Pattern of birth in anorexia nervosa. I: Early-onset cases in the United Kingdom

OBJECTIVES: Previous studies suggest that adults with anorexia nervosa are more likely to be born in spring and early summer. This study examines whether this pattern of birth is true of early-onset anorexia nervosa, and whether there is a relationship between environmental temperature at assumed time of conception and a later diagnosis of anorexia nervosa. METHOD: The population were children and adolescents with diagnoses of anorexia nervosa (N = 259) or "other eating disorders" (N = 149). Distribution of births across the year was compared between groups and relative to standard population norms. Temperature at assumed time of conception was taken from meteorological records. RESULTS: There was a significant preponderance of births among those with anorexia nervosa between April and June, compared with the other months of the year and with the "other eating disorders" group. Anorexia nervosa was also associated with higher environmental temperature at assumed time of conception. CONCLUSIONS: Among early-onset cases in the United Kingdom, patients with anorexia nervosa are more likely to be born between April and June, and to be conceived during warmer months. A tentative "temperature at conception" hypothesis is advanced to explain these findings and to generate further research.     

Pattern of birth in early-onset anorexia nervosa: an equatorial study

OBJECTIVE: Patients with anorexia nervosa (AN) born in the northern and southern hemispheres are more likely to be born during spring months than at any other time of the year. It has been hypothesized that environmental temperature at the time of conception may have a significant role in this pattern of findings. The current study aims to investigate the pattern of birth of early-onset AN patients in an equatorial region (Singapore), where there is little difference in environmental temperature throughout the year. METHOD: Dates of birth were collected for 102 patients who were born in Singapore and diagnosed with early-onset AN. The patterns of birth were analyzed using chi-square analysis. RESULTS: There was no difference across the year in the birth patterns of patients with early-onset AN in Singapore, nor were there any differences between patients with restrictive and binge/purge AN. DISCUSSION: This lack of seasonal variation in the equator adds support to the "temperature at conception" hypothesis.     

Season of birth and disordered eating in female college students

OBJECTIVE: Earlier studies have suggested relationships between season of birth and eating disorders. These studies have found that women with anorexia nervosa (AN) and bulimia nervosa (BN) are more likely to be born in the first 6 months rather than in the last 6 months of the year. The current study examines relationships between season of birth and general disordered eating in female college students. METHOD: Subjects included 155 female twin and triplet participants from the Michigan Twin Study. Disordered eating was assessed with subscales from the Minnesota Eating Disorders Inventory (M-EDI) and the Eating Disorders Examination Questionnaire (EDEQ). Both a two-group comparison and a three-group comparison of M-EDI and EDEQ scores were conducted. The two-group comparison comprised subjects born between January and June and subjects born between July and December. The three-group comparison comprised subjects born between January and April, between May and August, and between September and December. RESULTS: No significant differences in M-EDI or EDEQ scores were observed in any of the group comparisons. DISCUSSION: The lack of significant differences across birth periods suggests that season of birth effects may not generalize to general disordered eating characteristics in nonclinical samples.     

Pattern of birth in anorexia nervosa. II: A comparison of early-onset cases in the southern and northern hemispheres

OBJECTIVE: In the northern hemisphere, people with anorexia nervosa are more likely to be born in the spring and early summer, particularly when environmental temperature at assumed time of conception is warmer. This study investigates whether there is a comparable effect in the southern hemisphere (Australia), where seasonal and temperature patterns are reversed. METHOD: Date of birth and temperature at assumed time of conception were collected for 199 Australian and 259 UK patients with early-onset anorexia nervosa. Analyses determined patterns of birth and links to temperature at conception. RESULTS: There was little change across the year in the birth patterns of young people with anorexia nervosa in the southern hemisphere. However, there was a significant link between temperature at assumed time of conception and diagnostic subtype. Compared with anorexics of the binge/purge subtype, restrictive anorexics from the southern hemisphere were less likely to be conceived in relatively cool weather. CONCLUSIONS: The findings support a temperature at conception hypothesis (modified for local temperature ranges), rather than suggesting a simple seasonal pattern of birth.     

