Symptoms of obsessive-compulsive disorder in hospitalized eating disorder patients: A study using the maudsley obsessional-compulsive inventory (MOCI)

Thirty-one consecutive admissions with either anorexia or bulimia nervosa (DSM III R) were examined by the Maudsley Obsessional-Compulsive Inventory (MOCI). Nutritional status was documented by Body Mass Index (BMI), eating disorder psychopathology by the Eating Attitudes Test (EAT) and the Eating Disorders Inventory (EDI) and depression by the Beck Depression Inventory (Beck). MOCI scores were significantly higher than normative values, conflicting with previous reports using the same instrument, but supporting earlier studies which had employed the Leyton Obsessional Inventory (LOI). The MOCI score correlated with three subscales in the EDI, but none of the other measures. There were no significant differences in MOCI scores between anorexia and bulimia nervosa patients, or between patients with restricting or purging presentations. As the MOCI is a measure of obsessive-compulsive symtomatology, distinct both from those features of eating disorders which may resemble obsessional symptoms and from obsessional personality traits, the findings suggest a positive association of eating disorders with obsessivecompulsive disorder (OCD).     

The impact of a four‐month day treatment programme on alexithymia in eating disorders

High prevalence rates of alexithymia have been reported in eating‐disordered patients. The aim of this study was first to investigate whether a 4‐month day hospital treatment leads to a decrease in alexithymia in eating‐disordered patients and second to see whether alexithymia predicts short‐term outcome in this population. The Toronto Alexithymia Scale (TAS) and the Eating Disorder Inventory (EDI) were given to 47 patients with anorexia nervosa (n = 18), bulimia nervosa (n = 25) and eating disorders not otherwise specified (n = 4) respectively at the beginning and at the end of a 4‐month treatment programme. Comparison of pre‐ and post‐treatment scores showed significant declines in the EDI as well as in the TAS. However, baseline scores for alexithymia did not predict post‐treatment outcome. We conclude that even highly alexithymic patients benefit from psychological treatment which encourages understanding and expressions of emotion and also leads to significant reduction in eating disorder‐related symptoms. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.     

The prevalence and psychological correlates of anorexia nervosa,bulimia nervosa and binge eating among 15‐year‐old students: a controlled epidemiological study

The present study reports on the prevalence of adolescent anorexia nervosa, bulimia nervosa and binge eating disorders. Also, the hypothesis by Slade (1982) suggesting ‘perfectionism’ and ‘general dissatisfaction’ as setting conditions for eating disorders was tested. A total of 678 15‐year‐old adolescents were screened, and those who scored above 10 on the ‘drive for thinness’ subscale on the Eating Disorder Inventory (EDI) were interviewed for suspected eating disorders. A gender‐ and age‐matched control group of low scores were also clinically interviewed. The interviewers were blind to whether individuals were suspected of having eating disorders or not. The Setting Conditions for Anorexia Nervosa Scale (SCANS) was used to test the setting condition hypothesis. Other variables included were the EDI subscales ‘Bulimia’ and ‘Body dissatisfaction’. Weight was calculated using the Body Mass Index. For the total material, we found 1.0 per cent with a binge eating disorder, 0.7 per cent with bulimia nervosa, 0.3 per cent with a bulimic subtype of anorexia nervosa and 0.7 per cent with subclinical bulimia nervosa. All subjects were girls. In addition, 3.5 per cent were considered ‘at risk’, of whom we identified 22 girls (3.2 per cent) and two boys (0.3 per cent). High scores on ‘perfectionism’ were unrelated to the presence of eating disorders. Controlling for ‘body dissatisfaction’, ‘general dissatisfaction’, on the other hand, was related to eating disorders and an ‘at‐risk’ condition. The prevalence figures in this age cohort equal those for older age groups. The weak support to the setting condition hypothesis may point to an inadequate instrument and not necessarily to a theoretically blind alley. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association.     

Personality traits and self‐injurious behaviour in patients with eating disorders

The interest in different aspects of personality and the neuropsychological basis for behaviour in eating disorder patients has increased over the last decade. The present study aims at exploring personality traits, self‐injurious behaviour (SIB) and suicide attempts in a group of severely ill eating disorder patients. Patients with eating disorders (N = 38) and age‐matched controls (N = 67) were examined concerning self‐reported personality traits by means of the Karolinska scales of personality (KSP). Psychosocial history and SIB was collected from medical records. Depression was rated by means of the Beck Depression Inventory (BDI). Results indicated significantly higher anxiety‐related and detachment traits in both anorexia nervosa (AN) and bulimia nervosa (BN) patients and higher hostility in BN patients than controls. No specific personality traits could be defined as typical for self‐injurious or suicidal behaviour. The AN group was lower than the BN group on scales measuring impulsivity, guilt and anxiety. Furthermore, presence of SIB and suicide attempts was more frequent among the BN patients. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association.     

