An ongoing cross-sectional study of the prevalence of eating disorders in freshman college students

Our third cross-sectional survey designed to elicit DSM-III inclusion criteria for bulimia was completed by 1836 students, 97.2% of those surveyed. Based on operationalized criteria, 4.7% of females reported a current eating disorder diagnosis. These included bulimia (4.3%), bulimia nervosa (2.2%), bulimia with weekly binge/purging behavior (1.1%), and anorexia nervosa (0.1%). Current bulimia was reported by 0.1% of males and current bulimia nervosa by 0.3%. Those women with current bulimia were more likely to report a history of treatment for alcoholism and drug abuse than those bulimic women in remission. The data suggest that fear of loss of control over eating is an important part of the diagnostic criteria for bulimia nervosa, while fear of being fat is less apt to differentiate between bulimic and nonbulimic women. The desire for low weight was more pronounced in bulimic female students in the current survey than in previous surveys. The percentage of women who reported a history of bulimia with weekly binge eating and purging went from 1% in 1980 to 3.2% in 1983 and to 2.2% in the current survey indicating that the prevalence for this disorder may have peaked and may be declining.     

Diagnoses of eating or dieting disorders: What may we learn from past mistakes?

A brief history of a patient is given and an attempt is made to reconcile the clinical realities she presents with the various diagnostic criteria that have been proposed for eating disorders. Despite much deliberation and many formulations, no scheme fully encompasses her not-uncommon problem. Rather than tinker yet again with the criteria for the syndromes of anorexia and bulimia nervosa, or introduce yet another new condition such as binge eating disorder, the authors suggest a unitary approach to diagnosis. Emphasis should be placed on the preoccupation with weight loss, the illness should be conceptualized as a dieting disorder rather than an eating disorder, and patient status should be accorded only when the disturbance results in significant psychological or physical ill-effects. The term anorexia nervosa should be retained for such cases, and all anorexia nervosa patients should be categorized on three parameters, viz: their current state of nutrition; the presence or absence of significant purging behaviors; and whether or not they have binge eating episodes. © 1994 by John Wiley & Sons, Inc.     

Blood-letting in anorexia nervosa: a case study

BACKGROUND: Deliberate blood-letting has been characterized as an alternative to purging behavior in bulimia. METHOD: We describe a female healthcare worker with an 8-year history of restrictive anorexia nervosa, who initially presented with anemia, using blood-letting, cold baths, and starvation to control her mental state. RESULTS: In contrast with the previous cases of bulimia, the aim of blood-letting in this case of anorexia nervosa was to achieve anemia. She compared the psychic correlates of anemia to emaciation, rather than to deliberate self-harm or purging. DISCUSSION: We note that mainstream 19th century psychiatry prescribed "baths, blood-letting and diet" as a treatment of "madness." Copyright 2000 by John Wiley & Sons, Inc.     

Schema-level cognitions in patients with binge eating disorder: a case control study

OBJECTIVE: This study examined the schema-level cognitions (core beliefs) of patients with binge eating disorder to determine whether these patients differ from those with bulimia nervosa. A case control method (matching groups for age and body mass index [BMI]) was used, to avoid the confounding factors that are found in most studies of this sort. METHOD: All clinical women were recruited from a specialist eating disorder clinic. The index group consisted of 25 women with DSM-IV diagnoses of binge eating disorder, who were compared with a clinical group of 25 women with bulimia nervosa and a group of 25 women with no eating disorder. Groups were closely matched for age and BMI. Each participant completed a well-validated measure of core beliefs. RESULTS: Although the binge eating disorder group had a range of more negative core beliefs than nonclinical women, the differences between the clinical groups were much smaller. The binge eating disorder group had more negative core beliefs than the bulimia nervosa group in many areas. However, the bulimia nervosa group was distinguished by having the highest level of abandonment beliefs, and this difference may account for the difference in the presence of purging behaviors. CONCLUSIONS: Levels of abandonment beliefs seem to be crucial in understanding the behavioral differences between these clinical groups--particularly the absence of purging behaviors. However, the relevance of these beliefs to treatment outcome and to other aspects of psychopathology remains to be established.     

