Does the frequency of anxiety and depressive disorders differ between diagnostic subtypes of anorexia nervosa and bulimia?

OBJECTIVE: The objective of the present work is to determine whether the prevalence of depressive and anxiety disorders varies in subgroups of eating disorders (ED) according to age, ED duration, mode of care provision, and body mass index (BMI). METHOD: Using the Mini International Neuropsychiatric Interview (MINI), the frequency of anxiety and depressive disorders was evaluated in 271 ED participants. Their prevalence was compared in subgroups of anorexics (AN-R and AN-BN) and bulimics (BN), both before and after controlling for potential confounding variables. RESULTS: Current or lifetime comorbidity of anxiety and depressive disorders did not differ between AN-R and AN-BN groups. Social phobia, panic disorders, and obsessive-compulsive disorder (OCD) were significantly more frequent in AN-BN and AN-R groups. Panic disorder was more frequent in the BN group. CONCLUSION: Several confounding factors, in particular those identified in the present study, may explain previous conflicting results on the frequency of anxiety and depressive disorders in ED. Nevertheless, the study confirmed that OCD is more frequent in AN, even after controlling for confounding factors.     

A comparison of the frequency of familial suicide attempts across eating disorder diagnoses

This study examined the prevalence of reported suicide attempts among family members of individuals with an eating disorder (ED). 1870 individuals presenting for ED treatment reported whether their family members ever made a suicide attempt using the Eating Disorders Questionnaire. A lifetime suicide attempt by any family member was reported by 10.8% (n = 202) of the sample and ranged from 7.0% of those with eating disorder not otherwise specified to 16.1% of those with purging disorder. Controlling for age and gender, individuals with bulimia nervosa had a higher prevalence of any familial suicide attempt and mother suicide attempt than individuals with EDNOS; no other differences were observed across ED diagnoses. There were no differences in prevalence of reported suicide attempts made by fathers, brothers, sisters, uncles, or aunts by ED diagnosis. Findings support a growing literature indicating a familial association between EDs and suicide risk.     

Should night eating syndrome be included in the DSM?

OBJECTIVE: This article examines the status of the literature on night-eating syndrome (NES) according to five criteria that have been proposed by Blashfield, Sprock, and Fuller(1) (Compr Psychiatry 1990; 31:15-19) to determine whether NES warrants inclusion in the psychiatric nosology as a distinct eating disorder. METHOD: Relevant research papers were identified in Medline and PsychInfo using the search term "night-eating syndrome." RESULTS: None of the five criteria was met. Specifically, at the time of review, there were not yet 25 empirical papers on NES; no commonly accepted definition of or assessment approach to NES has been adopted; the utility and validity of NES need to be established, and NES needs to be differentiated more clearly from other eating disorder syndromes. CONCLUSION: This review suggests that the most pressing step toward clarifying the status of NES is to develop a uniform definition of NES. Once accomplished, research can progress to accumulating the necessary evidence to determine whether NES should be included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.     

Nutrition education in the treatment of eating disorders: a suggested 10 session course

Research has shown that many patients with eating disorders have poor nutritional knowledge. A dietitian can provide nutritional information and guidance to enable the patient to make food choices based on fact, not fear. The 10 session schedule presented here is designed to present factual information, then the opportunity for the individual to apply this to themselves. The format makes particular reference to the low body weight patient. The course can be used either in individual or group sessions.     

Shape- and weight-based self-esteem and the eating disorders

Objectives: To determine the psychometric properties of the Shape- and Weight-Based Self-Esteem (SAWBS) Inventory in women with eating disorders, and to compare SAWBS scores in women who have eating disorders with women from psychiatric and normal control groups. Method: Women with eating disorders (n = 48), women with other psychiatric disorders (n = 44), and undergraduate control women (n = 82) completed the SAWBS Inventory and measures of depression, self-esteem, and eating disorder symptomatology. Twenty women from the eating disorder group completed the SAWBS Inventory a second time 1 week later. Results: Similar to previous work in undergraduate samples, SAWBS scores were stable over 1 week, and demonstrated concurrent and discriminant validity in women with eating disorders. In between-group comparisons, SAWBS scores were higher among women with eating disorders than in either control group, even after controlling for age, socioeconomic status, body mass index, and self-esteem. A differing relationship between depression and SAWBS emerged as a function of group; SAWBS scores differed significantly among depressed, but not nondepressed women from the three groups. Conclusion: The psychometric properties of the SAWBS Inventory were established in women with eating disorders. As expected, SAWBS scores were higher in women with eating disorders than in the control groups. Clinical implications of these findings are discussed. © 1998 by John Wiley & Sons, Inc. Int J Eat Disord 24: 285–298, 1998.     

