The Prevalence of Disordered Eating Attitudes and Behaviours in Black-American and White-American College Women: Ethnic,Regional, Class,and Media Differences

The prevalence of eating disorders and severely distorted eating attitudes and behaviours in both white-American and black-American populations is reported to have increased during the past decade. College students of different racial groups were studied to examine the levels of clinical and subclinical eating disorders. Three college populations were used: Two from predominantly black-American universities, and one from a predominantly white-American university in the United States. The tendency toward anorexia nervosa and bulimia nervosa in behaviours and attitudes in black-American and white-American college women was compared as well as the subjects' socioeconomic status, region, race, cultural identification, and influences by the media and friends. A questionnaire was completed by 379 female students. Attitudes and behaviours about eating, dieting, and body image were measured using standardized tests of disordered eating. An acculturation measure was also completed by each subject. Differences were found between racial groups for the behaviours and attitudes of bulimia nervosa and binge eating: White-Americans were more likely to be identified with the behaviours of bulimia nervosa than black-Americans, and white-Americans were significantly more likely to binge eat than black-Americans. Subjects with the behaviours and attitudes of subclinical eating disorders were more likely to know friends with eating disorders, while those subjects with the behaviours and attitudes of bulimia nervosa and subclinical eating disorders read significantly more articles in magazines about eating disorders. In addition, subjects from the South region of the United States scored significantly lower on the Body Dissatisfaction subscale of the Eating Disorder Inventory than subjects from the Northeast or North Central regions. There were no significant differences due to socioeconomic status, acculturation, or television influences in the occurrence of eating disorders.     

Unintentional Role Models: Links Between Maternal Eating Psychopathology and the Modelling of Eating Behaviours

This study explored the relationships between maternal modelling of eating behaviours with reported symptoms of maternal eating psychopathology, anxiety and depression. Mothers (N = 264) with a child aged 1.5 to 8 years completed three self‐report measures designed to assess modelling of eating behaviours, eating psychopathology and levels of anxiety and depression. The study found that higher levels of maternal eating psychopathology were positively associated with eating behaviours that were unintentionally modelled by mothers but that maternal eating psychopathology was not associated with more overt/intentional forms of parental modelling. In addition, higher levels of maternal depression were associated with lower levels of both unintentional and intentional forms of maternal modelling, whereas maternal anxiety was not found to correlate with modelling behaviours. This study highlights the possible detrimental influences of maternal mental health in relation to mothers providing their child with a positive parental role model around eating and feeding. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.     

Body Image Dissatisfaction and Eating‐Related Psychopathology in Trans Individuals: A Matched Control Study

High levels of body dissatisfaction have already been reported in the trans population; however, the root of this dissatisfaction, and its association with eating disordered behaviours, has not been studied in‐depth. This study aims to assess eating disorder risk by comparing 200 trans people, 200 people with eating disorders and 200 control participants' scores on three subscales of the Eating Disorders Inventory‐2 (EDI‐2) and to further explore dissatisfaction in the trans participants using the Hamburg Body Drawing Scale (HBDS). The results showed that overall participants with eating disorders scored higher than trans or control groups on all EDI‐2 measures, but that trans individuals had greater body dissatisfaction than control participants and, importantly, trans males had comparable body dissatisfaction scores to eating disordered males. Drive for thinness was greater in females (cis and trans) compared with males. In relation to HBDS body dissatisfaction, both trans males and trans females reported greatest dissatisfaction not only for gender‐identifying body parts but also for body shape and weight. Overall, trans males may be at particular risk for eating disordered psychopathology and other body image‐related behaviours. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Clusters of Personality Disorder Cognitions in the Eating Disorders

This study examined whether comorbid personality disorder pathology in the eating disorders clusters into broader patterns, and whether those clusters have clinical validity in terms of levels of eating pathology and axis 1 comorbidity. The sample consisted of 214 eating‐disordered women who completed measures of personality disorder cognitions, eating pathology and axis 1 pathology at assessment. Three clusters of eating disorder patients emerged—low levels of personality pathology overall, high levels of cognitions underpinning anxiety‐based personality pathology, and high levels of all of the dimensions of personality pathology. These groups were validated by differences in levels of eating cognitions and axis 1 pathology. Personality disorder cognitions are clinically relevant to the eating disorders, but they might best be understood as broader sets of cognitions (‘anxiety‐centred’ and ‘general’), rather than in terms of individual personality disorder comorbidity or existing DSM personality disorder clusters. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Affect consciousness and eating disorders. Short term stability and subgroup characteristics

