Shape- and weight-based self-esteem and the eating disorders

Objectives: To determine the psychometric properties of the Shape- and Weight-Based Self-Esteem (SAWBS) Inventory in women with eating disorders, and to compare SAWBS scores in women who have eating disorders with women from psychiatric and normal control groups. Method: Women with eating disorders (n = 48), women with other psychiatric disorders (n = 44), and undergraduate control women (n = 82) completed the SAWBS Inventory and measures of depression, self-esteem, and eating disorder symptomatology. Twenty women from the eating disorder group completed the SAWBS Inventory a second time 1 week later. Results: Similar to previous work in undergraduate samples, SAWBS scores were stable over 1 week, and demonstrated concurrent and discriminant validity in women with eating disorders. In between-group comparisons, SAWBS scores were higher among women with eating disorders than in either control group, even after controlling for age, socioeconomic status, body mass index, and self-esteem. A differing relationship between depression and SAWBS emerged as a function of group; SAWBS scores differed significantly among depressed, but not nondepressed women from the three groups. Conclusion: The psychometric properties of the SAWBS Inventory were established in women with eating disorders. As expected, SAWBS scores were higher in women with eating disorders than in the control groups. Clinical implications of these findings are discussed. © 1998 by John Wiley & Sons, Inc. Int J Eat Disord 24: 285–298, 1998.     

The interaction of personality disorders and eating disorders: a two-year prospective study of patients with longstanding eating disorders

OBJECTIVE: The current study aimed to investigate the relation between personality disorders and symptoms of both eating disorders and general psychopathology over time. METHOD: Seventy-four patients, with a mean age of 30 years and admitted to a hospital for treatment of a chronic eating disorder, were assessed using the Eating Disorder Inventory (EDI), the Eating Disorder Examination (EDE), the Symptom Check List-90-Revised (SCL-90-R), and the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II) at admission, and after 1 and 2 years. RESULTS: At the 2-year follow-up, there was considerable reduction in both personality and symptoms (effect size = 0.83-0.94). Panel modeling using structural equation modeling techniques indicated that symptomatic changes generally preceded changes in the personality disorder. DISCUSSION: Eating disorder symptoms and general symptomatology had direct effects on a dimensional personality disorder index. Thus, personality disorders may be at least partially a consequence of general symptomatology in chronic eating disorders. Symptom improvement appears to precede changes in personality in this sample of patients with chronic eating disorders.     

Comparing clinical and research treatments for eating disorders

OBJECTIVE: This study evaluated whether there is a gap between research and practice in the treatment of eating disorders. METHOD: Psychologists in clinical practice (N = 126) were surveyed regarding their treatment of a recent client with an eating disorder and a content analysis of published treatment outcome studies for eating disorders (N = 76) was conducted. RESULTS: The treatment of eating disorders in clinical and research settings was found to differ significantly on several variables, including the types of therapeutic issues addressed and the frequency of comorbidity seen in clients. Logistic regression analyses found that the frequency with which psychologists read journal articles about eating disorders was significantly related to whether their clients received empirically validated treatment. DISCUSSION: Psychologists in clinical practice are not using empirically validated treatments not only because of a lack of training but also because such treatments provide little guidance for dealing with the issues and comorbid problems that their clients with eating disorders often have.     

Season of birth and eating disorders: patterns across diagnoses in a specialized eating disorders service

OBJECTIVE: In view of inconsistent findings from previous studies, the aim was to investigate possible seasonal variation in month of birth in patients with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. METHOD: We examined the month of birth in a cohort of 1,305 adult patients with a DSM-IV eating disorder diagnosis at first presentation to a specialized eating disorders service. RESULTS: When compared to general population data, we found no evidence of significant variation in month or season of birth in anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified. CONCLUSION: The authors question whether people who develop eating disorders differ from the general population in their season of birth. Caution is expressed about further speculation regarding the etiological significance of season of birth in eating disorders.     

Travel distance and attrition in outpatient eating disorders treatment

OBJECTIVE: The purpose of this study was to investigate the impact of the distance patients had to travel for treatment on attendance patterns and treatment attrition. METHOD: Contact information, clinical records, and/or appointment records of 209 adult patients presenting to an outpatient eating disorder treatment center over a specific period of time were reviewed. Information was obtained on demographics, diagnosis, number of appointments attended, cancelled, and failed, and termination status. Patients were classified as treatment completers or dropouts and compared on demographic, diagnostic, attendance, and distance to treatment site variables. RESULTS: Treatment completer and dropout groups did not differ significantly on demographic variables, with the exception of employed patients being more likely to drop out of treatment. Although not statistically significant, patients diagnosed with bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) were more likely to drop out of treatment prematurely. Surprisingly, distance traveled to the treatment site was not significantly different between groups and did not appear to significantly impact attendance patterns. CONCLUSION: Results of this archival investigation were unexpected and likely limited by the design. Results can be useful in understanding motivational factors inherent in noncompliance and premature termination of treatment. A prospective study including fine-grained analysis of variables associated with eating disorder treatment attrition is indicated.     

Sertraline in underweight binge eating/purging-type eating disorders: five case reports

DISCUSSION: Control trials show that antidepressants are efficacious in eating disorders. Although selective serotonin reuptake inhibitors (SSRIs) are used in clinical practice, there are relatively few controlled or open trials demonstrating that SSRIs are effective. We report five cases of underweight women with binge eating/purging-type eating disorders who gained weight and had reduced core eating disorder behaviors in response to sertraline.     

Objective and subjective binge eating in underweight eating disorders: associated features and treatment outcome

Objective:

To define the utility of the DSM‐IV‐TR definition of binge eating, as it applies to anorexia nervosa (AN) and underweight eating disorder not otherwise specified (ED‐NOS).

Method:

We investigated the psychopathological features associated with bulimic episodes in 105 underweight individuals with eating disorders who reported regular objective bulimic episodes with or without subjective bulimic episodes (OBE group, n = 33), regular subjective bulimic episodes only (SBE group, n = 36) and neither objective nor subjective bulimic episodes (n = 36, no‐RBE group). The Eating Disorder Examination (EDE), anxiety, depression, and personality tests were administered before and upon completion of inpatient cognitive behavior therapy (CBT) treatment 6 months later.

Results:

Compared with the SBE group, OBE subjects had higher body mass index, and more frequent self‐induced vomiting, while both OBE and SBE groups had more severe eating disorder psychopathology and lower self‐directness than the no‐RBE group. Dropout rates and outcomes in response to inpatient CBT were similar in the three groups.

Discussion:

Despite a few significant differences at baseline, the similar outcome in response to CBT indicates that categorizing patients with underweight eating disorder on the basis of the type or frequency of bulimic episodes is of limited clinical utility. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012;)