General population-based epidemiological study of eating disorders in Norway

In a questionnaire-based study of eating disorders in a representative sample of the general female population of Norway, the lifetime prevalence of eating disorders was 8.7% with a point prevalence of 3.8%. The lifetime prevalence of binge eating disorder (BED) was 3.2%, bulimia nervosa (BN) 1.6%, and anorexia nervosa (AN) 0.4%. Eating disorders not otherwise specified (EDNOS) had a lifetime prevalence of 3.0%. Point prevalence of BED was 1.5%, BN 0.7%, AN 0.3%, and EDNOS 1.3%. © 1995 by John Wiley & Sons, Inc.     

Family characteristics of binge-eating disorder patients

Binge-eating disorder (BED) has been described and proposed as a new eating disorder diagnosis. Although studies have examined the characteristics of the family members of patients with anorexia nervosa (AN) and bulimia nervosa (BN), little is known about the characteristics of family members of BED patients. The Family Environment Scale (FES) was administered to 88 patients with a DSM-III-R diagnosis of an eating disorder (23 AN, 45 BN, 20 BN+AN), as well as 43 patients with BED as defined by DSM-IV criteria. Statistically significant differences were found among the groups on the cohesion, expressiveness, and active-recreational subscales of the FES by analysis of variance (ANOVA). On the cohesion subscale, significant differences were noted between AN and BED, p < .019, with AN scoring higher than BED. On the expressiveness subscale, significant differences were noted for BED and BN, p < .016, with BN scoring higher than BED. On the active-recreational subscale, there were significant differences for BED versus BN, BED versus AN, and BED versus AN+BN (p < .0001), with BED scoring lower than all other groups. Comparison of BED data to existing normative data yielded significant differences on the cohesion, expressiveness, conflict, independence, intellectual-cultural, active-recreational, and control subscales, with BED patients scoring higher than controls on the conflict and control subscales and lower than controls on all others. These data represent the first study of family characteristics of BED patients utilizing DSM-IV criteria, and provide a beginning understanding of family factors that may be useful in treatment. © 1998 by John Wiley & Sons, Inc. Int J Eat Disord 23:145–151, 1998.     

Prevalence and utility of DSM-IV eating disorder diagnostic criteria among youth

OBJECTIVE: To examine the prevalence and utility of DSM-IV eating disorder (ED) criteria and anorexia (AN), bulimia (BN), and binge eating disorder (BED) among adolescents. METHOD: An ethnically diverse population-based sample of 4,746 public middle and high school students completed anthropometric measures and Project EAT survey items. RESULTS: Many youth endorsed body shape perception disturbance (41.5% female; 24.9% male), undue influence of body shape/weight on self-esteem (36.4% female; 23.9% male), and compensatory behavior (9.4% female; 13.5% male). Prevalence among females and males, respectively, was: AN = 0.04%, 0%; BN = 0.3%, 0.2%; BED = 1.9%, 0.3%. Analyses of individual criteria showed high sensitivity and negative predictive values for each disorder and corresponding criteria, low specificity for several AN (27.8%) and BN (32.0%) criteria, and low positive predictive values (0.06-40.2%). CONCLUSION: Body disparagement and compensatory behaviors indicate eating disturbance, despite low prevalence of EDs. Diagnostic classification may be clinically useful, but is complicated for use in epidemiological populations.     

Prevalence of eating disorders in dental patients

670 dental patients completed the Bulimic Investigatory Test Edinburgh (BITE). Criteria of the Diagnostic and statistical manual of mental disorders 4th Edition (DSM-IV) were used for identification of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). We identified one 19 year old woman with a questionnaire response suggestive of restricting type AN, one 49 years old man with a questionnaire response suggestive ofBN, and five subjects with questionnaire responses suggestive of BED. The prevalence of BITE symptom scores of 20 and more (indicating a highly disordered eating pattern and the presence of binge eating, probably meeting criteria of the Diagnostic and statistical manual of mental disorders 3rd Edition for BN) is 0%for male and 1.6% for female probands and 2.7% for girls and women up to the age of 30 years. We concluded that dentists could play an important part in secondary prevention of eating disorders.     