Bulimia nervosa with enema abuse: A preliminary analysis based on four case reports

Four cases of bulimia nervosa characterized by enema abuse as a means of purging are described and summarized. A brief overview of this variant form of bulimia nervosa follows, along with suggestions for clinicians who may encounter such cases.     

Age of onset in eating disorders

This paper presents age of onset data for anorexia nervosa and bulimia nervosa, derived from a sample of 323 patients referred to a tertiary referral center. Patients had anorexia nervosa (n = 39), bulimia nervosa (n = 173), or bulimia nervosa with a history of anorexia nervosa (n = 173). While the pattern of onset of anorexia nervosa and bulimia nervosa is similar up to age 25, there is a significant excess of new cases of anorexia nervosa beyond this point. Significantly, age of onset was constant for both anorexia nervosa and bulimia regardless of whether they occurred in isolation (anorexia or bulimia alone) or in concert in the same individual (bulimia with a history of anorexia nervosa).     

Self-Injury in Adolescents With Eating Disorders: Correlates and Provider Bias

IntroductionSelf-injurious behavior (SIB) is common among adolescents, and has been shown to be associated with eating disorders (ED). This study examines the prevalence of SIB and SIB screening in adolescents with ED, and associations with binge eating, purging, and diagnosis.MethodsCharts of 1,432 adolescents diagnosed with ED, aged 10–21 years, at an academic center between January 1997 and April 2008, were reviewed.ResultsOf patients screened, 40.8% were reported to be engaging in SIB. Patients with a record of SIB were more likely to be female, have bulimia nervosa, or have a history of binge eating, purging, co-morbid mood disorder, substance use, or abuse. Patients who engaged in both binge eating and purging were more likely to report SIB than those engaged in restrictive behavior or either behavior alone. Providers documented screening for SIB in fewer than half of the patients. They were more likely to screen patients who fit a profile of a self-injurer: older patients who binge, purge, or had a history of substance use.ConclusionsSIB was common in this population, and supports extant literature on associations with bulimia nervosa, mood disorders, binge eating, purging, abuse, and substance use. Providers may selectively screen patients.     

Repeated binge/purge cycles in bulimia nervosa: Role of glucose and insulin

The available data indicate that over half of patients with bulimia nervosa binge and purge daily with repetitions of the binge/purge cycle being common. An understanding of the biobehavioral mechanisms associated with frequent binge/purge cycles may aid the general conceptualization of bulimia nervosa including its development and maintenance. Binging and purging have demonstrable physiological effects that may be partially responsible for the repetition of binge/purge episodes. In the present study, the cephalic phase oversecretion of insulin and high insulin levels subsequent to purging were investigated as possible mediators of repeated binging and purging. Insulin and glucose levels of bulimic and nonbulimic women were measured in response to: thinking about food, the presence of food, while eating, and for the bulimic group, after purging. Bulimic subjects displayed a dramatic reduction in both insulin and glucose after purging the test meal. When these same subjects ate a subsequent meal that was not purged, they displayed elevations in insulin and glucose similar to those of the normal controls. The hypoglycemia resulting from purging appears to be partially responsible for the continuation of repeated binge/purge episodes.     

Dissimilarities in eating attitudes,body image distortion,depression, and self-esteem between high-intensity male runners and women with bulimia nervosa

It has been suggested that high-intensity exercise regimens in males bear a resemblance to the features of eating disorders and that male runners may resemble women with anorexia nervosa and bulimia nervosa with regard to eating and weight attitudes, negative body image, and negative psychological adjustment. Twenty high-intensity male runners were compared with 20 sedentary-moderate exercising male controls and 20 women with bulimia nervosa. Compared with the bulimia nervosa subjects, the male runners were not anxious about eating, overly preoccupied with food, excessive in binge-eating or purging behavior, negatively preoccupied with their weight, intent on losing weight, high on personality traits presumed to underlie eating disorders, nor depressed or low in self-esteem. The male groups of high-intensity runners and controls were not significantly different on any measure. These results suggest that high-intensity exercising in males is not analogous to anorexia nervosa and bulimia nervosa.     