Eating Disorders: A Trial of Prevention in a High Risk School Setting

The study describes the long-term outcome of a program aimed at the prevention of eating disorders in a world-class, residential ballet school for female and male students, ages 10–18. The prevention program followed the paradigm of health promoting schools outlined by the World Health Organization and involved systemic changes as well as direct interventions with students. Three all-school surveys have been conducted, the baseline survey was conducted in 1987, within the first year of implementation of the program, and the second and third ones in 1991 and 1996, respectively. Measures included the Diagnostic Survey for Eating Disorders, the Eating Attitude Test, and the Eating Disorder Inventory. Comparisons between the baseline cohort and the two latter cohorts, revealed significant reductions in disordered eating patterns and disturbed attitudes about eating and body shape, as well as significant increases in healthy eating patterns. The study suggests the benefits of implementing multifaceted prevention programs for eating disorders in high risk settings.     

Do eating disorders co‐occur with personality disorders? Comparison groups matter

OBJECTIVE: To assess and compare lifetime rates of occurrence of eating disorders (ED) with four Axis II personality disorders (PD) and with major depressive disorder (MDD) without PD. The eating disorders met criteria outlined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). METHOD: Six hundred sixty-eight patients recruited for the Collaborative Longitudinal Personality Disorders Study (CLPS) were reliably assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders. The distribution of ED diagnoses was compared among four PD study groups (schizotypal, borderline, avoidant, obsessive-compulsive) and a fifth study group with MDD without any PD. RESULTS: The distribution of lifetime diagnoses of anorexia nervosa (N = 40), bulimia nervosa (N = 56), and eating disorder not otherwise specified (N = 118) did not differ significantly across the five study groups, between the MDD group versus all PD groups, and among the four PD study groups. CONCLUSIONS: ED diagnoses did not differentially co-occur significantly across common Axis I and II disorders. The pattern of ED lifetime co-occurrence rates demonstrates the powerful influence of base rates and highlights that declarations of comorbidity demand significant variations from base-rate patterns.     

A naturalistic evaluation of the relation between dietary restraint, the urge to binge, and actual binge eating: a clarification

OBJECTIVE: The current study attempted to characterize the natural course of events linking dietary restraint to urges to binge and actual binge episodes. METHOD: Using preprogrammed, hand-held computers, 39 women with bulimia-spectrum eating disorders monitored ongoing eating episodes, dietary restraint, and binge cravings over a 7-29-day interval. RESULTS: Multilevel modeling analyses indicated that restraint was not systematically elevated before binging. However, elevated restraint preceded strong binge cravings. CONCLUSION: Results suggest that dietary restraint may contribute to binge cravings, but may not be a direct antecedent to binge episodes. Such findings are consistent with restraint theory, which suggests that dietary restraint potentiates binging, but does not necessarily trigger its occurrence.     

The Reward Re-Training protocol: A novel intervention approach designed to alter the reward imbalance contributing to binge eating during COVID-19

Reduced exposure to social reward during the COVID-19 pandemic may result in both reduced reward response to day-to-day life activities and elevated reward response to substances or naturally rewarding stimuli (e.g., food). The combined hypo- and hyper-reward responses results in a reward imbalance, which has been noted as a relevant maintenance factor for eating disorders (EDs) characterized by binge eating. This registered report describes the protocol for a pilot randomized controlled trial (RCT) comparing supportive therapy to a novel treatment targeting reward imbalance (Reward Re-Training; RRT) for individuals with binge eating. Aims of the current study include to confirm feasibility and acceptability of RRT, to evaluate the ability of RRT to engage critical targets, and to provide preliminary estimates of efficacy in reducing ED symptoms at both posttreatment and 3-month follow-up. Sixty participants will be randomized to either RRT or supportive therapy. For both conditions, treatment will be delivered in 10 weekly group outpatient therapy sessions conducted remotely using videoconferencing software. Assessments will be conducted at baseline, mid-treatment, posttreatment, and 3-month follow-up to measure feasibility, acceptability, critical treatment targets (i.e., reward to day-to-day life activities, reward to palatable foods, social isolation, and loneliness), and ED symptoms.     