Course and predictors of maternal eating disorders in the postpartum period

Objective:

To investigate course and predictors of eating disorders in the postpartum period.

Method:

A total of 77,807 women, participating in the Norwegian Mother and Child Cohort Study (MoBa), completed questionnaires during pregnancy including items covering DSM‐IV criteria for prepregnancy anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS‐P), and binge eating disorder (BED). Additional questionnaires were completed at 18 and 36 months postpartum.

Results:

Proportions of women remitting at 18 months and 36 months postpartum were 50% and 59% for AN, 39% and 30% for BN, 46% and 57% for EDNOS‐P, and 45% and 42% for BED, respectively. However, disordered eating persisted in a substantial proportion of women meeting criteria for either full or subthreshold eating disorders. BN during pregnancy increased the risk for continuation of BN. BMI and psychological distress were significantly associated with course of BED.

Discussion:

This is the first large‐scale population‐based study on course of eating disorders in the postpartum period. The results indicated that disordered eating persists in a substantial proportion of women with prepregnancy eating disorders. Health care professionals working with women in this phase of life need to pay specific attention to eating disorder symptoms and behaviors. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)     

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.     

Full syndromal versus subthreshold anorexia nervosa,bulimia nervosa,and binge eating disorder: a multicenter study

OBJECTIVE: The diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) establish symptom severity levels, which are used to separate full cases from partial cases. However, the value of these distinctions is unclear. METHOD: Three hundred eighty-five women with full or partial AN, BN, or BED were assessed at entry into a longitudinal study of eating disorders. RESULTS: Stepwise discriminant analysis revealed that full and partial BN were discriminated by the Yale-Brown-Cornell Eating Disorders Scale total scores (kappa =.46). However, it was not possible to discriminate between full and partial AN or BED. Discriminant analysis also demonstrated clear differences between full AN, BN, and BED. DISCUSSION: Full BN can be differentiated from partial BN by more severe eating disorder symptoms, whereas both full and partial AN and full and partial BED appear quite similar. These results emphasize the distinct nature of AN, BN, and BED, as well as the similarities between full and partial cases.     

Two-year prospective study of personality disorders in adults with longstanding eating disorders

OBJECTIVE: The current study had three objectives: to report the presence of personality disorders (PDs) in adults with longstanding eating disorders (EDs) at admission to inpatient treatment, and at 1 and 2-year follow-up; to compare the frequency of PDs in anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS); and to investigate whether recovered patients had lower frequency of PDs. METHOD: Seventy-four patients with a mean age of 30 years and long-lasting EDs were assessed with the Structured Clinical Interview for DSM-IV Axis-II disorders at admission to inpatient treatment, and at 1 and 2-year follow-up. RESULTS: At admission, 57 patients (77%) had one or more PDs, whereas 42 patients (57%) had one or more PDs at 2-year follow-up No statistically significant differences in frequencies of PDs among patients with AN, BN, and EDNOS were found. Recovered patients had a lower frequency of PDs (p < .01). DISCUSSION: At 2-year follow-up, there were substantial reductions in the frequency of PDs in patients with long-lasting EDs.     

Using the eating disorder examination to identify the specific psychopathology of binge eating disorder

OBJECTIVE: The clinical features of binge eating disorder (BED) are not well established. Therefore, a comprehensive assessment of the specific psychopathology of BED as compared to anorexia nervosa (AN) and bulimia nervosa (BN) is warranted. This comparison was the aim of the present study. METHOD: Detailed ratings from an investigator-based interview, the Eating Disorders Examination (EDE), were compared across three groups of female patients: those with BED, AN, and BN, as well as normal-weight and overweight control subjects. RESULTS: When comparing BED to AN and BN, patients with BED had lower levels of restraint, eating concerns comparable to AN patients but lower than BN patients, and weight and shape concerns comparable to BN patients but higher than AN patients. Significantly more eating disorder psychopathology was found for BED patients as compared to the overweight controls on all bar the EDE restraint subscale. On the majority of individual EDE items, BED patients' scores were similar to those of AN and BN patients, including importance of shape and weight in self-evaluation and preoccupation with shape and weight. No significant relationship was found between BED patients' degree of overweight and eating psychopathology. DISCUSSION: Our findings support the status of BED as an eating disorder and suggest that the elevated EDE scores reflect the combined impact of being objectively overweight and having disordered cognitions and behaviors about eating, shape, and weight.     

