Body shape concerns in bulimia nervosa

Overconcern with shape and weight is considered a primary feature of the psychopathology of bulimia nervosa and was included as a diagnostic criterion in DSM- III-R. In order to test the significance of shape and weight concern in bulimia nervosa, we administered the Body Shape Questionnaire (BSQ) to 78 outpatients with bulimia nervosa and three comparison groups: 14 women with seasonal affective disorder (SAD), 10 acquaintances of patients, and 32 normal controls. Women with bulimia nervosa had significantly higher mean BSQ scores than did other subject groups. Other self-report measures of body shape concern, eating attitudes, and depression were correlated with BSQ score. Furthermore, all patients had BSQ scores greater than the average score of the normal control group. These data support the continued inclusion of body shape and weight overconcern as a diagnostic criterion for bulimia nervosa but suggest that “overconcern” should be interpreted as “above average” rather than “outside the normal range”.     

Body shape concerns among adolescents

The Body Shape Questionnaire (BSQ) is a 34-item self-report questionnaire that measures the degree of body shape dissatisfaction. To date, the BSQ has not been used with adolescents. The present study compared the BSQ scores of five adolescent subject samples: Anorexia Nervosa (AN), Bulimia Nervosa (BN), Subclinical Bulimia Nervosa (SB), Subdinical Anorexia Nervosa (SA), and non-eating-disordered adolescent females (Q. Results show that patients with BN have the highest levels of body dissatisfaction. All clinical groups had higher BSQ scores than subjects in the comparison sample but only the BN patients had significantly higher scores. The mean BSQ score for the Comparison group was higher than published means for non-eating-disordered adult samples. The two major findings of the study are that significant body shape concerns are particular features of patients with bulimia nervosa but that some body shape concerns are common among non-eating-disordered adolescent females.     

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.     

On the emergence of bulimia nervosa as a syndrome a historical view

A review of the anorexia nervosa literature suggests that bulimia as a symptom has been known throughout the past century, but that bulimia as a syndrome is of recent origin, around 1940, when it occurred in connection with anorexia nervosa. Comments indicating concern over body shape are infrequent in case reports before the forties, but afterwards become the rule. It is hypothesized that changes in the cultural and economic conditions, such as the rising prosperity after the Depression Years, promoted an increased concern over body weight and recruited not only more, but also women of a psychologically different composition from the traditional anorexia nervosa patient, into dieting. This situation exposed more females to the risk of developing anorexia nervosa and those with a particular vulnerability, for example a tendency for affective instability, to the risk of developing bulimia nervosa. Similar dynamics might have promoted the unfolding of the bulimia nervosa syndrome in the late fifties and sixties.     

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.     

Changes in creatinine clearance during treatment of anorexia nervosa and bulimia nervosa

The improvement in renal clearance of creatinine in anorexia nervosa patients during treatment has been attributed to the increase in body weight. The body weight and creatinine clearance of 72 anorexia nervosa and 10 bulimia nervosa patients were studied during inpatient treatment. The anorexia nervosa patients gained an average of 4.5 kg, while the body weight of the bulimia nervosa patients was unchanged. Both groups showed a similar increase in weight-corrected creatinine clearance. The increase in creatinine clearance of eating disorder patients is associated with the cessation of the abnormal weight-controlling behaviors rather than weight gain.     

An adaptation of the stroop test for measuring shape and food concerns in eating disorders: A quantitative measure of psychopathology?

This report describes an adaptation of the Stroop Effect for measuring psychopathology. The Stroop Effect has been adapted to provide a quantitative measure of concerns relating to food and shape in patients undergoing treatment for anorexia nervosa and bulimia. The measure takes advantage of the disrupting effect of psychopathology on color naming of food and shape words. In comparison to agematched controls, anorexic and bulimic patients had significantly retarded colornaming of food words. There was a trend, which only reached significance with the bulimic subjects, for the color-naming of shape words to be similarly retarded. The potential utility of this adaptation of the Stroop Effect is discussed.     

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.     

