Eating Disorders Examination versus Eating Disorders Examination-Questionnaire in adolescents with full and partial-syndrome bulimia nervosa and anorexia nervosa

OBJECTIVE: The current study compared the Eating Disorders Examination (EDE) and the Eating Disorders Examination-Questionnaire (EDE-Q) in adolescents with eating disorders. METHOD: Adolescents (N = 70) with bulimia nervosa (BN; n = 21), partial-syndrome BN (PBN; n = 25), and anorexia nervosa (AN; n = 24) were assessed with the EDE and EDE-Q. RESULTS: Moderate to high correlations were found on all four subscales within and between diagnostic groups. The discrepancy between the EDE and EDE-Q was significantly greater in BN relative to PBN and AN for the Eating Concern subscale. Objective binge episode (OBE) frequency in BN and subjective binge episode (SBE) frequency in BN and PBN were higher with the EDE compared with the EDE-Q. Self-induced vomiting was highly correlated between the two measures. DISCUSSION: Adolescents with BN, PBN, and AN exhibited strong correspondence between the EDE interview and questionnaire formats. However, this consistency was not as pronounced for BN as it was for PBN and AN. The current study lends preliminary credibility to the use of the EDE-Q in adolescent eating disorder samples.     

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.     

Disordered eating attitudes and behaviors in ballet students: examination of environmental and individual risk factors

OBJECTIVE: The current study compared the prevalence of disordered eating attitudes and behaviors among adolescent ballet dancers at national, regional, and local schools. METHOD: Female ballet students (N = 239; mean age = 15.0 +/- 1.5 years) from five geographically disparate summer programs completed the Eating Dis-order Inventory (EDI) and answered questions regarding eating disorder symptoms. RESULTS: Students from both national and local schools reported significantly higher EDI total, Drive for Thinness, and Perfectionism scores compared with regional students. In contrast, national students reported significantly greater dieting scores and lifetime histories of self-induced vomiting compared with regional and local students. CONCLUSION: Eating pathology among adolescent ballet dancers may be a function of both genetic and environmental risk. Dancers who exhibit high levels of perfectionism and, perhaps consequently, place themselves in highly competitive environments, may exhibit a significantly increased risk for disordered eating in comparison to dancers who are less perfectionistic and/or place themselves in less competitive environments.     

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.     

Eating disorders and substance use. An examination of behavioral associations

The association between the eating disorders of anorexia nervosa (AN) and bulimia nervosa (BN) and substance use disorder (SUD) has been widely investigated, however, our understanding of the relationship between the disorders remains unclear. Explanatory models have tended to focus on behaviors, yet, little is currently known about the patterns of association among disordered eating and substance use behaviors. In this exploratory study, a behavioral approach was used to investigate the cooccurrence of seven disordered eating and three substance use behaviors in women meeting current DSM-III-R criteria for AN (n=12), subthreshold AN (n=14), BN (n=29), and subthreshold BN (n=24). Results suggest that disordered eating behaviors are differentially associated with substance use behaviors. The most robust finding was that diuretic use positively predicted the current level of alcohol use regardless of diagnostic group. The findings for marijuana and tobacco use were less consistent. Results suggest that rather than being pervasive in all eating disordered women, higher levels of alcohol use may be found in those women who use diuretics.     

Eating disorders, dieting, and the accuracy of self-reported weight

OBJECTIVE: This study investigated the accuracy of self-reported weight and height in individuals with an eating disorder (i.e., anorexia nervosa [AN] and bulimia nervosa [BN]) and in individuals without an eating disorder (i.e., dieters and nondieters). METHOD: Self-reported and measured weights and heights were obtained from the eating disorder sample (n = 81) and the college student sample (n = 163) and were compared within and between the groups. RESULTS: Eating disorder patients were extremely accurate at self-reporting their weight. However, there was a significant difference in accuracy between AN and BN patients. AN patients slightly overreported their weight, whereas BN patients slightly underreported their weight. Both dieters and nondieters significantly underreported their weight. However, dieters significantly underreported their weight to a greater degree than did the nondieters. DISCUSSION: The implications of these subgroup differences and their specificity to weight reporting are discussed with reference to the accuracy of self-reported height.     