Course and predictors of maternal eating disorders in the postpartum period

Objective:

To investigate course and predictors of eating disorders in the postpartum period.

Method:

A total of 77,807 women, participating in the Norwegian Mother and Child Cohort Study (MoBa), completed questionnaires during pregnancy including items covering DSM‐IV criteria for prepregnancy anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS‐P), and binge eating disorder (BED). Additional questionnaires were completed at 18 and 36 months postpartum.

Results:

Proportions of women remitting at 18 months and 36 months postpartum were 50% and 59% for AN, 39% and 30% for BN, 46% and 57% for EDNOS‐P, and 45% and 42% for BED, respectively. However, disordered eating persisted in a substantial proportion of women meeting criteria for either full or subthreshold eating disorders. BN during pregnancy increased the risk for continuation of BN. BMI and psychological distress were significantly associated with course of BED.

Discussion:

This is the first large‐scale population‐based study on course of eating disorders in the postpartum period. The results indicated that disordered eating persists in a substantial proportion of women with prepregnancy eating disorders. Health care professionals working with women in this phase of life need to pay specific attention to eating disorder symptoms and behaviors. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)     

Eating disorders and emotional and physical well-being: Associations between student self-reports of eating disorders and quality of life as measured by the SF-36

Objective: To assess health-related quality of life (HRQoL) in subjects with eating disorders in terms of eating disorder type and in relation to self-reports of longstanding illness, depression and self-harming behaviours. Method: Data on eating disorder history, SF-36 health status, longstanding illness, and self-reported frequencies of depression, self-harming behaviour, and suicidal thoughts or acts were collected during 1996 as part of a UK postal survey of students health. Completed questionnaires were returned by 1439 of 3750 students (response rate 42%). Results: Eighty-three respondents (5.8%; 8.9% of females) reported a probable eating disorder history: 54 (3.8%) bulimia nervosa, 22 (1.6%) binge eating disorder, and 7 (0.5%) anorexia nervosa. Eating disorder subjects reported more impairment in SF-36 emotional than physical well-being, with significantly lower mental (p<0.001) but not physical (p=0.21) component summary scores. This was most evident in bulimia nervosa and binge eating disorder subjects. Anorexia nervosa subjects reported fewer SF-36 emotional limitations although they were significantly more likely to report depression, self-harming behaviour, and suicidal ideation. Discussion: An eating disorder history is accompanied by HRQoL impairment primarily in emotional well-being. Anorexia nervosa subjects perceive fewer limitations than subjects with other eating disorders. While this is consistent with previous reports of better SF-36 emotional well-being in those with restrictive eating behaviours, it may also suggest that the SF-36 is insensitive to emotional distress in anorexia nervosa.     

Food cravings discriminate between anorexia and bulimia nervosa. Implications for “success” versus “failure” in dietary restriction

Food cravings are subjective, motivational states thought to induce binge eating among eating disorder patients. This study compared food cravings across eating disorders. Women (N = 135) diagnosed with anorexia nervosa, restrictive (ANR) or binge–purging (ANBP) types, or bulimia nervosa, non-purging (BNNP) or purging (BNP) types completed measures of food cravings. Discriminant analysis yielded two statistically significant functions. The first function differentiated between all the four group pairs except ANBP and BNNP, with levels of various food-craving dimensions successively increasing for ANR, ANBP, BNNP, and BNP participants. The second function differentiated between ANBP and BNNP participants. Overall, the functions improved classification accuracy above chance level (44% fewer errors). The findings suggest that cravings are more strongly associated with loss of control over eating than with dietary restraint tendencies.     