A sequenced group psychotherapy model for bulimia nervosa patients: a pilot study

The main objective with this study was to develop a sequenced treatment model for group psychotherapy with bulimia nervosa patients including cognitive‐behavioural therapy and interpersonal psychotherapy techniques. This study comprises 29 participants in four successive treatment groups who meet the DSM‐IV criteria for bulimia nervosa or eating disorder NOS. All the participants were measured pre‐ and post‐treatment using the following instruments: a semi‐structured interview for eating disorder symptomatology (BAB.4.1), Eating Disorder Inventory (EDI‐2), Symptom Check List (SCL‐90), Beck's Depression Inventory (BDI), Coping Resources Inventory (CRI) and Body Mass Index (BMI). Ratings for the participants' weight phobia, bingeing and vomiting decreased significantly. Significant pre‐ to post‐ differences were demonstrated for EDI, SCL and CRI but not for BDI. A 1‐year follow‐up, including both clinical and self ratings, showed that the improvement was sustained and that progress seemed to have continued. In addition to post‐treatment effects, now both BDI and the interpersonal sensitivity subscale of the SCL showed significant changes. The results suggest that there is reason to continue the development of a sequenced treatment model based on CBT and IPT techniques and to test the model in a controlled study. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association.     

Prevalence of Eating Disorders amongst Dancers: A Systemic Review and Meta‐Analysis

Eating disorders in dancers are thought to be common, but the exact rates remain to be clarified. The aim of this study is to systematically compile and analyse the rates of eating disorders in dancers. A literature search, appraisal and meta‐analysis were conducted. Thirty‐three relevant studies were published between 1966 and 2013 with sufficient data for extraction. Primary data were extracted as raw numbers or confidence intervals. Risk ratios and 95% confidence intervals were calculated for controlled studies. The overall prevalence of eating disorders was 12.0% (16.4% for ballet dancers), 2.0% (4% for ballet dancers) for anorexia, 4.4% (2% for ballet dancers) for bulimia and 9.5% (14.9% for ballet dancers) for eating disorders not otherwise specified (EDNOS). The dancer group had higher mean scores on the EAT‐26 and the Eating Disorder Inventory subscales. Dancers, in general, had a higher risk of suffering from eating disorders in general, anorexia nervosa and EDNOS, but no higher risk of suffering from bulimia nervosa. The study concluded that as dancers had a three times higher risk of suffering from eating disorders, particularly anorexia nervosa and EDNOS, specifically designed services for this population should be considered. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.     

An evaluation of the Oxford Adult Eating Disorders Service between 1994 and 2002

This paper examines the outcomes of 631 patients who were assessed at the Oxford Adult Eating Disorders Service between May 1994 and December 2002. After treatment, significant improvements were reported across the total sample for body mass index (BMI), the Beck Depression Inventory, the Beck Anxiety Inventory and the Robson Self Concept Questionnaire. Significant improvements were also reported for all measures of the Eating Disorder Questionnaire (EDE) and for all measures of the Eating Disorder Inventory (EDI) except for perfectionism. Patients with anorexia nervosa showed improvements in both BMI and associated psychopathology. Patients with bulimia nervosa showed a reduction in the number of self‐induced vomiting occasions and the number of objective binges and improvements in the associated psychopathology. Further research is required to identify factors associated with improvements in symptomatology. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Premature termination of treatment in an inpatient eating disorder programme

This retrospective study was conducted to explore rates, timing and predictors of two forms of premature termination of treatment (PTT) in an inpatient eating disorders programme: patient dropout (DO) and administrative discharge (AD). A chart review was conducted to obtain demographic, Eating Disorder Inventory‐2 (EDI‐2), and Resident Assessment Instrument‐Mental Health (RAI‐MH) data for 186 patients being treated for bulimia nervosa (BN), anorexia nervosa (AN), or eating disorder not otherwise specified (EDNOS). Overall, of the 37.6% of patients who terminated treatment prematurely, 22.1% of patients dropped out, and 15.5% of patients were administratively discharged. Time at which discharge occurred was found to be associated with the type of premature termination. The presence of DSM‐IV Axis‐I comorbidity was found to be the only factor associated with an increased risk of being administratively discharged. No factors were predictive of patients dropping out of treatment. The findings support the notion that AD and patient DO are different events that may have different factors influencing their rates and timing. Implications for future research and programme planning are discussed. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.     