Empirical classification of eating disorders

Although the eating disorder nosology has become refined over the years, considerable problems remain. The purpose of the present study was to empirically examine eating disorder classification using a sample of treatment-seeking eating-disorder patients. One hundred and fifty-nine patients with diagnoses of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder, not otherwise specified (EDNOS), were included in a cluster analysis using a variety of eating disorder variables. Findings revealed four clusters, with three clusters resembling AN, restricting type, BN, and binge-eating disorder (BED). The remaining cluster appeared to be a group of patients that were subthresholded in terms of symptom severity. Results also indicated a relatively poor fit between the empirically derived groupings and clinical diagnoses. The implications of these findings for both the current classification system and treatment considerations are discussed.     

Prevalence of eating disorders in a Spanish school-age population.

PURPOSE: To determine the prevalence of eating disorders (anorexia nervosa, bulimia, and partial syndromes) in students in a Madrid school district during the 1993-1994 academic period. The results were compared with those of an earlier study performed in 1985-1986 and with findings in other countries. METHODS: In the first phase, 1314 adolescents (731 girls and 583 boys) with a mean age of 15.05 +/- 0.98 years were surveyed according to the Eating Disorder Inventory (EDI) and a psychosocial data survey. Of these, 1281 (97.48%) [724 girls (99.04%) and 557 boys (95.54%)] were considered appropriate for the study. The risk population included individuals with a total EDI score over 50, plus a drive for thinness (DT) score over 10; 180 girls (24.86%) and 19 boys (3.41%) were identified on this basis. To reduce possible false negatives, those whose score on the bulimia scale was over 5, with amenorrhea of more than 3 months duration and a body mass index (weight in kilograms per height in square meters) under 18 were also considered to be at risk. The total risk population thus defined consisted of 293 adolescents (22.87%): 67 boys (12.02%) and 226 girls (31.21%). In the second phase, all risk subjects were reevaluated with a semistructured interview for ED, and they were also weighed and measured. In all, 156 adolescents (53.24%)[103 girls (45.57%) and 53 boys (79.10%)] participated in person. The remaining 137 subjects completed the interview by telephone. Diagnostic and Statistical Manual (DSM)-III-R diagnostic criteria were applied. RESULTS: Five girls (0.69% of the total study population) fulfilled the DSM-III-R criteria for anorexia nervosa, and nine (1.24%), for bulimia nervosa. Two boys (0.36%) had bulimia. Twenty girls (2.76%) and three boys (0.54%) represented partial syndromes. The results of adding the full and partial syndromes showed that 4.7% of the girls and 0.9% of the boys had eating disorders. CONCLUSIONS: This study demonstrates an increase in the prevalence of eating disorders in Madrid, reaching similar levels to those reported in the literature for other developed countries.     

The natural course of bulimia nervosa and eating disorder not otherwise specified is not influenced by personality disorders