Body size distortion in bulimia nervosa

Body size estimation was studied in normal weight women with bulimia nervosa and a matched group of normal controls in order to determine whether bulimia nervosa patients overestimate their body size and whether they do so to a greater degree than women who are not suffering from an eating disorder. Estimation of five body locations was measured objectively with adjustable markers. Percentage of over- or underestimation was determined by the ratio of estimated to actual body size. Relative to control subjects, bulimia nervosa subjects significantly overestimated the size of their bust, waist, hips, and abdomen. Both groups overestimated the size of their face. Compared with previous studies of body size estimation in anorexia patients, the present study suggests that body size distortion might be less extreme in patients with bulimia nervosa.     

The eating disorder examination: A semi-structured interview for the assessment of the specific psychopathology of eating disorders

The specific psychopathology of anorexia nervosa and bulimia nervosa is complex in form. Although for many purposes self-report questionnaires are a satisfactory measure of this psychopathology, for detailed psychopathological studies and for investigations into the effects of treatment, more sensitive and flexible assessment measures are required. For this reason a semi-structured interview was developed. This interview, the Eating Disorder Examination, is designed to assess the full range of the specific psychopathology of eating disorders, including these patients' extreme concerns about their shape and weight.     

Education for Healthy Body Weight: Helping Adolescents Balance the Cultural Pressure for Thinness

Though education for healthy body weight traditionally has focused on obesity, the increased incidence of anorexia nervosa and bulimia among young women suggests education also is needed to address the opposite end of the spectrum. Anorexia nervosa and bulimia are complex and multidimensional disorders associated with individual, family, and sociocultural factors. This article examines the cultural pressure for dieting and thinness currently experienced in America and its impact as a possible predisposing factor for developing eating disorders among adolescent females. Literature is reviewed related to the changing American standard of attractiveness for females reflected by 20th century mass media and its subsequent influence on adolescent concerns for dieting and thinness. Preventive strategies are recommended to help adolescents balance the cultural pressure for thinness and their own desires for attractiveness within the larger context of overall good health.     

Review of the prevalence and incidence of eating disorders

OBJECTIVE: To review the literature on the incidence and prevalence of eating disorders. METHODS: We searched Medline using several key terms relating to epidemiology and eating disorders and we checked the reference lists of the articles that we found. Special attention has been paid to methodologic problems affecting the selection of populations under study and the identification of cases. RESULTS: An average prevalence rate for anorexia nervosa of 0.3% was found for young females. The prevalence rates for bulimia nervosa were 1% and 0.1% for young women and young men, respectively. The estimated prevalence of binge eating disorder is at least 1%. The incidence of anorexia nervosa is 8 cases per 100,000 population per year and the incidence of bulimia nervosa is 12 cases per 100,000 population per year. The incidence of anorexia nervosa increased over the past century, until the 1970s. DISCUSSION: Only a minority of people who meet stringent diagnostic criteria for eating disorders are seen in mental health care.     

Dating People with Anorexia Nervosa and Bulimia Nervosa: Attitudes and Beliefs of University Students

ABSTRACT

Attitudes and beliefs about dating people with eating disorders were investigated in men and women using a questionnaire administered to 752 university students. Students believed that people with anorexia nervosa and bulimia nervosa had a difficult time dating, dates would involve conflict, and dating would be a negative experience. Students were more comfortable in casual interactions than more serious dating activities with people with anorexia nervosa and bulimia nervosa. Men were somewhat comfortable dating people with anorexia nervosa or bulimia nervosa, but less so for obesity. Most students believed dating people with anorexia nervosa and bulimia nervosa would not be a positive experience, and men Stigmatized people with eating disorders differently, than did women.     