Relationship between Negative Running Addiction and Eating Disorder Patterns in Runners

Current studies show an increase in the risk of eating disorders in runners. Since it is known that abusive exercise can be both a cause and a consequence of such developments, the main objective of the present study was to examine the risk and possible relationships between negative running addiction (NRA), as measured by the reduced and validated SAS-40 scale, and the tendency to be a compulsive eater (measured by YFAS 2.0), anorexia nervosa (AN), and/or bulimia nervosa (BN) (measured by EAT-40). This study highlights the novelty of researching the level of influence of NRA on each defined eating disorder. Method: A total of 167 Spanish-speaking federated runners in cross-country and track running (42% women and 58% men), with an average age of 24 years and an average BMI of 21 kg/m², responded to an online questionnaire that asked about sociodemographic data and the Spanish versions of the SAS-40, YFAS 2, YFAS 3, and YFAS 4. Through a quantitative methodology using logistic regressions—the coefficient of determination and Pearson’s correlation coefficient—we created a sample analysis that related the significant items of the DSM-V to the results of the questionnaires administered, as well as their relationship with the practice of the sport in question and various variables of the environment. Results: The rates of CE, AN, and BN were 65, 11.4, and 16.2%, respectively. The tendency towards CE increased with a lower weight (r = 0.156, p < 0.05), not having been overweight in childhood (r = 0.151, p < 0.05), and being a long-distance runner (r = 0.123 p < 0.05). The risk of AN increased with the absence of menstruation for more than 3 months (r = 0.271 p < 0.01), having suffered from childhood obesity (r = 0.213 p < 0.05), and being underweight (r = 0.064 p < 0.05). The risk of BN increased with having suffered from childhood obesity (r = 0.194 p < 0.05), having a higher weight (r = 0.140, p < 0.05), and practicing athletics, especially the relay modality (r = 0.044 p < 0.05). Conclusions: A considerable number of runners are at risk of suffering from some type of eating disorder. A significant relationship was observed between long-distance runners and the risk of eating disorders (AN, BN, and CE), and the association is stronger for CE than for AN and BN. Lastly, childhood experiences (such as being obese/a healthy weight) were notorious for increasing the risk of eating disorders. Further studies are needed to research each particular parameter and the relationships between the possible levels of dependence on exercise. Level of evidence: Level III, cohort analytic study.     

Early environmental influences on restrictive eating pathology among nonclinical females: the role of temperature at birth.

OBJECTIVE: In eating-disordered populations, restrictive pathologies are associated with a higher rate of births in the spring and early summer. The reasons for this relationship are not understood. The present study of a nonclinical group aimed to determine whether there is a link between being born in warmer months and the level of restrictive pathology in later years. METHODS: The participants (N = 117) were all young adult females who were conceived and born in England. Each completed the relevant scales of the Eating Disorders Inventory and provided demographic information. Temperature at birth was determined using national meteorological records. RESULTS: Restrictive attitudes were stronger among women born during the warmer part of the year (May-August), and those attitudes were dimensionally associated with temperature at birth. Body dissatisfaction showed some of the same relationships. Neither period of birth nor temperature at birth was related to bulimic attitudes or body mass index. CONCLUSIONS: Being born during warmer months is significantly associated with restrictive eating attitudes among nonclinical females, although the link is relatively weak. Potential causal mechanisms are outlined, but further research is needed to explain this link in clinical and nonclinical groups.     

Anorexia nervosa following sexual harassment on the internet: a case report

BACKGROUND: Sexual abuse may be a risk factor for the development of anorexia nervosa. No information is available on sexual abuse through the Internet and its connection to the development of eating disorders. METHOD: We report on a case of an adolescent female with the diagnosis of anorexia nervosa, whose symptomatology correlated significantly with an incident of sexual harassment experienced via the Internet. RESULTS: A case of on-line harassment suffered without off-line follow-up is reported to have led to a restrictive type of anorexia nervosa, where the symptomatology was connected to a "computer scatology" like persecution of our patient. DISCUSSION: A causal connection of the on-line sexual harassment suffered and development of eating disorder is reported.     

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.     

Effects of treating gender dysphoria and anorexia nervosa in a transgender adolescent: Lessons learned

Patients with gender dysphoria and patients with eating disorders often experience discontent with their bodies. Several reports have recognized the co‐occurrence of these two conditions, typically in adults who identify as transgender females and desire a more feminine physique. This case report, in contrast, describes a 16‐year‐old patient with a female sex assigned at birth who first presented with features consistent with anorexia nervosa and later revealed underlying gender dysphoria with a drive for a less feminine body shape. We discuss both the path to recognizing gender dysphoria in this patient as well as the impact of treatment on his eating disorder and overall well‐being. This case is one of only a few reports describing a female‐to‐male transgender patient with an eating disorder and is the first to explore the effects of hormone and surgical intervention in an adolescent patient. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:942–945).     