The aim of the study was to analyse differences in observer rated affect consciousness (AC) between subgroups of patients diagnosed with eating disorders (N = 44; 30 with anorexia nervosa and 14 with bulimia nervosa), and a non‐clinical group (N = 40). Another aim was to study the short‐term stability of AC over 10–11 weeks of treatment and its relation to self‐reported eating pathology and general psychopathology. A moderate short‐term stability of AC was found but the levels were not correlated with eating pathology or psychopathology. No differences between the two diagnostic categories were found, but the eating disorder group as whole had significantly lower AC compared with a non‐eating disorder reference group. AC seems to be a moderately stable ability that differentiates patients diagnosed with eating disorders from a non‐clinical population. However, AC is not related to symptoms of eating disorder or general psychiatric symptoms in this group of patients. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Sensation seeking: a personality trait characteristic of adolescent girls and young women with eating disorders?

The aim of the following study was to evaluate the role of sensation seeking in eating disorders (anorexia and bulimia), taking into account the subtypes (purging versus nonpurging) and the concept of binge‐eating disorder. The study involved 141 adolescent girls and young women, aged 14 to 25 years who lived in the French speaking part of Switzerland (79 clinical subjects with eating disorders according to DSM‐IV criteria, and 62 control subjects without eating disorders from the general population). All the subjects completed the Sensation Seeking Scale (SSS, Zuckerman, 1971). The results show that subjects with bulimic behaviours characterized by recurrent episodes of binge‐eating, whatever their exact diagnosis and subtype, do not significantly differ from one another on the Sensation Seeking Scale. They all had higher scores than the control group especially on the ‘Thrill and Adventure Seeking’ dimension. In contrast, restricting anorexics had lower scores on the Sensation Seeking Scale than the control group, especially on the ‘Experience Seeking’ dimension. Copyright © 2000 John Wiley & Sons, Ltd and Eating Disorders Association.     

Association Between Oxytocin Receptor Genotype,Maternal Care,and Eating Disorder Behaviours in a Community Sample of Women

This study aimed to investigate associations between oxytocin receptor gene (OXT‐R) polymorphisms (rs53576 and rs2254298), their interaction with maternal care (GxE), and ED behaviours in a community sample. We studied 3698 women from the Avon Longitudinal Study of Parents and Children (ALSPAC) who participated in a two‐phase prevalence study of lifetime ED and had genotype data. The GG rs53576 genotype was associated with binge eating and purging, and the rs2254298 AG/AA genotype with restrictive eating lifetime. In addition, the rs2254298 AG/AA genotype interacted with poor maternal care to increase the odds of binge eating and purging (odds ratio = 4.40 (95% confidence intervals: 1.11–17.4)). This study replicates previous findings of an association between OXT‐R polymorphisms and ED, and it is the first to show an interaction between OXT‐R genotype and poor maternal care. As such, these findings highlight the important role of oxytocin in understanding the pathophysiology of ED. © 2016 The Authors European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd     

First do no harm: Iatrogenic Maintaining Factors in Anorexia Nervosa

The aim of this paper is to reflect on the way that we as clinicians may play an inadvertent role in perpetuating eating disordered behaviour. This is considered within the theoretical framework of Schmidt and Treasures' maintenance model of anorexia nervosa (AN). The model includes four main domains; interpersonal factors, pro‐AN beliefs, emotional style and thinking style. Interpersonal reactions are of particular relevance as clinicians (as with family members) may react with high expressed emotion and unknowingly encourage eating disorder behaviours to continue. Hostility in the form of coercive refeeding in either a hospital or outpatient setting may strengthen conditioned food avoidance and pessimism may hamper motivation to change. Negative schema common to eating disorders, for example low self‐esteem, perfectionism and striving for social value may augment existing or initiate new eating disorder behaviour. Services can become a reinforcing influence by providing an overly protective, palliating environment which ensures safety, security and acceptance whilst reducing loneliness and isolation. This stifles the need for an individual to develop their own sense of responsibility, autonomy and independence allowing avoidance to dominate. Furthermore, the highly structured environment of inpatient care supports the rigid attention to detail and inflexibility that is characteristic of people with eating disorders, and allows these negative behaviours to thrive. Careful planning of service provision, reflective practice, supervision and regular team feedback is essential to prevent iatrogenic harm. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Childhood experiences of being bullied and teased in the eating disorders