A follow-up study of 33 subdiagnostic eating disordered women

Thirty-three female subjects with subdiagnostic DSM-III-R anorexia nervosa (SAN) and/or subdiagnostic bulimia nervosa (SBN) were reinterviewed 24 to 52 months (mean 41 months) after seeking treatment for an eating disorder. Subjects were administered a semi structured interview by telephone and assessed for level of functioning, eating disorder symptoms, course of illness, and treatment sought. During the course of the follow-up, 15 (46%) subjects went on to meet full DSM-III-R criteria for AN and/or BN. At follow-up, 4 (12%) met full DSM-III-R criteria for AN and/or BN, 22 (67%) were subdiagnostic, and 6 (18%) had recovered. The high percentage of subdiagnostic women that eventually develop full DSM-III-R criteria for AN and/or BN and the low rates of recovery at 2 to 4 years suggest that the current diagnostic criteria may be too restrictive. © 1993 by John Wiley & Sons, Inc.     

Alcohol and drug-related negative consequences in college students with bulimia nervosa and binge eating disorder

OBJECTIVE: The purpose of this study was to investigate the association between disordered eating and substance use in a nonclinical sample of college students. METHOD: Participants completed the Eating Disorder Diagnostic Scale (EDDS), which includes full diagnostic criteria for bulimia nervosa (BN), binge eating disorder (BED), and anorexia nervosa (AN) as outlined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, as well as assessments of both alcohol and drug use and use-related consequences. RESULTS: Individuals meeting criteria for BN reported more alcohol-related negative consequences despite the fact that they did not drink significantly more alcohol and did not drink more frequently than non-eating-disordered individuals. Similarly, individuals with BN reported more negative consequences related to illicit drug use than non-eating-disordered individuals, although no differences in lifetime and recent use of drugs were found. DISCUSSION: Results highlight the importance of distinguishing between use and consequences in evaluating eating disorders and comorbid substance use problems.     

Drug abuse in women with eating disorders

OBJECTIVE: Drug abuse in women with eating disorders has received relatively little attention. The frequency of drug use disorder (DUD) by specific drug type was examined in the current longitudinal study. METHOD: In a prospective study, women diagnosed with either anorexia nervosa (AN; n = 136) or bulimia nervosa (BN; n = 110), were interviewed and assessed for research diagnostic criteria (RDC) DUD every 6-12 months over 8.6 years. RESULTS: Forty-two (17%) women in the current longitudinal study had a lifetime history of DUD, with 19 prospective onsets over the course of the study (9 AN and 10 BN). The most commonly abused illicit drugs were amphetamines, cocaine, and marijuana, and rates of DUD did not differ between intake diagnoses of AN and BN. CONCLUSION: Drug abuse in women with eating disorders is an area of clinical concern and should be monitored routinely throughout the treatment process.     

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.     

Features associated with excessive exercise in women with eating disorders

OBJECTIVE: Excessive exercise and motor restlessness are observed in a substantial number of patients with eating disorders. This trait has been studied extensively among animal models of activity anorexia nervosa (AN) and may hold particular interest as an endophenotype for AN. We explored features associated with excessive exercise across subtypes of eating disorders. METHOD: Participants were female probands and affected female relatives from the multi-site international Price Foundation Genetic Studies with diagnoses of AN, bulimia nervosa (BN), and both AN and BN or eating disorder not otherwise specified (ED-NOS) (N=1,857). Excessive exercise was defined based on responses to the Structured Interview for Anorexic and Bulimic Disorders (SIAB). RESULTS: Among the eating disorder diagnostic groups, excessive exercise was most common among the purging subtype of AN. Individuals who reported excessive exercise also reported lower minimum BMI, younger age at interview, higher scores on anxiety, perfectionism, and eating disorder symptom measures, more obsessions and compulsions, and greater persistence. CONCLUSION: Excessive exercise may be associated particularly with the purging subtype of AN as well as with a constellation of anxious/obsessional temperament and personality characteristics among women with eating disorders.     