Changes in eating disorder characteristics over the years

Since 1980, the diagnostic criteria of patients with eating disorders (ED) have changed over the years. Are these changes also expressed in the clinical features of the ED patients? A cross‐sectional sample was drawn consisting of 100 consecutive female patients' files diagnosed with anorexia nervosa (AN) and bulimia nervosa (BN) and bulimia nervosa and admitted at an inpatient unit from the first of January 1990, 2000, and 2010, respectively. Several reliable and well‐validated questionnaires (Eating Disorder Inventory, Body Attitude Test, Symptom Checklist, and the Beck Depression Inventory) were administered and scores were compared. The ratio AN/BN remained the same (65/35). No differences were found between the three cohorts except for depression, which increased over the years. This pattern is the same for the subsamples of anorexia nervosa and bulimia nervosa. Specific characteristics of eating disorder pathology did not change across time.     

Eating disorders and concurrent psychopathology: a reconceptualisation of clinical need through Rasch analysis

Therapies for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS) take as their focus, perhaps of necessity, the eating disorder symptomatology. However, there is increasing evidence of comorbidity of psychopathological mechanisms (e.g. perfectionism, depression) with eating disorders which, left untreated, may diminish any therapeutic effects. Thus identifying the extent of comorbidity in an eating disorder population and assessing the relationship between psychopathological mechanisms and the eating disorder is important. Rasch analysis was applied to the findings from questionnaires (EDI‐2; SCL90‐R) completed by 105 female patients referred to an eating disorder unit. General psychopathology was found to be more indicative of ‘caseness’ than eating disorder psychopathology. In particular, interpersonal sensitivity, depression and mild interpersonal aspects of psychoticism emerged as important factors across eating disorders. The comorbidity of psychopathological mechanisms needs to be given consideration in the successful treatment of eating disorders. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.     

The prevalence of eating disorders and weight‐control methods among young women: a Hungarian representative study

The aim of this study is to analyse data concerning 15–24‐year‐old Hungarian women to estimate the prevalence of anorexia nervosa, bulimia nervosa and subclinical eating disorders. A cross‐sectional representative survey was conducted among 3615 young women using a self‐report questionnaire. The point prevalence of anorexia nervosa was 0.03%, of bulimia nervosa 0.41%, of subclinical anorexia nervosa 1.09% and of subclinical bulimia nervosa 1.48%. Our results show that 6.3% of the sample were ‘dieting’ daily, 7% exercised daily, 2.7% reported binge eating, and use of laxatives, diet pills and self‐induced vomiting at least twice a week was reported by 0.7%, 0.9% and 0.2%, respectively. This study was the first to be conducted on a nationally representative sample of young women in Hungary. The data are also analysed within a cross‐cultural perspective, comparing data from other Central–Eastern European and western countries. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Effectiveness of day hospital treatment for anorexia nervosa and bulimia nervosa

The aim of this observational study was to examine the short‐term effectiveness of a structured, largely manualised day hospital treatment, as well as the stability of short‐term effects in patients with anorexia nervosa (AN) and bulimia nervosa (BN). Eighty‐three patients, 47 with AN and 36 with BN, were assessed at pre‐treatment, at the end of the day hospital treatment and at follow‐up approximately one year after post‐treatment. Outcome measures were body mass index (BMI), disturbed eating attitudes and behaviours assessed by the Eating Disorder Inventory (EDI), frequency of bingeing and purging, and general psychopathology assessed by the Symptom Checklist‐90 (SCL‐90). At the end of the day hospital treatment, significant improvements could be found on all outcome variables (frequency of binge eating/vomiting/laxative abuse, BMI and core EDI‐subscales ‘drive for thinness’/‘bulimia’/‘body dissatisfaction’). Effect sizes were generally large (.74 > d < 2.44). The effects were maintained or improved until follow‐up (18 months). At follow‐up, 40.2% of AN patients and 40.4% of BN patients could be classified as remitted. General psychopathological impairment was also significantly reduced at post‐treatment and maintained until follow‐up. The results demonstrate both the short‐term effectiveness and long‐term stability of day hospital treatment in a large sample of patients with anorexia and BN. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association.     