Empirical studies have found associations between eating pathology and childhood experiences of being bullied and teased about appearance. However, the nature of these links is not clear. This study investigated the possible links between such experiences and eating disorders, focusing on the potential mediating role of two socially oriented emotions–shame and social anxiety. Ninety‐two eating‐disordered women completed measures of social anxiety, shame, eating pathology and childhood experiences of being bullied and teased about their appearance (by peers and family). There was a specific relationship between teasing by peers about appearance and body dissatisfaction, which was mediated by shame. These findings support existing evidence regarding the associations between trauma and eating pathology. They suggest that clinicians need to consider the potential role of teasing by peers about appearance and shame when understanding body dissatisfaction. Further research is needed to determine if the model proposed here reflects true causal links. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.     

Temperament Dispositions,Problematic Eating Behaviours and Overweight in Adolescents

Obesity, a common health condition in adolescence leading to severe medical complications, is assumed to be influenced by temperament factors. This paper investigates associations between reactive and regulative temperament, problematic eating behaviours and excess weight. Several self‐report instruments were completed by 130 adolescents (mean age 14.13 ± 0.61 years), including 27 overweight and obese individuals (20.8%). Bootstrap analysis revealed a mediating effect of restrained eating on the relation between reactive temperament and body mass index percentile, which differed according to gender: Restrained eating, which predicted weight gain, was more present in girls having a higher sensitivity to reward and in boys showing a higher sensitivity to punishment. No effect of regulative temperament was found. These results have important implications for weight management programmes, as they suggest that reducing restrained eating by working on temperament may help to control weight. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Demographic,psychiatric, and personality correlates of adults seeking treatment for disordered gambling with a comorbid binge/purge type eating disorder

Preliminary evidence suggests that binge/purge type eating disorders and gambling disorder may commonly co‐occur. However, this dual‐diagnosis population remains understudied. The present research examined the prevalence rates and correlates of binge/purge type eating disorders (i.e., bulimia nervosa, binge‐eating disorder, and anorexia nervosa binge/purge type) among adults seeking treatment for their gambling (N = 349). In total, 11.5% of the sample (n = 40) met criteria for a binge/purge type eating disorder, most commonly bulimia nervosa (n = 33). There was a higher preponderance of binge/purge type eating disorders in women. People with a comorbid binge/purge type eating disorder reported more days gambling, gambling‐related cognitive distortions, impulsivity, suicidality, and other current psychiatric comorbidities including addictive behaviours. These findings suggest that binge/purge type eating disorders in people seeking treatment for gambling may be more common than previously believed. Furthermore, the increased psychopathology among people with binge/purge type eating disorder and gambling disorder identify vulnerabilities of this dual‐diagnosed population that may require clinical attention.     

Preoperative and post‐operative psychosocial interventions for bariatric surgery patients: A systematic review

Psychosocial interventions are increasingly being utilized to help patients prepare for, and adjust to changes following, bariatric surgery in order to optimize psychosocial adjustment and weight loss. The current systematic review examined the impact of preoperative and post‐operative psychosocial interventions with a behavioural and/or cognitive focus on weight, dietary behaviours, eating pathology, lifestyle behaviours, and psychological functioning. A PsycINFO and Medline search of publications was conducted in March 2019. Two authors assessed retrieved titles and abstracts to determine topic relevance and rated the quality of included studies using a validated checklist. Forty‐four articles (representing 36 studies) met the study inclusion criteria. The current evidence is strongest for the impact of psychosocial interventions, particularly cognitive behavioural therapy, on eating behaviours (eg, binge eating and emotional eating) and psychological functioning (eg, quality of life, depression, and anxiety). The evidence for the impact of psychosocial interventions on weight loss, dietary behaviours (eg, dietary intake), and lifestyle behaviours (eg, physical activity) is relatively weak and mixed. Psychosocial interventions can improve eating pathology and psychosocial functioning among bariatric patients, and the optimal time to initiate treatment appears to be early in the post‐operative period before significant problematic eating behaviours and weight regain occur.     