Lower serum leptin levels in female students of the nutritional sciences with eating disorders

Summary. Background: Evidence has accumulated that in both acutely ill and recovered patients with either anorexia or bulimia nervosa circulating leptin levels (LL) are lower than in controls matched for body mass index (BMI; kg/m²). It is unknown if these lower leptin levels represent a state or trait marker. Aim of the study: We aimed to confirm the lowered leptin levels in eating disordered females and to identify underlying mechanisms. Methods: We screened 181 female students of the nutritional sciences for eating disorders with the respective module of the M-Composite International Diagnostic Interview and the Cognitive Restraint scale of the Three Factor Eating Questionnaire. The physical assessment included determinations of BMI, body composition and LL. Each case fulfilling lifetime DSM-IV criteria for an eating disorder was BMI matched to two controls. We used a multivariate mixed regression model to evaluate if the observed difference in lg₁₀-leptin level between cases and controls is actually due to the influence of restrained eating and/or previous weight loss after adjustment for BMI and percent body fat. Results: In accordance with our hypothesis the 32 (17.7 %) cases had a lower serum lg₁₀-leptin level than the 64 BMI matched controls (one-sided p < 0.001). We were not able to detect an influence of restrained eating or previous weight loss. Conclusions: We confirm that females with a lifetime history of an eating disorder have lower LL. We were not able to identify an underlying mechanism. Similar to most previous studies we found a high rate of eating disorders among female students of nutritional sciences. Received: 24 June 2002, Accepted: 12 December 2002 Correspondence to: Prof. Johannes Hebebrand     

Subjective binge eating with compensatory behaviors: A variant presentation of bulimia nervosa

Objectives:

To determine whether a variant bulimic‐type presentation, whereby one meets criteria for bulimia nervosa (BN) except that binge eating episodes are not objectively large (i.e., “subjective bulimia nervosa,” SBN), has comparable clinical severity to established eating disorders, particularly BN.

Method:

Treatment‐seeking adults with BN (N = 112), SBN (N = 28), anorexia nervosa restricting type (AN‐R) (N = 45), and AN‐binge/purge type (AN‐B/P) (N = 24) were compared.

Results:

Overall, SBN could not be meaningfully distinguished from BN. SBN and BN had equivalent eating pathology, depression and anxiety symptoms, low quality of life, impulsivity, Axis I comorbidity, and lifetime psychiatric history, and comparable clinical severity to AN‐R and AN‐B/P.

Discussion:

Individuals with SBN, differing from BN only by the smaller size of their binge eating episodes, had a form of eating disorder comparable in clinical severity to threshold AN and BN and warranting clinical attention. Health professionals and the community require greater awareness of this variant to optimize detection, treatment‐seeking, and outcomes. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)     

Anorexia and Bulimia

ABSTRACT

Eating disorders are complicated mental illnesses that can have tremendous physical and psychological consequences. This article provides general information on the two most common eating disorders: anorexia nervosa and bulimia nervosa. It discusses the symptoms of these diseases, their effects, some of the factors in their development, and common forms of treatment. The article concludes with a bibliography of selected Internet resources that provide additional information on anorexia, bulimia, and other eating disorders.     

Seasonally bound ovopathy versus "temperature at conception" as cause for anorexia nervosa and other eating disorders

