was found in the anorexic group.     

Bulimia nervosa with and without alcoholism: A comparative study in Japan

To characterize females with bulimia nervosa and alcoholism, this study compared the social and family backgrounds, as well as the clinical symptoms of alcoholics with bulimia and patients with bulimia only. The subjects were 22 Japanese female patients with both bulimia nervosa and alcoholism; the comparison group comprised 22 age-matched female patients with bulimia nervosa but without alcoholism. Patients with both bulimia and alcoholism had more borderline personality disorders and pathological symptoms such as stealing, suicide attempts, and liver injuries than the nonalcoholic comparison group. The subjects' average body weight was significantly less than that of the comparison group. Whereas the clinical characteristics of females with bulimia and alcoholism differ in many respects from those with bulimia only, it is suggested that alcoholic bulimia patients form a distinct clinical subgroup among patients with bulimia nervosa. © 1994 by John Wiley & Sons, Inc.     

Drug use in women with anorexia and bulimia nervosa

Forty-two inpatient women with bulimia nervosa and 29 women with anorexia nervosa were surveyed regarding eating behavior, patterns of licit and illicit substance use, and relation between drug use and appetite. Substantial use of licit substances such as laxatives, diuretics, and emetics were reported in women with bulimia nervosa. In addition, alcohol and cigarette use were significantly more common in women with bulimia nervosa than anorexia nervosa. The majority of bulimic subjects reported that smoking decreased appetite, alcohol increased appetite, and laxatives had no effect on appetite. Analysis of temporal patterns of drug intake suggested that binging and purging as well as alcohol, cigarette, and laxative use were considerably more prevalent in the evening hours. We suggest that the high rates of drug use in women with bulimia nervosa may be related to effects of food deprivation associated with the disorder.     

Patients admitted to hospital with anorexia nervosa and bulimia nervosa: Psychopathology,weight gain,and attitudes toward treatment

Ten percent of patients assessed at Toronto General Hospital Eating Disorder Centre require admission to hospital. In a comparative study of 100 consecutive admissions, differences in weight, eating disorder symptoms, and psychopathology between inpatients and outpatients were most apparent in the group with bulimia nervosa. Patients admitted with anorexia nervosa and with bulimia nervosa also had a longer duration of illness compared to outpatients. At discharge the anorexic patients weighed approximately 85% of ideal body weight. After a mean follow-up period of 2 years, 50% of patients were in the “good” outcome category, vshereas 16% were rated as having a “poor” outcome. Patient attitudes to various components of the program did not appear to influence outcome.     

Running and anorexia nervosa: An empirical study

It has been suggested that long-distance runners may show characteristics similar to those of patients suffering from anorexia nervosa. The present study attempted to obtain objective data pertaining to this issue by circulating to female marathon runners a questionnaire known to relate to personality characteristics associated with anorexia nervosa. On the scale of “Perfectionism” assessed by the questionnaire, the runners did indeed resemble anorexic patients in their scores. However, unlike the anorexic patients, runners did not appear to suffer as a result; their “Dissatisfaction” scores resembled those of normal individuals. It is concluded that, although superficial similarities exist between anorexics and runners, these do not reflect similarities at a more fundamental, causal level.     

Body composition in bulimia nervosa patients compared to healthy females

Summary. Objective: In contrast to anorexia nervosa there is a lack of research on body composition in bulimia nervosa patients. The aim of the study was to examine the body composition in underweight, normal-weight and overweight bulimia nervosa patients in comparison with healthy sedentary females, to assess the changes in body composition and subcutaneous fat after five months treatment, and to analyze the relation between body composition variables. Design: The body composition of 138 female bulimia nervosa patients and 188 healthy sedentary females was studied using underwater weighing and skinfold measurements. Results: A good agreement was found between the results obtained by underwater weighing and skinfold measurements. Normal-weight bulimics and control subjects did not differ significantly in body composition. In comparison with healthy controls, underweight and overweight bulimics showed a lower or higher percentage body fat, respectively. In underweight bulimics the fat mass increased after five months of treatment, whereas it decreased in normal-weight and overweight patients in comparison with control subjects. In bulimics more significant relations between body composition variables were found than in the controls. Conclusion: Body composition of bulimia nervosa patients may show great differences related to their (varying) body weight. Future research should take the patients body weight into account.     

Olfactory dysfunction in anorexia and bulimia nervosa

Fifty-five eating-disordered women and 16 normal controls participated in this study to determine whether olfactory function is altered in patients with food-restricting anorexia, anorexia with bulimic features, and bulimia nervosa. Olfactory function was assessed using the University of Pennsylvania Smell Identification Test and by determining phenyl ethyl alcohol odor detection thresholds. Only the very low-weight anorexics showed impairments in their identification and detection of odors. This group's olfactory function did not improve from admission to discharge despite significant weight gain. Although, overall, smoking had only a minor influence on olfactory function, the very low-weight anorexic smokers had the lowest scores of all subjects. Since higher-weight anorexics did not show such impairments, the results suggest that the severe and prolonged starvation experienced by the very low-weight anorexics caused or contributed to intractable deficits in the olfactory system and that these deficits are compounded by smoking. © 1995 by John Wiley & Sons, Inc.     

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.     

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.     

Impulsivity ratings in bulimia nervosa: Relationship to binge eating behaviors

Although impulsive behavioral patterns are often described by patients with bulimia nervosa, there has been little formal evaluation of the relationship between impulsivity and eating-related symptomatology in this disorder. In this controlled outpatient study, ratings on the Barratt Impulsivity Scale were significantly elevated in 20 women with bulimia nervosa in comparison to 20 healthy female volunteers. Frequency of binge eating episodes was not significantly correlated with impulsivity ratings. Although these results indicate increased prevalence of impulsive behavioral style in patients with bulimia nervosa, impulsivity per se does not appear to be a predictor of symptom severity as reflected in frequency of bulimic episodes. © 1994 by John Wiley & Sons, Inc.     

Body shape perception in bulimia and anorexia nervosa

Nineteen female patients with bulimia and thirty-one with anorexia nervosa were studied using a distorting lens technique. Both groups overestimated their actual body shapes and the bulimia patients desired to be much thinner than they were. These findings are discussed in relation to the literature on the treatment of these disorders.