Eating disorders

Eating disorders are common among adolescent girls and young women and are associated with potentially serious medical complications, yet they often go undetected and untreated. All patients with eating disorders should be evaluated and treated for medical complications of the disease at the same time that psychotherapy and nutritional counseling are undertaken. Pharmacologic agents are often useful as adjuncts to psychotherapy for bulimia nervosa or binge-eating disorder; in the case of anorexia nervosa, psychotropic medication is generally reserved for patients with a concurrent psychiatric illness or those who have recovered some weight.     

Eating disorders and comorbidity

Summary This review summarizes the current literature on the comorbidity of psychiatric disorders with anorexia nervosa, bulimia nervosa and binge eating disorder. The elevated prevalence of depres-sion, anxiety disorders, obsessive-compulsive disorders, substance abuse, childhood sexual abuse, and personality disorders will be reviewed. In addition, the relationship of eating disorders to body dysmorphic disorder, the menstrual cycle, pregnancy, and diabetes will be discussed.     

Social ecological predictors of prostate-specific antigen blood test and digital rectal examination in black American men

BACKGROUND: Black American men continue to suffer disproportionately from epidemically higher rates of prostate cancer. We hypothesize that complex reasons for persistently higher death rates of prostate cancer in this group are steeped in social factors associated with health access. METHODS: We utilized data from the It''s All About U prostate cancer prevention study among black men to investigate: 1) what social ecological factors were predictive of prostate-specific antigen (PSA) testing and digital rectal examinations (DRE); 2) if black men were aware of prostate cancer screening and, if screening was available, would they take the PSA and DRE? Quantitative cross-sectional data from a cohort of 276 black men with no diagnosis of prostate cancer were analyzed to identify characteristics, beliefs, practices and attitudes of this group toward prostate cancer screening. We created a social ecological model to examine which social factors (i.e., environmental, personal, person/environment interplay, black culture and institutional policy) were predictive of PSA and DRE, PSA only and DRE only. To reduce data and identify data patterns, factor analyses (tested for reliability by calculating Cronbach alpha scores) were performed. Variables were standardized with Z scores and analyzed with predictive analytic software technology (SPSS, version 12). A multivariate binary logistic regression was conducted to identify predictors of PSA and DRE. RESULTS: A significant predictor of both PSA and DRE was the physician''s direct prostate cancer communication message (P<0.010). Significant correlations exist in PSA and DRE outcomes with a physician''s engaging communication style (P<0.012), encouragement to screen (P<0.001) and sharing prostate cancer information (P<0.001); as was men understanding the serious risk of prostate cancer (P<0.001), culture (P<0.004), positive interaction with healthcare staff, significant other(s) and providers (P<0.001), and environmental dimensions (P<0.006). A profile of four major self-reported barriers to screening were identified (i.e., fear, internal locus of health, comfort level and external locus of health). Lastly, men who utilized health systems with a prostate cancer screening policy had high percentages of PSA and DRE (63.3%), PSA only (70.9%) and DRE only (81.7%). CONCLUSION: A physician''s aggressive, positive engagement in shared decision-making, tailored social influences promoting prostate cancer prevention among black men, as well as institutional screening policy, has the potential to increase early detection and reduce morbidity among this group.     

Eating disorders: clinical features and pathophysiology

Anorexia nervosa (AN) and bulimia nervosa (BN) are disorders of eating and weight-related behavior that together afflict some 1-3% of women in the United States. One of the remarkable features about each of the eating disorders is how persistent the disordered eating behavior becomes once it has begun. Substantial psychological, social, and physiological disturbances are associated with eating disorders, and it has been very difficult to disentangle those factors that may result from the disturbed behavior from the factors that may have predisposed individuals to, or precipitated the development of, the disorder. This article will briefly review the definitions, phenomenology, and identified risk factors for development of each of the major eating disorders. Pathophysiology will be discussed, with a particular focus on candidate factors that might sustain disordered eating behavior, as informed by clinical and basic science research. Future research directions will be suggested.     

Eating behavior in eating disorders: response to preloads

Eating behavior in eating-disordered subjects was investigated by recording food intake and subjective ratings following three preloads differing in calories, weight and connotation. Subjects were patients with a DSM-IIIR diagnosis of anorexia nervosa or bulimia nervosa and nonpatient volunteers (normal-weight or overweight dieters, and normal-weight nondieters). After all preloads, anorectics ate significantly less than all other subjects except normal-weight dieters, and anorectics rated hunger and desire to eat consistently lower and fullness greater than all other subjects. When analysis of intake was adjusted for body weight, anorectics and normal-weight dieters still consumed significantly less than controls. Anorectics selected foods that were lower in fat and carbohydrate and ate a larger proportion of calories as protein than the other subjects. All groups decreased subsequent intake after the high-calorie preload except bulimics. This study demonstrates that the regulatory capacity of eating-disordered individuals can be investigated and that aberrant eating behavior was observed.     

Eating disorders: lessons from a cross-cultural study

Five hundred and eighty schoolgirls living in a small North Indian industrial town were screened using the EAT-26. Although twenty-nine per cent scored above the threshold for the questionnaire (greater than or equal to 20), closer scrutiny of the pattern of responses revealed misinterpretations of a large number of questions possibly on a conceptual basis. Linguistic and conceptual pitfalls inherent to cross-cultural epidemiological research are discussed with reference to previous work.     