FPI profiles in a European sample of 1068 female patients suffering from anorexia or bulimia nervosa

Thirty‐two centres from nine European countries participated in a research programme about eating disorders. This study presents results of patients aged 17–26 years suffering from anorexia (N = 418) and bulimia nervosa (N = 650) according to DSM‐IV criteria (American Psychiatric Association, 1994). Patients' personality profiles were assessed with the revised version of the Freiburger Personality Inventory (FPI‐R). Compared to the comparison subjects, the eating‐disordered patients showed lower life satisfaction, health concern and extraversion and higher social orientation, inhibition, irritability, strain, somatic complaints, frankness and emotionality. Anorexic patients had similar scores to the comparison group on achievement orientation and aggressiveness scales. Non‐purging bulimic patients were not different from comparison subjects in aggressiveness and purging bulimic patients showed no difference for extraversion. Differences in the diagnostic subgroups are discussed in light of the literature in this area. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

EDI results of Japanese and German women and possible sociocultural explanations

The goal of this study was to compare data for women with bulimia nervosa and for a healthy control group both in Japan and Germany. These data were obtained using the Eating Disorder Inventory (EDI‐2). In Germany, EDI‐2 data and BMI values were collected from 102 nurses in training, 57 female medical students, and 29 patients with bulimia nervosa. In Japan, data were gathered from 243 female ‘short college’ students and 20 patients with bulimia nervosa. The Japanese non‐clinical control group showed significantly higher values on nearly all EDI scales than the German control group. They had a markedly higher drive for thinness, though their BMI values were lower. When the German and the Japanese bulimia nervosa patients were compared, the Japanese patients also showed higher values than their German counterparts on three EDI scales, but these differences were negligible. It is suggested that sociocultural factors in Japan, in particular a significant dependency on social norms, may contribute to the high EDI values. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Motivators for smoking in women with eating disorders

Women with eating disorders sometimes smoke to control their weight. This study examined the relative contributions of the range of factors that motivate smoking in women with eating disorders. Twenty‐five women with anorexia nervosa and 16 women with bulimia nervosa were compared with 21 women with a depressive mood disorder. Each completed measures of current and lifetime prevalence of smoking, motivation to smoke and dependence on smoking. Smoking was less prevalent in anorexia nervosa than in bulimia nervosa or in mood disorders. Although the eating‐disordered women had a higher motivation to smoke for weight control than the mood‐disordered group, overall motivation to smoke was higher in the eating‐disordered women. Their strongest motivator for smoking was coping with stress. The eating‐disordered women showed similar levels of dependence on smoking to the mood‐disordered group, but tended to have a lower desire to give up smoking. Clinical interventions for women with eating disorders who smoke might be targeted at helping them cope with stress, as well as viewing their smoking as a method of weight control. Assessment of women with eating disorders should address the use of nicotine and motivations for its use, to help identify targets for intervention. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Motivation to change in adolescents with bulimia nervosa mediates clinical change after treatment

Several studies have related motivation to change and treatment response in adult patients with bulimia nervosa but there are no longitudinal studies analysing this relationship in adolescents. The objective was to determine whether motivation to change is related to clinical improvement after treatment in adolescent patients with bulimia nervosa. The Bulimia Nervosa Stages of Change Questionnaire, the Eating Disorders Inventory (EDI‐2) and the Beck Depression Inventory (BDI) were administered at the beginning of treatment to 40 adolescent patients with bulimia nervosa (DSM‐IV) (mean age = 16.2 years). Thirty‐one patients were re‐assessed after 6 months of treatment. The majority of clinical and psychological variables improved significantly at the second evaluation. There were significant correlations between initial motivation to change and improvement in number of binges and the EDI‐2 scales of Bulimia and Interoceptive Awareness. In the stepwise multiple linear regression analysis, which included initial motivation to change and other potential confounding variables such as age, BDI, duration of disorder and body mass index, only motivation to change was selected as a predictor of improvement in number of binges (standardized β coefficient = 0.45; p = 0.012) and of decrease on the Bulimia scale (standardized β coefficient = 0.43; p = 0.029). Regarding improvement in Interoceptive Awareness, only the BDI score was selected as an independent predictor (β coefficient = 0.58; p = 0.002). In conclusion, in adolescent patients receiving treatment for bulimia nervosa, improvement in bulimic symptomatology seems to be especially related to initial motivation to change. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

