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.     

Treating adults with eating disorders by using an inpatient approach

Although eating disorders like anorexia nervosa and bulimia have received wide attention in the media, specific treatments for specific populations have received less notice. Treating adult patients in the hospital can be a successful approach to dealing with these complex and multifaceted conditions, as the program outlined here illustrates.     

Obsessive compulsive disorders in eating disorders

OBJECTIVE: The aim of this study is to explore current and lifetime prevalence of obsessive compulsive disorders (OCD) in eating disorder (ED) subgroups and subtypes defined by the DSM-IV and to study the chronology of appearance of these disorders taking into account the role played by denutrition. METHOD: Current and lifetime prevalence were investigated using the Mini International Neuropsychiatric Interview (MINI) and the Yale-Brown Obsessive Compulsive Scale in a sample of 89 DSM-IV ED patients (58 AN and 31 BN) and 89 matched controls. RESULTS: Current and lifetime prevalence of OCD in ED was significantly higher than in general population (15.7% and 19% vs. 0% and 1.1%, P<.05). Anorexic patients presented a slightly higher current and lifetime comorbidity than bulimic patients (19% and 22.4% vs. 9.7% and 12.9%, n.s.). Purging anorexia was the diagnostic subtype, which presented the higher prevalences (29% and 43%), followed by restrictive anorexia (16%) and purging bulimia (13%). In the great majority of cases (65%), OCD diagnosis preceded ED diagnosis. Finally, OCD current prevalence and Y-BOCS scores of underweight patients were not significantly higher than normal-weight patients, suggesting that there were only limited links between denutrition and obsessionality.     

Smoking in eating disorders

OBJECTIVE: Smoking has been reported as an appetite and weight control method in eating disorders; however, few studies have explored patterns of smoking across subtypes of eating disorders. The aim of this paper was to explore the patterns and prevalence of smoking behavior in 1,524 women from two of the multisite Price Foundation Genetic studies. METHOD: Smoking behavior was assessed in 306 individuals with anorexia nervosa-restricting type (RAN), 186 with anorexia nervosa-purging type (PAN), 180 with anorexia nervosa and bulimia nervosa (ANBN), 107 with anorexia nervosa-binging type (BAN), 71 individuals with purging type-bulimia nervosa (PBN), and 674 female community controls. We compared smoking prevalence and smoking behaviors across eating disorder (ED) subtypes and in comparison to controls using the Fagerstrom Test of Nicotine Dependence (FTND). RESULTS: Overall, women with eating disorders reported higher rates of smoking and greater nicotine dependence than controls. Women with binge/purge subtypes of eating disorders reported the highest rates of smoking of all of the subtypes. Smoking in eating disorders was related to impulsive personality traits. CONCLUSIONS: Women with eating disorders appear to be at increased risk for smoking, particularly those who binge eat and/or purge and display impulsive personality characteristics. Given the high prevalence, the impact of ongoing smoking on maintenance of eating disorders symptoms is worthy of both clinical and research attention.     

Preliminary study of eating disorders among French female adolescents and young adults

We have performed an exploratory study of eating disorders among female adolescents (N = 38) and young adult (N = 38) students living in Paris, France. A high percentage of the subjects in the adolescent (68.4%) and young adult (50%) groups displayed one or more atypical eating behaviors with grazing being prominent (60.5% and 42.1%, respectively) in both groups. Bulimia nervosa (DSM-III-R) was found only in the older group (3/38 vs. 0/38). Binge eating was significantly more frequent among the older subjects (12/38 vs. 1/38). Nicotine dependence and daily grazing with a history of grazing during childhood were reported in all subjects with bulimia nervosa (DSM-III-R). These data, while requiring replication in larger samples, indicate that atypical eating behaviors are common in the populations sampled. Furthermore, daily grazing (especially with a history of grazing during childhood) and nicotine dependence may be strongly associated with the development of bulimia nervosa. © 1994 by John Wiley & Sons, Inc.     

Eating disorders in sports--sport in eating disorders

OBJECTIVE: The current study presents one of the underprivileged populations of the national epidemiological scientific literature by the eating disorders. THE PURPOSE OF STUDY: Based on a review of selected publications over the past 10 years, the author summarizes definitions of the anorexia athletica and the female athlete triad. METHODS: Analysis of the international epidemiological data. RESULTS: The base definitions were more exact: the symptoms of anorexia athletica became differentiated, and the data of epidemiological studies were standing between smaller ranges. The "athlete triad" concept has got a new interpretation. CONCLUSIONS: The strong correlation of eating disorders with excessive physical activity and sport underlines the significant role of the weight loss method among diagnostical criteria of eating disorders. Among sportsmen, eating disorders have a higher prevalence (23-25%).     