Psychological Risk Factors for the Development of Restrictive and Bulimic Eating Behaviors: A Polish and Vietnamese Comparison

The aim of this paper is to identify psychological factors which are culture specific or common predictors for restrictive and bulimic behaviors towards eating for young women raised in different cultures. The study included 661 young women from Poland (n = 233) and Vietnam (n = 428). Subjects filled-in the Eating Disorders Inventory (EDI-3) and the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS), and body measurements were collected to calculate anthropometric indices. Women form Vietnam were less satisfied with their appearance than were their Polish peers, but Vietnamese showed a lower level of preoccupation with being overweight and fear of obesity. Intercultural differences indicate that Vietnamese women show greater intensities for psychological variables, connected with restrictive and bulimic eating behaviors, verified in the research model: low self-esteem, personal alienation, interpersonal insecurity, interpersonal alienation, emotional dysregulation, interoceptive deficits, perfectionism and asceticism, and anxiety.     

Night eating syndrome among nonobese persons

OBJECTIVE: To compare the characteristics of obese persons with the night eating syndrome (NES) with those of nonobese persons with the NES. METHODS: Eighty subjects (40 with a body mass index [BMI] greater than 30 and 40 with a BMI less than 25) identified themselves on a website for the Night Eating Questionnaire (NEQ) as suffering from the NES. The responses of the 40 obese website subjects were compared with 21 obese persons with the NES who had undergone face-to-face interviews. The responses on the NEQ of the 40 obese and the 40 non-obese website subjects were then compared. RESULTS: There was no difference in the NEQ results of the 40 website obese subjects and 21 obese night eaters who had undergone face-to-face interviews. The responses of these same 40 obese subjects showed very little difference compared with those of the 40 nonobese subjects. The major difference between the two groups was the considerable younger age of the normal-weight NES subjects. DISCUSSION: The striking similarity in the characteristics between obese and nonobese subjects with the NES indicates that this disorder, considered until now to occur primarily among obese persons, also occurs among nonobese persons. The younger age of the nonobese subjects suggests that the NES may contribute to the development of obesity.     

Responses to warnings about the impact of eating disorders on fertility: a qualitative study

Eating disorders (EDs) have often been discussed as a risk to reproductive health. But existing research is quantitative in nature, paying no attention to issues of patient experience. In discussing data from 24 semi‐structured interviews, this article draws on sociological approaches to medical ‘risk’ and feminist approaches to EDs to explore how women with experience of an ED responded to fertility warnings within treatment contexts. In doing so, it is suggested that responses to fertility warnings offer unique insight into the potentially damaging limitations of biomedical approaches to eating problems and their focus on EDs as individual ‘pathologies’ (rather than culturally embedded expressions of gendered embodiment). At best warnings are seen as making problematic assumptions about the aspirations of female patients, which may curtail feelings of agency and choice. At worst, they may push women further into destructive bodily and eating practices, and silence the distress that may be articulated by an ED.     

Assessing the functional nature of binge eating in the eating disorders

This study explored the functional nature of binge eating through the development of a new self-report instrument called the Binge Eating Adjective Checklist. Participants were 405 adult females who presented to a specialized eating disorders clinic. A subset of participants with bulimia nervosa also completed additional psychometrics and treatment. Those participants who reported greater reductions in negative affective and somatic states during a binge episode were also more distressed on measures of perfectionism, self-esteem, ineffectiveness, and interceptive awareness. They were also less likely to achieve abstinence from bingeing and vomiting over the course of treatment. Thus, the instrument appears to offer a methodology for studying the phenomenology of binge eating and the prediction of therapeutic outcome in bulimia nervosa.