Divergent forms of purging behavior in bulimia nervosa patients

Though DSM-III-R equates several different forms of purging behavior, including use of vomiting, laxatives, diuretics, dieting, and exercise, there is little work that has examined patient subgroups based on divergent forms of purging. An attempt to investigate subgroups based on purging criteria was thwarted because of low base rates for specific purging behaviors, despite having a relatively large clinic sample of bulimia nervosa patients (n = 245). As an intermediary step to the investigation of functional equivalence of different forms of purging, we propose classifying patients based on the number of purging behaviors they employ to control weight. Our findings suggest that patients who employ more than one strategy are generally more disturbed on a number of psychiatric indices, including state and trait depression. This contrasts with recent findings that the frequency of any one purging behavior is unrelated to level of depression or course of treatment in clinical samples. This study suggests that clinicians who must evaluate and effectively triage bulimia nervosa patients would benefit from utilizing the number of purging strategies rather than the frequency of any one purging behavior as an indication of severity and possible comorbidity.     

Comparison of binge eating disorder and bulimia nervosa in a community sample.

OBJECTIVE: This study examined the relationship between binge eating disorder (BED), a newly proposed eating disorder, and bulimia nervosa (BN). METHOD: Three groups recruited from the community were compared: women with BED (n = 150), women with purging BN (n = 48), and women with nonpurging BN (n = 14). RESULTS: The three groups did not differ significantly in education, weight or shape concern, and current or lifetime prevalence of nine major mental disorders. Women with BED, compared with women with purging BN, were older, less likely to have a history of anorexia nervosa, and less likely to have been treated for an eating disorder. Obesity was more commonly associated with BED than with either subtype of BN. DISCUSSION: Our results lend some support to BED as an eating disorder distinct from purging BN. More research is needed to clarify the position of nonpurging BN relative to BED and purging BN.     

Bulimia: medical complications

Bulimia nervosa is a common eating disorder that predominantly affects young women. There are three main models of purging in bulimia. Resulting medical complications are related to the particular mode and frequency of purging. Commonly, there are oral and gastrointestinal complications along with serious electrolyte and endocrine complications. The majority of the medical complications of bulimia nervosa are treatable if diagnosed in a timely fashion. Some of these patients require inpatient hospitalization, and others can be managed along a continuum of outpatient care. The American Psychiatric Association has comprehensive treatment guidelines for the management of bulimia. Primary care physicians and gynecologists need to be familiar with this disorder and its medical implications.     

Binge eating disorder: Its further validation in a multisite study

Binge eating disorder (BED) is a new eating disorder that describes the eating disturbance of a large number of individuals who suffer from recurrent binge eating but who do not regularly engage in the compensatory behaviors to avoid weight gain seen in bulimia nervosa. This multisite study of BED involved 1,785 subjects drawn from 18 weight control programs, 942 subjects from five nonpatient community samples, and 75 patients with bulimia nervosa. Approximately 29% of subjects in weight control programs met the criteria for BED. In the nonpatient community samples BED was more common than purging bulimia nervosa. The validity of BED was supported by its strong association with (1) impairment in work and social functioning, (2) overconcern with body/shape and weight, (3) general psychopathology, (4) significant amount of time in adult life on diets, (5) a history of depression, alcohol/drug abuse, and treatment for emotional problems. © 1993 by John Wiley & Sons, Inc.     

Suicide and attempted suicide in anorexia nervosa and bulimia nervosa

Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Risk factors for suicide and attempted suicide (which in many cases results in successful suicide) in anorexia nervosa include: purging type, chronic disease, and during treatment, obsessive symptoms and drug abuse, major depression, and for anorexia nervosa low body mass index (BMI) at presentation. In anorexia nervosa suicide has been considered the first cause of death and attempted suicide is a serious threat to these individuals. Data concerning suicide in bulimia nervosa has still scarce whereas attempted suicides are easily found in clinical histories of patients. No doubt suicidal behavior is underestimated amongst patients with anorexia nervosa and bulimia nervosa. An effort to reconcile with subject of suicide and a better evaluation of these patients' psychopathology should improve suicide prevention strategies amongst these individuals.     

