Season of birth and bulimia nervosa

OBJECTIVE: Previous studies suggest season of birth variation in eating disorders akin to those of psychoses. We studied season of birth variation in bulimia nervosa. METHOD: Season of birth variation in 935 patients was examined after adjustment for population trends. Variation was also examined for subgroups by age and previous anorexia nervosa. RESULTS: Season of birth did not differ significantly from population norms among bulimics (p >.30), contrasting with studies of other eating disorders. With a history of anorexia nervosa (n = 227), peak season of birth was in March (p <.05). This is consistent with previous studies and also with seasonal birth variation for psychoses. DISCUSSION: Overall, we find no evidence of season of birth variation in bulimia nervosa, and suggest any positive findings be treated with caution. We discuss a number of confounding influences and argue that one explanation remains shared trait vulnerability between anorexia nervosa and psychoses.     

Clinical and personality correlates of body size overestimation in anorexia nervosa and bulimia nervosa

A video camera technique was used to assess perceived actual and ideal size in patients with a restricting type of anorexia nervosa (n = 17), bulimia nervosa patients with previous anorexia (n = 23), bulimia nervosa patients with no previous anorexia (n = 24), phobic controls (n = 18), and normals (n = 33). Bulimic patients with previous anorexia demonstrated a significantly greater tendency to overestimate their actual body size (p <.05) than subjects in the restricting anorexic or control groups. Previously anorexic bulimics also demonstrated more overall clinical and personality disturbance than any of the other groups (p <.01). Body size overestimation and dissatisfaction were strongly associated with the duration and severity of the eating disturbance in previously anorexic bulimics but there were no clear relationships between clinical or personality disturbances and body size distortions in the restricting anorexic or never-anorexic bulimic groups. Results are discussed with respect to the importance of refining diagnostic criteria for subtypes of anorexia and bulimia nervosa. Multitrait-multimethod methodologies are recommended for purposes of elucidating “body image disturbance” and its importance in the etiology and maintenance of eating disorders.     

Racial and socioeconomic: Influences in anorexia nervosa and bulimia

Eight black and 120 white patients with anorexia nervosa or bulimia were compared with each other and with 21 black control patients. Biack and white patients with eating disorders were similar in demographic features (except for later age of onset in blacks), in clinical characteristics, and in course of illness. Both racial groups with eating disorders had a significantly higher socioeconomic status than control patients. A diagnosis of anorexia nervosa or bulimia can be confidently made independent of racial designation. Socioeconomic status appears to be a risk factor for development of anorexia nervosa or bulimia in both black and white populations.     

Neuropsychological correlates of dieting disorders

Various studies have suggested that patients with anorexia nervosa may have cognitive deficits on neuropsychological examination. A battery of tests was administered to 35 patients (34 female, 1 male), diagnosed as suffering from anorexia nervosa (n = 20) or bulimia nervosa (n = 15) during the early stages of admission to a specialized eating disorders unit. Results revealed no significant differences between the anorexia nervosa and bulimia nervosa patients on any of the intellectual, neuropsychological, or academic-related tasks that were administered. There was no evidence of cognitive deficits in certain patient groups when compared with theoretical norms.     

Gastrointestinal transit is delayed in patients with bulimia

Orocecal transit time was measured in 13 patients with bulimia and in 15 healthy age- and sex-matched controls. Diagnosis was made according to DSM-III. Bulimic patients had a signficantly longer transit time. Patients with a history of anorexia nervosa (n = 4) had a longer transit time than patients without such a history (n = 8). These results indicate that gastrointestinal transport remains disturbed when anorexia nervosa develops into bulimia. The indicator intermittent dieting did not show significant correlations with transit time.     

Caffeine intake in eating disorders

OBJECTIVE: The current study compares caffeine consumption in females with an eating disorder and females without an eating disorder. METHOD: Caffeine intake in three diagnostic groups (10 females with anorexia nervosa, 27 females with bulimia nervosa, and 42 females with binge eating disorder [BED]) was compared with caffeine intake in three comparison groups (n = 659 each). Data were obtained from a longitudinal study of Black and White girls. Three-day food records were examined for the years before the onset of the eating disorder, the onset year, and the years after the onset of the eating disorder. Data from the same years were used for the comparison groups. RESULTS: Caffeine intake increased over time between ages 9 and 19 years across all groups and this trend was not moderated by diagnostic status. For anorexia nervosa, relative to the non-eating disorder group, the proportional intake of caffeine from soda increased significantly before onset to onset to after onset and ingestion of chocolate-containing foods decreased sharply over time. CONCLUSION: Caffeine consumption in young girls with eating disorders differs from girls with no eating disorders only for anorexia nervosa, but not for bulimia nervosa or BED.     