OBJECTIVE: To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) and to test the effects of personality disorder (PD) comorbidity on the outcomes. METHOD: Ninety-two female patients with current BN (N=23) or EDNOS (N=69) were evaluated at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study (CLPS). Eating disorders (EDs) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders. Personality disorders (PDs) were assessed with the Diagnostic Interview for DSM-IV PD (DIPD-IV). The course of BN and EDNOS was assessed with the Longitudinal Interval Follow-up Evaluation and the course of PDs was evaluated with the Follow-Along version of the DIPD-IV at 6, 12, and 24 months. RESULTS: Probability of remission at 24 months was 40% for BN and 59% for EDNOS. To test the effects of PD comorbidity on course, ED patients were divided into groups with no, one, and two or more PDs. Cox proportional regression analyses revealed that BN had a longer time to remission than EDNOS (p<.05). The number of PDs was not a significant predictor of time to remission, nor was the presence of Axis I psychiatric comorbidity or Global Assessment of Functioning scores. Analyses using proportional hazards regression with time-varying covariates revealed that PD instability was unrelated to changes in ED. CONCLUSIONS: BN has a worse 24-month course (longer time to remission) than EDNOS. The natural course of BN and EDNOS is not influenced significantly by the presence, severity, or time-varying changes of co-occurring PDs, co-occurring Axis I disorders, or by global functioning.     

Bulimia nervosa and binge-eating disorder in adolescents

Bulimia nervosa (BN) and binge-eating disorder (BED) are separate entities with the common denominator of binge eating. In this chapter, Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for BN are reviewed, including both recurrent episodes of binge eating and inappropriate compensatory behaviors to prevent weight gain in one whose self-evaluation is unduly influenced by body weight and shape. Two percent of adolescent females and 0.3% of adolescent males fulfill criteria for BN. Risk factors, medical complications of binge eating (vomiting, use of ipecac, diet pills, diuretics, and laxatives), physical and laboratory findings, and treatment options and outcome are discussed. BED is seen in 1-2% of adolescents. The DSM-IV lists BED under Eating Disorder Not Otherwise Specified. DSM-IV research criteria for BED is reviewed, including binge eating, distress over binge eating, and absence of regular extreme compensatory behaviors. The mean age of onset is 17.2 years. Up to 30% of obese patients have BED. Risk factors are discussed. Because most patients with BED are obese, medical evaluation is similar to that for obesity. Treatment goals must be geared not only toward decreased binge eating but toward weight loss. Outcome is discussed.     

Individual and family eating patterns during childhood and early adolescence: an analysis of associated eating disorder factors

To examine whether there is an association between individual and family eating patterns during childhood and the likelihood of developing an eating disorder (ED) later in life. The sample comprised 261 eating disorder patients [33.5% [N=88] anorexia nervosa (AN), 47.2% [N=123] with bulimia nervosa (BN) and 19.3% [N=50] with Eating Disorders Not Otherwise Specified (EDNOS)] and 160 healthy controls from the Province of Catalonia, Spain, who were matched for age and education. All patients were consecutively admitted to our Psychiatry Department and were diagnosed according to DSM-IV criteria. Participants completed the Early Eating Environmental Subscale of the Cross-Cultural (Environmental) Questionnaire (CCQ), a retrospective measure of childhood eating attitudes and behaviours. In the control group, also the General Health Questionnaire-28 (GHQ-28) was used. During childhood and early adolescence, the following main factors were identified to be linked to eating disorders: eating excessive sweets and snacks and consuming food specially prepared for the respondent. Conversely, regular breakfast consumption was negatively associated with an eating disorder. Compared to healthy controls, eating disorder patients report unfavourable eating patterns early in life, which in conjunction with an excessive importance given to food by the individual and the family may increase the likelihood for developing a subsequent eating disorder.     

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.     

Binge eating behavior in patients with eating disorders

The purpose of this study was to determine whether the objectively observed binge eating behavior of obese subjects meeting the proposed DSM-IV criteria for binge eating disorder would be similar to that observed in patients with bulimia nervosa. Non-obese patients with bulimia nervosa (BN), obese subjects with binge eating disorder (BED), obese and non-obese women without eating disorders were each instructed to binge eat single- and multiple-item meals. In the multiple-item meal, the obese subjects with BED ate significantly more (1515 kcal) than obese subjects without BED (1115 kcal), but they ate less than the normal-weight bulimic patients (2680 kcal). The non-obese controls ate amounts similar to the obese non-binge-eating-disordered group (1093 and 1115.2 kcal, respectively). In the single-item meal, consisting of ice cream, patients with BN ate significantly more than any other group (1307 kcal), while obese subjects with or without binge-eating disorder ate significantly more (762 kcal) than non-obese controls (308 kcal). This study has demonstrated that although both BN and BED are characterized by recurrent episodes of binge eating, quantitatively there appear to be differences between the eating disturbances in the two disorders. Because single- and multiple-item meals differ in external cues, these results also suggest that the obese subjects with BED may be disinhibited by external cues, while obese subjects without BED may be inhibited by external cues.     