The use of multiple purging methods as an indicator of eating disorder severity

OBJECTIVE: Previous studies indicate a distinction between those who use one versus multiple methods of purging, but these studies have not controlled for differences in purging frequency. The current study examined whether purging frequency or the use of multiple purging (MP) methods provides more information about eating disorder severity. METHOD: Existing data were reanalyzed to examine associations between facets of purging and psychological measures among women with bulimia nervosa, purging disorder, and controls. Analyses compared the use of MP methods and purging frequency as indicators of eating pathology. RESULTS: MP methods demonstrated associations with greater eating disorder severity; purging frequency was associated with increased binge frequency and general psychopathology. CONCLUSION: The presence of MP methods provides more information about eating disorder severity than purging frequency, which seems to be a marker of related psychopathology.     

Assessment of diagnostic features of bulimia nervosa: Interview versus self-report format

In order to determine the clinical severity of bulimia nervosa and to measure symptomatic improvement during treatment, the behavioral and psychological features of the syndrome must be assessed. Focused semistructured interviews have recently been designed for this purpose, but such instruments can be time-consuming and costly. The present study compared the assessment of the key symptoms of bulimia nervosa using the Eating Disorder Examination with data obtained in self-report inventories and in patients' diaries of binge eating and purging. Results suggest that once the diagnosis has been established and patients have been instructed in the construct of a binge, the essential features of bulimia nervosa (frequency of binge eating and purging, and overconcern with body shape and weight) can be evaluated with self-report measures. These findings may be useful for the purposes of repeated assessment of progress and measurement of outcome in treatment studies. © 1994 by John Wiley & Sons, Inc.     

Criterion validity of the multiaxial assessment of eating disorders symptoms

OBJECTIVE: The purpose of this investigation was to establish the criterion validity of the Multiaxial Assessment of Eating Disorders Symptoms (MAEDS). The MAEDS is a brief, comprehensive, self-report measure for the evaluation of eating disorders treatment outcome. It assesses six symptoms associated with eating disorders with subscales for binge eating, purgative behavior, avoidance of forbidden foods, restrictive eating, fear of fatness, and depression. METHOD: To establish criterion validity, we compared the subscale scores of the MAEDS across four eating disorder diagnoses, specified by subtype (bulimia nervosa, purging type; anorexia nervosa, binge-eating/purging type; anorexia nervosa, restricting type; and binge eating disorder). Participants who did not meet the full diagnostic criteria for an eating disorder, but who did meet criteria for a partial syndrome eating disorder, were grouped with the full eating disorder diagnostic subtypes. RESULTS: The criterion validity of the MAEDS was supported by the pattern of subscale scores for the different eating disorder diagnostic groups. Also, with few exceptions, persons diagnosed with anorexia nervosa, bulimia nervosa, and binge eating disorder, in comparison to subthreshold cases of anorexia nervosa, bulimia nervosa, and binge eating disorder, had equivalent scores on the subscales of the MAEDS. DISCUSSION: These findings support the criterion validity of the MAEDS and add to a growing literature that questions differences in severity of eating disorder symptoms in full syndrome versus partial syndrome cases.     

Demographic and clinical correlates of selective information processing in patients with bulimia nervosa

Demographic and clinical correlates of interference with color-naming words related to eating, weight, and shape were investigated in 75 patients with bulimia nervosa. Interference with color-naming was related to two measures, overall level of psychiatric symptoms and frequency of purging. Multiple regression analysis showed that frequency of purging, and not level of general psychiatric symptoms, was the best predictor of interference. Thus, as would be predicted by cognitive theories, interference appears to be most closely related to features specific to bulimia nervosa rather than to measures of general psychopathology. © 1993 by John Wiley & Sons, Inc.     

Barrett's esophagus in anorexia nervosa: A case report

Barrett's esophagus (BE) is a metaplastic lesion that may result from long‐lasting gastroesophageal reflux and it is an established precursor of esophageal adenocarcinoma. There are reports of an increased prevalence of BE, and eventually esophageal adenocarcinoma, in patients with eating disorders characterized by purging behaviors like those with bulimia nervosa (BN). Among patients with eating disorders, those affected by anorexia nervosa binging purging subtype (ANBP), are behaviorally very similar to those with BN, but to our knowledge there are no data in literature about BE in patients with ANBP. We present the case of a 37‐year‐old female with a 20‐year history of ANBP in comorbidity with bipolar disorder, who developed a BE requiring multi‐specialistic intervention. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:147–150)