Gastric inhibitory polypeptide (GIP) in anorexia nervosa

Simultaneous glucose, insulin, and gastric inhibitory polypeptide (GIP) responses to meal stimulation were measured in five anorexia nervosa patients, eight bulimia patients with a past history of anorexia nervosa, and twenty-two healthy subjects. Although basal levels of GIP were similar, anorexia nervosa patients had an early and significantly higher (p <.05) mean peak GIP response than controls or bulimics with past anorexia nervosa. Mean peak insulin levels in anorexia nervosa patients did not differ significantly from those of control or bulimia/past anorexia nervosa patients, although anorexia nervosa patients had a nonsignificantly prolonged elevation of serum insulin. Glucose responses were not significantly different among the various groups. The exaggerated CIP response to meal stimulation with no significant difference in insulin levels suggests that the usual association between insulin and GIP is altered in anorexia nervosa. This is apparently a state-dependent abnormality since GIP responses in bulimia patients with a history of anorexia nervosa do not differ from healthy subjects. Altered GIP responses may contribute to the gastric hypomotility and acid secretion changes previously reported in low-weight anorexia nervosa patients.     

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.     

The psychiatric history of anorexia nervosa and bulimia nervosa: Weight concerns and bulimic symptoms in early case reports

British, French, American, German, and Italian historical medical reports on possible cases of anorexia nervosa and bulimia nervosa were critically reevaluated in order to trace the history of weight concerns, binge eating, and methods of food reversal like self-induced vomiting in these texts. It is argued that weight concerns are a new phenomenon in prolonged extreme fasting and has superseded traditional ascetic motivations for fasting from the first use of the term anorexia nervosa on. Binge eating, or bulimia as a symptom, on the other hand, has been known ever since ancient times; what is new here is its combination with methods of food reversal, which are motivated by concerns about weighing too much. This combination, bulimia nervosa (DSM-III-R), was first described in cases of primary anorexia and started becoming more frequent only in the 1940s. First accounts of possible cases of bulimia nervosa at normal body weight were published in the 1930s. Methodological problems of retrospective diagnosing and factors inherent to the history of medicine which might have influenced the history of medical writing about eating disorders are discussed.     

Subtyping of bulimia nervosa

Several possible ways of subtyping bulimia nervosa are discussed. Two possibilities, subtyping bulimia nervosa by presence or absence of a history of anorexia nervosa or presence or absence of a history of obesity, both represent interesting approaches, but there is inadequate data to support either as a subclassifying system at this point. There is considerable interest in requiring purging behavior for the diagnosis of bulimia nervosa, or for subtyping bulimia nervosa into purging vs. non-purging types. Also the issue of bow to classify over-weight bulimic individuals by DSM-Ill-R criteria who do not purge remains controversial.     

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.     

Temperament in eating disorders

This study examined dimensional personality and temperamental characteristics in women with eating disorders. Clinical symptoms, personality, and temperament were examined in 30 women with anorexia nervosa (AN), 32 women with bulimia nervosa with no history of anorexia nervosa (BN), and 20 women with comorbid anorexia and bulimia nervosa (AB). Temperament differed markedly across the groups on the Tridimensional Personality Questionnaire (TPQ) with AN women showing greater reward dependence, BN women scoring higher on novelty seeking subscales, and AB women showing high harm avoidance. The TPQ subscales also displayed higher classification accuracy than other personality and symptom measures. Temperamental features are distinct across eating disorder subtypes. Temperament could reflect differential vulnerabilities for the development of specific eating disorder symptom clusters. © 1995 by John Wiley & Sons, Inc.     

Premorbid onset of psychopathology in long-term recovered anorexia nervosa

It is recognized that patients with anorexia nervosa commonly have other psychiatric illnesses. No study, to our knowledge, has determined whether these other psychiatric disorders occur prior to the age of onset of anorexia nervosa. We obtained a retrospective history from 24 subjects who were long term (more than 1 year) recovered from anorexia nervosa. We found that 58% reported that they had the onset of one or more childhood anxiety disorder diagnoses at the age of 10 ± 5 years old. This was 5 years before the mean age of onset of anorexia nervosa. The onset of depression was about 1 year before the onset of anorexia nervosa in about one half the subjects. Alcohol and substance abuse/dependency tended to occur after the onset of anorexia nervosa and only occurred in anorexic subjects who binged and/or purged. The early and common onset of childhood anxiety disorders in a substantial percentage of anorexics raises the possibility that childhood anxiety disorders herald the first behavioral expression of a biologic vulnerability in some subjects who develop anorexia nervosa. © 1995 by John Wiley & Sons, Inc.     

Mitral valve prolapse in eating and panic disorder: A pilot study

The prevalence of echocardiographic mitral valve prolapse (MVP) and arrhythmias was studied in controls (n = 23) and patients with panic disorder (n = 14), bulimia nervosa (n = 14), and anorexia nervosa (n = 21). There was approximately twice the rate of MVP in patient groups compared to controls, a statistically insignificant difference. Importantly, the presence of prolapse was not associated with measures of weight or depression but there was a trend for MVP to be associated with anxiety disorder in bulimic patients. There were no significant arrhythmias found. These results raise the possibility that MVP may not be a state weight-related phenomenon as has been proported, but rather a trait phenomenon reflecting comorbidity with anxiety disorder.     