Eating disorder symptomatology among ballet dancers

OBJECTIVE: The current study sought to compare eating disorder symptomatology among ballet dancers and individuals with restricting anorexia nervosa (RAN), bulimia nervosa (BN), and no eating pathology. METHOD: Twenty-nine female ballet dancers completed assessments and were compared with an archival dataset of 26 women with RAN, 47 women with BN, and 44 women with no eating pathology. Eating disorder diagnoses and behaviors were assessed with a semi-structured clinical interview, the Eating Disorder Inventory (EDI), and a weight history interview. RESULTS: Eighty-three percent of dancers met lifetime criteria for AN (6.9%), BN (10.3%), AN+BN (10.3%), or EDNOS (55.0%). Moreover, dancers looked more similar to eating-disordered individuals than to control individuals on measures of eating pathology. CONCLUSION: Despite previous emphasis on the pathology AN, the current findings suggest that dancers frequently engage in binge eating and purging behaviors. Moreover, it appears that their pathology is as severe as that of non-dancing women with eating disorders.     

An epidemiological study of eating disorders in Iran

OBJECTIVE: The purpose of this study was to assess the prevalence of anorexia nervosa (AN) and bulimia nervosa (BN) as well as the prevalence of weight concerns and weight loss behaviors among schoolgirls in Tehran, Iran. METHOD: A two-stage approach was used. We screened a large sample of adolescent girls aged 15-18 (n = 3, 100) with a Persian translation of the Eating Attitudes Test (EAT-26). Girls who screened positively were further evaluated with the Eating Disorder Diagnostic Inventory and a supplementary clinical interview. RESULTS: Results showed a lifetime prevalence of 0.9% for AN, 3.2% for BN, and 6.6% for the partial syndrome. Body dissatisfaction and a desire to be thin were common in this population. DISCUSSION: This study suggests that the prevalence of eating disorders among female adolescents in Teheran is comparable to prevalence rates reported by studies in Western societies, and somewhat higher than what has been reported in other non-Western societies.     

Comparison of DSM-IV versus proposed DSM-5 diagnostic criteria for eating disorders: reduction of eating disorder not otherwise specified and validity

Objective:

Revised Eating Disorder (ED) diagnostic criteria have been proposed for the Diagnostic and Statistical Manual (DSM)‐5 to reduce the preponderance of eating disorder not otherwise specified (EDNOS) and increase the validity of diagnostic groups. This article compares DSM‐IV and proposed DSM‐5 diagnostic criteria on number of EDNOS cases and validity.

Method:

Participants (N = 397; 91% female) completed structured clinical interviews in a two‐stage epidemiological study of EDs. Interviewers did not follow standard skip rules, making it possible to evaluate alternative ED diagnostic criteria.

Results:

Using DSM‐IV versus DSM‐5 criteria, 34 (14%) versus 48 (20%) had anorexia nervosa, 43 (18%) versus 44 (18%) had bulimia nervosa, and 163 (68%) had EDNOS versus 20 (8%) had binge eating disorder (BED), and 128 (53%) had EDNOS, respectively, reflecting a significant decrease in EDNOS. Validation analyses supported significant differences among groups with some improvement associated with delineation of BED.

Discussion:

Proposed revisions to EDs in the DSM‐5 significantly reduced reliance on EDNOS without loss of information. © 2011 by Wiley Periodicals, Inc.