The Eating Disorder Diagnostic Scale: Psychometric Features Within a Clinical Population and a Cut‐off Point to Differentiate Clinical Patients from Healthy Controls

The Eating Disorder Diagnostic Scale (EDDS) is a brief self‐report measure for diagnosing anorexia nervosa, bulimia nervosa and binge eating disorder. Research has provided evidence of the reliability and validity of this scale in non‐clinical populations. Our study is the first to examine the psychometric features of the EDDS in a clinical population of eating disordered patients. We identified a cut‐off point that differentiates clinical patients from healthy controls. A clinical group of 59 Dutch female eating disordered patients and a control group of 45 Dutch students completed the EDDS, the Eating Disorder Examination Interview, the Body Attitude Test and the Beck Depression Inventory—II. The EDDS showed good test–retest reliability, internal consistency, criterion validity and convergent validity with other scales assessing eating and general pathology. An overall symptom composite cut‐off score of 16.5 accurately distinguished clinical patients from healthy controls. The EDDS may be a useful instrument in clinical settings and in aetiologic, prevention and treatment research. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

An Investigation of Goodman's Addictive Disorder Criteria in Eating Disorders

The aim of this study was to examine how far Goodman's addictive disorder criteria were met by individuals with eating disorders according to subtypes. The study provided a cross‐sectional comparison among three samples of eating disorders [restricting anorexia nervosa (R‐AN), N = 68; purging anorexia nervosa (P‐AN), N = 42; and bulimia nervosa (BN), N = 66], a sample of substance‐related disorders (SRDs, N = 48) and a sample of matched controls (N = 201). Diagnosis of addictive disorder was made following Goodman's criteria. Addictive personality traits were assessed with the Addiction Potential Scale of the Minnesota Multiphasic Personality Inventory—2 and with the Zuckerman's Sensation Seeking Scale. Results showed that individuals with BN met Goodman's addictive disorder criteria in the same proportion as drug‐addicted individuals (65% vs 60%, p = NS). They both showed higher rates than R‐AN individuals (35%; R‐AN versus BN: F = 11.9, p < 0.001 and R‐AN versus SRD: F = 7.16, p < 0.01). Although BN and SRD showed higher rates of addictive disorders compared with P‐AN, differences were not significant. Scores on the Sensation Seeking and on the Addictive Potential scales paralleled the distribution of addictive disorders, with individuals with BN and with P‐AN showing higher levels than individuals with R‐AN. Results showed that a subgroup of individuals with an eating disorder experiences their disorder as an addiction and may deserve specific therapeutic attention. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Day treatment group programme for eating disorders: reasons for drop‐out

This study was designed to identify clinical variables and personality factors that could predict the completion or non‐completion of a day treatment group programme for patients with eating disorders. Patients (n = 125) were subdivided into those who had completed a 4‐month day treatment programme (n = 106) and those who had dropped out (n = 19). All the patients had been assessed with regard to eating psychopathology, general psychopathology and personality features at the beginning of the programme. At presentation, 50.4 per cent fulfilled DSM‐IV criteria for anorexia nervosa, 39.2 per cent for bulimia nervosa and 10.4 per cent for an eating disorder not otherwise specified. Non‐completion of therapy was associated with more severe bulimic symptoms, high levels of aggression and extraversion and low levels of inhibitedness. Assessment of these characteristics could be used to improve the therapy programme and to help those patients at increased risk of dropping out. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.     

Dietitians: are they a risk group for eating disorders?

The present study examined the eating behaviour and eating disorders of Austrian dietitians. Questionnaires were distributed to 500 Austrian dietitians and completed by 320 (64 per cent) subjects. Of the entire sample, 21 (6.6 per cent) of the dietitians were underweight, more than two‐thirds normal in weight, and 40 (12.3 per cent) overweight, while 24 (7.5 per cent) met the EDI criteria for being at risk for developing an eating disorder. The prevalence rates of eating disorders in the past or present were 2.5 per cent (n=8) for anorexia nervosa and 3.4 per cent (n=11) for bulimia nervosa. Of the 40 overweight dietitians, six (15 per cent) met the diagnostic criteria for binge eating syndrome. The findings show that, on the one hand, dietitians are quite similar in their weight, eating attitudes and eating behaviour to other women, and that, on the other hand, some dietitians may be considered at risk for developing eating disorders or having an eating disorder. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association.