The diagnosis of bulimia nervosa

The interpretation of research into the eating disorder bulimia nervosa is complicated by the use of two different sets of diagnostic criteria. In North America the DSM III criteria are usually employed (American Psychiatric Association, 1980), whereas in Britain Russell's criteria (Russell, 1979) are preferred. While the two sets of criteria appear to be designed to identify people with essentially the same disorder, they embrace different, but over-lapping, populations. Discrepancies between the findings of various investigations may therefore be attributed in part to the fact that different patient groups have been studied. In this paper both these sets of diagnostic criteria and the proposed DSM III R criteria (American Psychiatric Association, 1985) are reviewed in the light of current knowledge. In addition, the relationship between bulimia nervosa and anorexia nervosa is examined. Certain revisions to the diagnostic criteria for both disorders are suggested reflecting the view that extreme concerns about shape and weight are a central psychopathological feature uniting anorexia nervosa and bulimia nervosa.     

Suicide and attempted suicide in eating disorders, obesity and weight-image concern

Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Meta-analyses have shown that individuals suffering from anorexia nervosa and bulimia nervosa commit suicide more often than their counterparts in the general population; also a few studies have suggested that suicide is the major cause of death among patients with anorexia nervosa, refuting the assumption that inanition generally threatens the life of these patients. Data concerning suicide in bulimia nervosa, on the other hand, are still scarce but suicide attempts are easily found among cohorts of patients with bulimia nervosa, which constitutes a risk factor for completed suicide. Suicidality in obesity and individuals with disturbed weight status has been reported. Both in the case of bulimia nervosa and obesity more long-term follow-up studies need to be completed before the risk of suicide for such disorders may be compared with that for anorexia nervosa.     

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.     

Body dissatisfaction, bulimia, and depression among women: the mediating role of drive for thinness

OBJECTIVE: Past research has called into question the apparent relationship between body dissatisfaction and bulimia among women once effects of depression are statistically controlled. We further investigated interrelations among body dissatisfaction, depression, and bulimia, as well as considered individual differences in drive for thinness, within two samples of young adult women. METHOD: The first sample included women diagnosed with anorexia nervosa (n = 91) or bulimia nervosa (n = 142), whereas the second sample included college student women (N = 228). Respondents completed self-report measures of bulimia, drive for thinness, negative affect, and body dissatisfaction. RESULTS: At the univariate level, all of the above constructs were significantly related to body dissatisfaction. In multiple regression analyses using depression and bulimia as predictors of body dissatisfaction, both were uniquely related to body dissatisfaction. These findings were similar to the results of previous research. However, when drive for thinness was added to the regression equations, drive for thinness was a unique predictor of body dissatisfaction whereas bulimia was not (neither was depression among college women). DISCUSSION: Bulimia, depression, and body dissatisfaction may be the results of incorporation of cultural standards regarding thinness, hence the apparent relationships among these variables. The role of drive for thinness in the pathogenesis of depression and body dissatisfaction among women needs to be investigated further.     

Survey of eating disorders in English-medium schools in Lahore,Pakistan

A survey of 369 schoolgirls was conducted in Lahore, Pakistan, using the Eating Attitudes Test (EAT-26) and Body Shape Questionnaire (BSQ) in English. Factor analyses of the EAT and BSQ supported their cross-cultural validity in these English medium schools. Girls who scored highly on either questionnaire were invited for interview. One girl met DSM-/I/-R criteria for bulimia nervosa and there were five subjects with partial syndrome bulimia nervosa. No girls suffered from anorexia nervosa. There was some evidence that the most ‘Westernized’ girls were at greatest risk of developing an eating disorder. Comparison is made with a survey con- ducted by the authors among Asian schoolgirls in Bradford, UK. The results are discussed in the light of previous claims that eating disorders should be regarded as ‘culture-bound syndromes’.     

Lay beliefs about disordered eating

Although “disordered eating,” as a set of psychiatric conditions, implicitly evaluates components of a social phenomenon, little attention has been paid to the boundaries between socially accepted and abnormal eating. Lay knowledge and evaluations of the formal criteria for a diagnosis of anorexia nervosa or bulimia were therefore examined. The results show that although males and females know more about anorexia nervosa than bulimia, the DSM-III criteria for anorexia nervosa, which involve the determined pursuit of slimness and a body image disturbance, were judged by very few people to be both uncommon and abnormal. Bulimia, however, seems to be much closer to what is commonly judged to involve unusual behavior.     

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).