Neuroimaging in eating disorders

Neuroanatomical and functional studies in the eating disorders (ED) are reviewed. Typically, anorexia nervosa (AN) is associated with cerebral spinal fluid spaces enlargement which generally recover as a function of re-feeding. However, specific cortical areas fail to correct in weight restored anorectic patients suggesting trait-related abnormalities. Functional changes in AN associated with starvation reverse with weight recovery, however, reduced 5-HT2A receptor binding may be fundamental to the pathophysiology of AN since this remains after long term weight restoration. Structural studies of bulimia nervosa (BN) provide evidence of brain atrophy, in the absence of significant weight loss but potentially related to chronic dietary restriction. Functional investigations reveal reduced thalamic and hypothalamic serotonin transporter availability in BN which increases with longer illness duration. Thus, BN is associated with substantial structural and functional alterations despite normal weight. Recent advances in neuroimaging techniques and their interpretation are increasing our understanding of normal processes in the control of food intake including neuroanatomical correlates of hunger and satiety. Taken together with the structural and functional changes observed in the ED, neuroimaging provides a powerful platform to identify the underlying trait-related pathophysiological mechanisms in the aetiology and maintenance of AN and BN.     

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.     

Somatostatin in eating disorders

Somatostatin concentrations in plasma were measured before and after a standardized fat and protein-rich fluid test meal in patients with anorexia nervosa, weight-recovered anorectic patients, obese women, and healthy controls. Somatostatin was significantly elevated in all four groups after the test meals. Hormone levels remained elevated for up to 100 min after the test meal. The area under the response curve was significantly higher (p < .01) in the anorectic patients as compared with healthy controls and weight-recovered anorectics. Obese women had blunted somatostatin responses. The findings may explain alterations in insulin secretion and in gastric emptying described earlier in patients with eating disorders. © 1994 by John Wiley & Sons, Inc.     

Beliefs about eating and eating disorders

Beliefs about foods and binge eating may influence the development and maintenance of eating disorders and the likelihood that people will seek treatment. We found that the majority of a random sample of members of a large health maintenance organization considered binge eating a problem for which there are effective treatments. Self-reported binge eaters, however, were significantly less likely to agree that there are effective treatments. Two thirds of the sample reported that certain foods are addictive and also believed that strict dieting is an effective means of reducing binge eating. Therapeutic implications of these attitudes are discussed.     

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.     

Childhood eating disorders

Eating is a sensitive barometer of emotional state and parent-child interaction. Psychosocial distortions often appear first to the health worker and are referred to the dietitian as distortions in eating. At times, the distortion is severe enough to be called an eating disorder. An eating disorder of childhood is the misuse of feeding in an attempt to solve or camouflage family problems of living that seem otherwise insoluble. The childhood eating disorder might take the form of failure to thrive, obesity, excessive finickiness, or, most commonly, vehement and protracted struggles between parent and child about eating. An eating disorder is a biopsychosocial problem. It is based on characteristics and distortions in physical, physiological, psychological, and social factors. The dietitian who is to be helpful with families referred to her for correction of eating difficulties must be able to detect the disordered situation and differentiate it from one that is simply problematic. If an eating disorder exists, it is unlikely that the situation will change without psychotherapeutic intervention into family functioning. An appropriately conducted symptom management approach to correct the eating distortion is a helpful and potentially successful adjunct to psychotherapy. Such a component should be constructed around the restoration of a positive feeding relationship.     

The course and outcome of eating disorders in adults and in adolescents: a review

Over 100 studies have been published in the literature to date on the course and outcome of eating disorders. These have generally shown that approximately 50% of patients do well over time, approximately 30% do reasonably well but continue to have symptoms, and approximately 20% do poorly. In this article, the literature on the course and outcome of eating disorders is reviewed from two perspectives. The first is an analysis of studies in adults, looking in depth at a range of issues (weight, eating behaviors, menstrual function, psychosocial functioning, psychosexual function, mortality, bulimia nervosa, long-term follow-up, comorbidity, and prognostic factors) and reviewing the difficulties inherent to the performance of all eating disorders follow-up studies. The second is an analysis of whether adolescents with eating disorders have a better prognosis than adults, as has been considered in the literature. It is concluded that adolescents do, in fact, have a somewhat better prognosis than adults, with the differences seeming to be greater with a longer duration of follow-up.