OBJECTIVE: A preponderance of births between April and June in patients with anorexia nervosa (AN) and other eating disorders (EDs) has recently been explained by a higher environmental temperature at conception. This hypothesis, however, does not explain some other irregularities in the month of birth distribution in contrast to the seasonal preovulatory overripeness ovopathy (SPrOO) and seasonal optimally ripened oocytes (SOptRO) hypotheses. METHOD: The month of birth distribution of 408 patients with EDs from Southeast England and of 199 patients from Australia has been reassessed in relation to previously determined high-risk and low-risk months based on a priori knowledge from mammals and on the physiologic birth peaks and troughs in humans at population level. The differences between high-risk and low-risk months were assessed by conventional chi-square analyses and by relative risks (RRs) with 95% confidence intervals (CI). RESULTS: In England, fewer AN patients (n = 259) were born at the peaks of the total birth pattern, that is, during the 2 low-risk months, and more were born during the transitional stages, that is, during the remaining 10 high-risk months (p = .004; RR = 1.66 [95% CI = 1.13-2.41]). After the addition of 149 other ED patients (n = 408), this result remained (p = .005; RR = 1.47 [95% CI = 1.10-1.97]). Similar results were found in 199 ED patients from Australia (p = .009; RR =1.70 [95% CI = 1.09-2.64]). CONCLUSION: ED patients appear to be more frequently conceived during the transitional stages of the ovulatory pattern due to SPrOO and less frequently at the ovulatory peaks due to SOptRO. The pathophysiologic processes of oocyte maturation in estrous animals and the circumstantial evidence of similar phenomena in humans are more appropriate to explain these coincidences than the temperature at conception hypothesis.     

Quality of life and eating disorders

Objective: Eating disorders (EDs) can have a serious impact on various life domains and may lead to physical, mental and social impairment and consequently to poor quality of life (QOL). This study compared the QOL of ED patients and former ED patients in a large community based sample to the QOL of a normal reference group and to the QOL of patients with mood disorders. Differences between ED diagnostic groups were examined. The study investigated what factors contribute to QOL.Methods: A generic health-related quality of life questionnaire, the Short Form-36 (SF-36), and the Eating Disorder Examination-Questionnaire were administered to 156 ED patients – 44 anorexia nervosa patients, 43 bulimia nervosa patients, 69 eating disorder not otherwise specified patients – and 148 former ED patients.Results: ED patients reported significantly poorer QOL than a normal reference group. No differences were found between the diagnostic groups. Former ED patients still had poorer QOL than a normal reference group. ED patients reported significantly poorer QOL than patients with mood disorders. Self esteem contributed most to QOL.Conclusion: EDs have a severe impact on many domains of QOL. Therefore QOL needs to be addressed in effectiveness research and clinical practice.     

Comparative prevalence,correlates of impairment,and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders

Objective:

The study compared the prevalence, correlates of functional impairment, and service utilization for eating disorders across Latinos, Asians, and African Americans living in the United States to non‐Latino Whites.

Method:

Pooled data from the NIMH Collaborative Psychiatric Epidemiological Studies (CPES;NIMH, 2007) were used.

Results:

The prevalence of anorexia nervosa (AN) and binge‐eating disorder (BED) were similar across all groups examined, but bulimia nervosa (BN) was more prevalent among Latinos and African Americans than non‐Latino Whites. Despite similar prevalence of BED among ethnic groups examined, lifetime prevalence of any binge eating (ABE) was greater among each of the ethnic minority groups in comparison to non‐Latino Whites. Lifetime prevalence of mental health service utilization was lower among ethnic minority groups studied than for non‐Latino Whites for respondents with a lifetime history of any eating disorder.

Discussion:

These findings suggest the need for clinician training and health policy interventions to achieve optimal and equitable care for eating disorders across all ethnic groups in the United States. © 2010 by Wiley Periodicals, Inc. (Int J Eat Disord 2011)

     

Season of birth in females with anorexia nervosa in Northeast Scotland.

OBJECTIVE: To determine whether patients with anorexia nervosa exhibit an abnormal pattern in their season of birth. METHOD: Case records of female patients presenting to secondary services in Northeast Scotland from 1965 to 1997 who received a clinical diagnosis of anorexia nervosa were examined. The months of birth of the 446 anorexic patients with a confirmed diagnosis were compared with 5,766 female control subjects born locally in 1951, 1961, 1971, and 1981. RESULTS: Patients with anorexia nervosa had an excess of births in the first 6 months of the year (p =.013). The greatest excess was from March to June. DISCUSSION: This provides further evidence that birth dates of anorexics peak in the late spring and early summer. There are parallels with the epidemiology of schizophrenia. The evidence suggests that a seasonally fluctuating factor, most plausibly an intrauterine effect of common infectious agents during the winter months, is of etiological significance.