Eating disorders. New threats to health.

I feel honored by this opportunity to pay tribute to my former chief, Tom Hackett. I was indeed fortunate to know Tom. He was a major influence in my life. He knew of my interest in eating disorders and was instrumental in helping me start the Eating Disorders Unit at Massachusetts General Hospital. The clinic was opened in 1981, and in the 10 years hence we have evaluated more than 2,500 adolescent and adult patients with eating disorders. At the outset Tom was not particularly interested in eating disorders, yet he was always willing to put time into my projects. He assisted me in developing a curriculum for a top-notch course on eating disorders and helped me obtain necessary funding for eating disorder research. Tom always encouraged me to embrace new challenges. I will be eternally grateful to him, and I miss him.     

Eating habits and eating disorders during pregnancy.

A general population sample of 100 primigravid women was studied prospectively to describe the changes in eating that occur in pregnancy with particular reference to cravings and aversions and the behavior and attitudes characteristic of clinical eating disorders. Assessment was by standardized interview. Dietary cravings and aversions were found to be common and largely confined to early pregnancy. Eating disorder features decreased in severity early in pregnancy but increased later on. Dietary cravings rarely resulted in episodes of overeating like those seen in patients with eating disorders. In this study of a general population sample, no evidence was found of a relationship between pregnancy outcome and the severity of eating disorder features prior to pregnancy.     

Eating disorders and associated psychiatric comorbidity in elderly Canadian women

This study examined the prevalence of disordered eating symptomatology and their associations with socio-demographic characteristics and health indicators in a nationally representative sample of Canadian women aged 50 years and older. The study also examined associations of disordered eating symptomatology with comorbid mood disorders, anxiety disorders and alcohol dependence. The study was based on secondary data analysis of the Canadian Community Health Survey, cycle 1.2. About 2.6% of women 50-64 years old and 1.8% of women 65 years or older reported disordered eating symptomatology. These women exhibited elevated frequencies of dieting behaviors and preoccupation with food intake and body shape. Disordered eating symptomatology was positively associated with stress level and negatively associated with physical health. Similar to findings in younger women, risk of eating disorders was strongly associated with mood and anxiety disorders. Results indicate that the risk of having eating disorders is a lifelong concern. Hence, older women should be screened for symptoms of disordered eating and associated psychiatric comorbidity.     

Eating disorders and psychiatric morbidity in patients with diabetes mellitus

The role of psychological factors in diabetes mellitus is discussed, with particular reference to the influence of eating disorders. The paper describes a prevalence study of eating disorders in outpatients with insulin-dependent diabetes (IDDM) and a controlled questionnaire study of eating attitudes in a similar population. These studies suggest there is a genuine association between eating disorders and IDDM.     

Prostate cancer knowledge among multiethnic black men

The purpose of this survey of 528 black men in Miami and Fort Lauderdale, FL, was to assess prostate cancer knowledge among African-American, English-speaking Caribbean, Haitian-American, and African men in America. Knowledge levels were assessed by education, ethnicity, age, income, family history of prostate cancer, and perceived prostate cancer knowledge. Twenty-five barbershops were visited during Fridays, Saturdays, and Sundays over a course of five months. The response rate was 99%. As the black men waited to be seen by their barbers, three interviewers asked them to answer the demographic and knowledge questions. SPSS was used to analyze the data. The main findings were that knowledge levels were adequate, with mean correct responses being 68.4%. Approximately 19.1% of respondents answered 80% of questions correctly, and 7.1% answered 100% of questions correctly. There were no statistically significant differences in knowledge among black men of different ethnicities. There were only two factors which were significantly related to prostate cancer knowledge. Men who earned more than dollars 50,000 and those with a family history of prostate cancer scored significantly higher than lower-income men and men with no family history of prostate cancer. As the percentage of Caribbean-American men and African men in the United States continues to increase, especially in metropolitan centers, those men at highest risk need to be targeted vigorously so that the disproportionate burden of prostate cancer on black men can be relieved.     

Eating attitudes, behaviors, and disorders in female juvenile delinquents

Forty-one female juvenile delinquents completed a self-report questionnaire designed to assess their eating attitudes and behaviors. Responses were analyzed using DSM-III-R criteria to determine the presence of clinically significant eating disorders. Aberrant eating behaviors were very common, and 22% of respondents had probable eating disorders. Significant eating problems may exist in this delinquent population.     

Eating disorders and intentional insulin undertreatment in adolescent females with diabetes

Intentional undertreatment with insulin was found to be a common method of inducing weight loss or preventing weight gain in female adolescents with insulin-dependent diabetes mellitus (IDDM) and eating disorders. More than half of those with eating disorders intentionally omitted insulin to produce hyperglycemia and weight loss. Individuals with eating disorders were also less compliant with other aspects of IDDM management and had poorer metabolic control than the rest of the sample. It is suggested here that intentional undertreatment with insulin in some individuals with IDDM may be regarded as an equivalent to purging, with similar purpose and consequences.