Prevalence of anorexia nervosa and bulimia in three student populations

A confidential questionnaire, covering the DSM-III criteria for anorexia nervosa and bulimia, was administered to three samples of students, totalling 1060 individuals, at two colleges and a secondary school. Although none of the male respondents met DSM-III criteria for either disorder, 1.0% to 4.2% of women met DSM-III criteria for a history of anorexia nervosa (with or without a history of bulimia), and an additional 6.5% to 18.6% met DSM-III criteria for a history of bulimia alone. Even when allowance is made for the number of nonrespondents, possible falsepositive questionnaire responses, and the limitations of the DSM-III criteria themselves, the prevalence rates appear substantial. Taking into account the mean ages of various samples, our results agree closely with two previous studies that each examined a single sample of students. These results augment the growing evidence that the eating disorders represent a serious public health problem.     

How do eating disorders and alcohol use disorder influence each other?

OBJECTIVE: Although eating disorders and alcohol use disorder (AUD) are known to co-occur, the influence of one on the other has not been studied. 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) AUD every 6-12 months over 8.6 years. RESULTS: Over one fourth of the sample (n = 66 [27%]) reported a lifetime history of AUD. Ten percent of the study subjects (n = 24) developed AUD over the course of the study. AUD did not influence recovery from either eating disorder. Poor psychosocial functioning and history of substance use predicted prospective onset of an episode of AUD for both diagnostic groups. Unique predictors for AUD for women with AN were depression, overconcern with body image, and vomiting. Recovery from AUD was predicted by group therapy and hospitalization (women with AN) and individual therapy and exercise (women with BN). CONCLUSION: The influence of eating disorders on AUD appears to be greater than the reverse. A substantial number of patients who initially present with an eating disorder develop alcohol problems over the course of time, suggesting that the risk is an ongoing one that should be monitored by clinicians.     

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.     

The current status of treatment for anorexia nervosa and bulimia nervosa

A survey investigating the current status of treatment for anorexia nervosa and bulimia nervosa was distributed at the International Conference on Eating Disorders in 7988 and again in 1990. Respondents answered questions regarding treatments they had endorsed for their last patient with anorexia nervosa and for bulimia nervosa. One hundred and seven medical doctors and psychologists completed the survey in 1988 and 115 in 1990. The results indicate that: (1) less than 50% of the respondents believe there is a consensus regarding the treatment of eating disorders; (2) talking therapy is overwhelmingly endorsed for the treatment of both anorexia and bulimia nervosa; (3)there is a trend in clinical practice towards using drug therapy more frequently in treating patients with bulimia nervosa than in treating patients with anorexia nervosa; (4)physicians are more likely than psychologists to endorse drug therapy when treating patients with anorexia and for bulimia nervosa; and (5) about one third of the respondents endorse drug therapy for treating anorexia nervosa. © 1992 John Wiley & Sons, Inc.     

Cognitive style of patients with anorexia nervosa and bulimia nervosa

Nine female patients with anorexia nervosa and 7 female patients with bulimia nervosa were assessed on the Matching Familiar Figures Test (MFFT). This study found that subjects with bulimia nervosa responded more quickly than did the anorexic subjects. Results such as these suggest that not only are bulimic patients more behaviorally impulsive than anorexic patients, they are also more cognitively impulsive. Patients with anorexia nervosa in contrast seemed to display a reflective cognitive style. Extreme cognitive styles may contribute to resistance in treatment and/or relapse in anorexia or bulimia nervosa. © 1995 by John Wiley & Sons, Inc.     

Males with anorexia nervosa: a controlled study of eating disorders in first-degree relatives

OBJECTIVE: To compare lifetime rates of full and partial anorexia nervosa and bulimia nervosa in first-degree relatives of males with anorexia nervosa and in relatives of never-ill comparison subjects. METHODS: Rates of eating disorders were obtained for 747 relatives of 210 probands from personal structured clinical interviews and family history. Best-estimate diagnoses were determined blind to proband diagnosis and pedigree status. RESULTS: Full and partial syndromes of anorexia nervosa aggregated in female relatives of ill probands. For the full syndrome of anorexia nervosa, the crude relative risk was 20.3 among female relatives and for partial syndrome anorexia nervosa, the crude relative risk was 3.3. In contrast, bulimia nervosa was relatively uncommon among relatives of ill probands. CONCLUSION: Although anorexia nervosa in males is exceedingly rare, there is a pattern of familial aggregation that is highly similar to that observed in recent family studies of affected females. On the basis of these findings, there is no evidence that familial-genetic factors distinguish the occurrence of anorexia nervosa in the two sexes.