Assessment of patients with anorexia nervosa: interview versus self-report

OBJECTIVE: The current study compared the agreement between the Eating Disorders Examination (EDE) and the Eating Disorders Examination-Questionnaire (EDE-Q) in the diagnosis and assessment of eating disorder pathology in a sample of women with anorexia nervosa. METHOD: First, a physician administered a clinical interview to each patient. Then, before hospital admission, all subjects were given the EDE-Q and the EDE interview. RESULTS: Results indicate that agreement between the EDE and the EDE-Q on the individual items informing the overall diagnosis of anorexia nervosa ranges from low to moderate. Agreement for the overall diagnosis of anorexia nervosa and for the binge/purge subtype was more impressive. Although correlations between subscale scores as well as eating disorder behaviors were strong, higher levels of disturbance were consistently reported on the EDE-Q than on the EDE interview. DISCUSSION: The pattern of findings suggests that the EDE-Q may be used in place of the interviewer-based measure when assessing overall diagnosis and subtype, as well as specific, well-defined features (vomiting/laxative use). However, there was a low level of agreement with respect to less-defined features, like binge eating, for which significantly higher frequencies were generated by the self-report questionnaire.     

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)     

Patterns of maternal feeding and child eating associated with eating disorders in the Norwegian Mother and Child Cohort Study (MoBa)

The impact of eating disorders on maternal feeding practices and children's eating behaviors is not well understood. In the prospective Norwegian Mother and Child Cohort Study (MoBa), we compared self-reported feeding behavior in mothers with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and no eating disorders (No ED) as well as child eating behaviors and psychological symptoms. The sample comprised 13,006 women and their children from a prospective population-based study of 100,000 births throughout Norway. Eating disorder status was measured 6 months prior to pregnancy and during pregnancy. Maternal feeding, child eating, and psychological variables were reported by mothers when their child was 36 months old. Mothers with BN and BED were more likely to report restrictive feeding styles and child eating problems than mothers without eating disorders. Regarding the pressure to eat feeding style, no significant differences emerged across groups. Differences in self-reported feeding styles and children's eating behavior exist between mothers with and without eating disorders. Longitudinal follow-up will assist in determining the implications of feeding style on later growth trajectories and development.     

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.     

A comparison of early family life events amongst monozygotic twin women with lifetime anorexia nervosa, bulimia nervosa, or major depression

OBJECTIVES: To investigate the differential profile of early family life events associated with lifetime anorexia nervosa (AN), bulimia nervosa (BN), and major depression (MD). METHOD: Only data from the monozygotic twins (n = 622) were examined from a community sample of female twins who had participated in three waves of data collection. Eating disorder and MD diagnoses were ascertained from the Eating Disorder Examination at Wave 3 and interview at Wave 2 respectively. Early family events were ascertained from self-report measures at Waves 1 and 3. Two case control designs were used, including a comparison of women: (1) who had lifetime AN, BN, MD, and controls, and (2) twin pairs discordant for either AN, BN, or MD (where the unaffected cotwin formed the control group). RESULTS: Across the two types of designs, compared to controls, both AN and BN were associated with more comments from the family about weight and shape when growing up. AN was uniquely associated with higher levels of paternal protection while BN was associated with higher levels of parental expectations. CONCLUSION: While some overlap among early life events was indicated, especially related to parental conflict and criticism, there was evidence to support some degree of nonoverlap among life events associated with AN, BN, and MD.     

The Eating Disorder Inventory-2 Perfectionism scale: factor structure and associations with dietary restraint and weight and shape concern in eating disorders

The Eating Disorder Inventory-2 Perfectionism subscale (EDI-P) was originally construed as a unidimensional measure of perfectionism. However, research in non-clinical samples suggests that the EDI-P measures two dimensions of perfectionism: self-oriented and socially prescribed perfectionism. This study aimed to investigate the factor structure of the EDI-P in a transdiagnostic sample of females seeking treatment for an eating disorder, and to determine the unique association between EDI-P dimensions, weight and shape concern, and dietary restraint in anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified. Two hundred and ninety nine females seeking treatment for an eating disorder at an outpatient eating disorder service completed the Eating Disorder Examination and the EDI-P. Confirmatory factor analysis supported a two-factor model of the EDI-P comprising self-oriented and socially prescribed perfectionism. Self-oriented perfectionism, but not socially prescribed perfectionism, accounted for unique variance in weight and shape concern and dietary restraint in both AN and BN. Results highlight the potential importance of self-oriented perfectionism in eating disorders and support the argument that self-imposed standards are central to perfectionism in eating disorders.     