Obesity‐related eating behaviours in the adult population of Spain, 2008–2010

Knowledge of the socio‐demographic distribution of eating behaviours can aid our understanding of their contribution to the obesity epidemic and help to address healthy eating interventions to those who can benefit most. This cross‐sectional study assessed the frequency of self‐reported eating behaviours among 11,603 individuals representative of the non‐institutionalized Spanish population aged ≥18 years in the period 2008–2010. In the adult population of Spain, 24.3% had lunch and 18.2% had dinner away from home >3 times per month. About three‐fourths of adults did not plan the amount of food to be eaten, and did not choose light foods and/or skim dairy products. Also, 26% did not trim visible fat from meat, and 74.7% usually ate while watching television. Compared with individuals with primary or less education, those with university studies were more likely to remove fat from meat (age‐ and sex‐adjusted odds ratio [aOR] 1.25; 95% confidence interval [CI] 1.08–1.44), and to choose light food and/or skim dairy (aOR 1.50; 95% CI 1.30–1.77), and less likely to eat while watching television (aOR 0.54; 95% CI 0.47–0.63). In conclusion, the prevalence of several obesity‐related eating behaviours is high in Spain, which indicates a deficient implementation of dietary guidelines. Socioeconomic inequalities in eating behaviours should also be addressed.     

Exploring Types of Family Environments in Youth with Eating Disorders

While many studies have explored the relationship between different eating disorder diagnoses and the familial social environment, current evidence does not support associations between distinct family interaction patterns (e.g. high enmeshment) and particular diagnoses (e.g. anorexia nervosa). The current study seeks to move beyond the current literature to explore whether empirically derived subtypes of family environment are associated with clinical features within a transdiagnostic sample of youth seeking treatment for eating disorders (n = 123). Latent class modelling of the Family Environment Scale identified three classes (i.e. different Family Environment Scale profiles): (1) Control‐Oriented; (2) System Maintenance‐Oriented; and (3) Conflict‐Oriented. Data are presented to characterize the classes (e.g. age, gender, rates of different eating disorders, severity of eating disorder pathology and rates of comorbid disorders). These preliminary results suggest that family interaction types may help personalize treatment for eating disorders and encourage future research to guide such efforts. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Body‐related Sport and Exercise Motives and Disturbed Eating Attitudes and Behaviours in Adolescents

Motives underlying sport and exercise involvement have recently been hypothesized as potential factors influencing the positive association between sports/exercises involvement and disturbed eating attitudes and behaviours (DEAB) among adolescents. Nevertheless, very few studies have examined this hypothesis or the moderating role of gender, context of practice, performance levels and sport type on these relationships. In this study, these questions were addressed among 168 male and 167 female French adolescents involved in various types, contexts and performance levels of sport and exercise. Participants were asked to indicate their main motives for involvement in sport practice and to self‐report DEAB (generic DEAB, vomiting–purging behaviours, and eating‐related control) on a French adaptation of the Eating Attitudes Test‐26. The results shared positive associations between body‐related sport and exercise motives and most of the DEAB subscales. Furthermore, they show that the relationship between body‐related sport and exercise motives and Vomiting–Purging Behaviours differs according to involvement in individual and competitive sports and exercises. Copyright ©2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

A new instrument measuring disturbed eating patterns in community populations: development and initial validation of a five‐item scale (EDS‐5)

This paper reports on the development and validation of a brief scale, the Eating Disturbance Scale (EDS‐5), as a screening instrument for problematic eating disorders in normal populations. A nationwide sample of 6313 subjects completed 22 questions about eating patterns. Using principal component analysis, these questions were cut down to five items, forming a scale. From another epidemiological study (N = 835), 51 female subjects responded to these five questions in addition to a clinical interview. The scale yielded a Cronbach alpha of 0.83 and 0.86, respectively, Also, a sensitivity and specificity of 0.90 and 0.88 was found with respect to DSM‐IV eating disorders. The concurrent and construct validity show significant correlations with Eating Disorder Inventory subscales measuring disturbed eating (M = 0.55, range 0.44–0.73), and even higher correlations with similar factors from the self‐report version of the Eating Disorder Examination (M = 0.73, range 0.60–0.89). The results suggest that the EDS‐5 is sensitive to disordered eating patterns and that this instrument appears promising for screening purposes in community samples. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association.     