Predicting the outcome of eating disorders using structural equation modeling

OBJECTIVE: There is a need for models that predict accurately the course of mental disorders. METHOD: Eating-disordered female inpatients were assessed longitudinally at the beginning of treatment (t1), at the end of treatment (t2), at 2 or 3-year follow-up (t3), and at 6-year follow-up (t4). The sample consisted of 196 women with bulimia nervosa (BN) purging type, 103 women with anorexia nervosa (AN), and 68 women with binge eating disorder (BED; N=367). Confirmatory factor analysis and path analysis were used to predict the women's status at 6-year follow-up. RESULTS: The results for BN and BED show that the specific eating disorder pathology was influenced mainly by specific eating disorder pathology at earlier time points and not by non-eating-specific (general) psychopathology. Similarly, general psychopathology was influenced mainly by general psychopathology at earlier time points. For AN patients, both categories of psychopathology (eating specific and general) were relevant for the 6-year outcome. The potential impact of 14 factors on the level of pathology was estimated (a) at baseline (at the beginning of treatment), (b) during the course of illness (baseline controlled), and (c) on the 6-year outcome of eating disorders (baseline and course controlled). Although there were many correlations between potential factors and baseline pathology, there was only a limited number of significant correlations with the 6-year outcome. This effect was mediated largely by the level of general psychopathology. DISCUSSION: The models for outcome prediction based on structural equation modeling techniques were very similar for BN and BED. For both BN and BED, there were almost entirely separate predictions for the specific eating disorder on the one hand and non-eating-related (general) psychopathology on the other hand. This was true to a lesser degree for AN. CONCLUSIONS: The use of refined path analytic methods in follow-up studies on larger general populations will be helpful to increase our understanding of the course of illness of psychiatric disorders.     

Personality disorders among subjects recovered from eating disorders

OBJECTIVE: Personality disorders are common in symptomatic eating disorders subjects. Because personality symptoms could be exaggerated by malnutrition or Axis I disorders, we studied women who had recovered from eating disorders for at least 1 year to see if personality disorder symptoms persisted in the well state. METHOD: Personality disorders were evaluated in 10 women recovered from anorexia nervosa (AN), 28 women recovered from bulimia nervosa (BN), and 16 women recovered from AN and BN, using the Structured Clinical Interview for DSM-III-R personality disorders. RESULTS: Fourteen of 54 subjects (26%) met the criteria for at least one personality disorder, such as self-defeating, obsessive-compulsive, or borderline personality disorder. Cluster B personality disorders were closely associated with bulimic subtypes. CONCLUSIONS: While a recovery from eating disorders may have an attenuating influence on the symptoms of personality disorders, such personality disorder diagnoses persist after recovery in some recovered subjects.     

Binge eating and psychological distress in ethnically diverse undergraduate men and women

Binge eating symptomatology affects African Americans and Caucasians at similar rates. Moreover, compared to anorexia nervosa (AN) and bulimia nervosa (BN), binge eating and BED are more evenly distributed across genders. Undergraduates are likely to be affected by binge eating, yet, relatively few studies have investigated this behavior and its correlates in college samples. This study examined the influence of alexithymia, depression, and anxiety on binge eating among ethnically diverse undergraduates. Results indicated that these variables significantly predicted eating symptomatology among Caucasian and African American women but not among Caucasian men. Further, among Caucasian women, depression was the only unique predictor of eating pathology. In contrast, anxiety was the only unique predictor of disordered eating in African American women. There were no differences between Caucasians and African Americans in severity of disordered eating symptomatology; however, in both ethnic groups, women reported greater eating pathology than men. Eating disorders of all types may be more prevalent among African American undergraduates than previously thought. These results highlight the need to study binge eating and its correlates in this traditionally underserved group.