Classification of eating disturbance in children and adolescents: Proposed changes for the DSM‐V

Childhood and adolescence are critical periods of neural development and physical growth. The malnutrition and related medical complications resulting from eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth than during other age periods. The consensus opinion of an international workgroup of experts on the diagnosis and treatment of child and adolescent eating disorders is that (a) lower and more developmentally sensitive thresholds of symptom severity (e.g. lower frequency of purging behaviours, significant deviations from growth curves as indicators of clinical severity) be used as diagnostic boundaries for children and adolescents, (b) behavioural indicators of psychological features of eating disorders be considered even in the absence of direct self‐report of such symptoms and (c) multiple informants (e.g. parents) be used to ascertain symptom profiles. Collectively, these recommendations will permit earlier identification and intervention to prevent the exacerbation of eating disorder symptoms. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Screening and identification of disordered eating in people with type 1 diabetes: A systematic review

People with Type 1 diabetes (T1D) have been shown to be an at-risk group for the development of disordered eating behaviours, however, the validity of tools used to assess disordered eating behaviours in T1D is unclear. This review aimed to identify tools used to screen or identify disordered eating behaviours and eating disorders in people with T1D, and evaluate the validity and reliability of these tools. A systematic search strategy was conducted to October 2019 according to the PRISMA guidelines. The search strategy retrieved 2714 articles, with 100 articles describing 90 studies included in the review. Studies were predominantly conducted in adolescent females in clinical settings. Forty-eight individual tools were used across retrieved studies. Overall, the quality of tools reported in included articles was poor, with high risk of bias due to the use of non-validated tools (n = 44 articles) and few studies comparing to the reference standard (n = 10 articles) of a diagnostic interview. This review shows that a variety of tools have been used to screen and identify disordered eating behaviours and eating disorders in people with T1D. Future research including comparison to a gold standard diagnostic interview is warranted to further evaluate the validity and reliability of available tools.     

The Role of Non‐Suicidal Self‐Injury and Binge‐Eating/Purging Behaviours in Family Functioning in Eating Disorders

This study aimed to investigate family functioning of restrictive and binge‐eating/purging eating disordered adolescents with or without non‐suicidal self‐injury (NSSI), as perceived by the patients and their parents (mothers and fathers). In total, 123 patients (between 14 and 24 years), 98 mothers and 79 fathers completed the Family Assessment Device. Patients completed the Self‐Injury Questionnaire‐Treatment Related and the Symptom Checklist 90‐Revised. No main effects were found of restrictive versus binge‐eating/purging behaviour nor of presence/absence of NSSI. For the parents, a significant interaction between binge‐eating/purging behaviour and NSSI emerged: Mothers and fathers reported worse family functioning in the binge‐eating/purging group in presence of NSSI, whereas mothers reported worse family functioning in the restrictive group without NSSI. Parental perception of family functioning is affected by the combined presence of binge‐eating/purging behaviour and NSSI. This finding should be taken into account when treating families living with eating disorders. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Binge eating and restraint model: psychometric analysis in binge eating disorder and normal weight bulimia

There are numerous unanswered questions concerning the aetiology of Binge Eating Disorders (BED). In DSM IV it is still seen as a pathology in the study stage. Although BED and Bulimia Nervosa have some common characteristics, it is still difficult to identify the exact mechanisms that lead to binge‐eating in the two disorders. This study involved the detailed examination of relationships between cognitive restriction and disinhibition in three groups (100 obese subjects with BED, 210 non‐BED obese subjects and 31 BN subjects) through three psychometric instruments: TFEQ, BITE, SCL90. Statistical analysis of the results confirmed a close relationship between restriction and disinhibition in BN, that was not present in BED subjects, where high disinhibition levels were associated with low restriction levels. These data suggest that BED should be regarded as a distinct form of eating disorder. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association.