Stages of change in anorexic and bulimic disorders: the importance of illness representations

This study investigated the relationship between illness representations and stage of change in women with anorexic (N=33) and women with bulimic (N=36) disorders. A cross-sectional design was employed and participants were asked to complete a set of questionnaires. The relationship between illness representations and stage of change was explored in the two groups separately using hierarchical multiple regression analyses. A number of different items from the illness representations measure, together with locus of control and social support, explained relatively high proportions of the variance in each stage of change in the two groups. Where similar items emerged as important in both groups, their relative importance showed variation according to stage of change being considered. Implications for differential approach to treatment in the two disorders are discussed in the context of the study limitations.     

成都市区1486名女性大、中学生进食障碍的 现况调查

目的 探讨女性大、中学生进食障碍的患病率及其相关因素.方法 采用最优分配分层整群随机抽样法从成都市区抽取大学6所、普通高中1所、普通中专1所、成人中专2所、职业高中1所、初中3所,共1486名女性大、中学生,采用进食障碍问卷、体像障碍量表、抑郁自评量表、贝克焦虑自评量表、自编调查问卷进行现场调查.采用t检验和logistic回归分析数据.结果 成都市女性大、中学生进食障碍估计患病率3.32%;各年龄组中17岁组估计患病率最高(7.16%);各学龄阶段中高中组最高(5.21%).进食障碍倾向组在认识偏差(P=0.009)、期望偏差(P=0.000)方面均比非进食障碍倾向组得分高.关注减肥相关媒体宣传、童年时父母关系紧张、童年时受虐待、进食障碍问卷的不满体型因子、内感受意识因子及焦虑是进食障碍倾向的相关危险因素.结论 进食障碍在女性大、中学生中估计患病率较高,应积极干预.     

High prevalence of abnormal eating and weight control practices among U.S. high-school students

OBJECTIVE: This study sought to determine the prevalence and to identify correlates of abnormal eating and weight control practices in U.S. high-school students. METHOD: A three-stage cluster design technique was used to select 15,349 students from 144 different high schools. Each completed the 1999 Youth Risk Behavior Survey (YRBS) Questionnaire. RESULTS: Abnormal eating and weight control practices during the past month were reported by over 26% of female students and 10% of male students. Rates of abnormal eating and weight control practices varied by ethnicity and geographic location. Other correlates of abnormal eating and weight control practices included having an underweight body mass index (BMI): (OR=1.39, 95% CI=1.01-1.91), exercising to control weight in past 30 days (OR=1.51, 95% CI=1.30-1.76), dieting to control weight in past 30 days (OR=3.89, 95% CI=2.65-5.73), and interactions between gender and both weight perception and weight satisfaction. DISCUSSION: The high proportion of U.S. high-school students who have participated in abnormal eating and weight control practices in the past month demands immediate attention. The identified correlates may help target prevention and control programs.     

Worry and eating disorders: a psychopathological association

Worry is a mental process associated with anxiety disorders. The key feature of worry is the predominance of a negative-type and preoccupied thought about possible threatening future events.

Objective

Some studies have shown that worry may be a feature of eating disorders. This study aims to measure whether worry is significantly higher in eating disordered individuals than in a normal control group and whether worry is associated with the Eating Disorders Inventory.

Methods

Sixty-three individuals affected by an eating disorder (34 anorexics and 29 bulimics) completed the Penn State Worry Questionnaire, the Structured Clinical Interview for DSM, and the Eating Disorder Inventory. Thirty normal controls completed the Penn State Worry Questionnaire.

Results

Penn State Worry Questionnaire scores were significantly higher in eating disordered individuals than in controls. It was associated with all the symptoms of eating disorders and was correlated with all the EDI subscales, except for the subscale ‘bulimia’. These findings suggest that worry is important for understanding the psychopathology of eating disorders.     

Emerging role of autoantibodies against appetite-regulating neuropeptides in eating disorders

OBJECTIVE: Recent findings of autoantibodies directed against melanocortin peptides suggest that these autoantibodies may represent a source of variability in peptidergic signaling that can be responsible for altered appetite and emotion in eating disorders. However, it is still unknown if autoantibodies directed against some other appetite-regulating neuropeptides and peptide hormones exist in healthy human subjects and if these autoantibodies can regulate appetite and emotion. METHODS: We determined the presence of autoantibodies against some key appetite-regulating neuropeptides and peptide hormones in sera of human subjects and in rats, and used animal models to study the role of alpha-melanocyte-stimulating hormone autoantibodies in food intake and anxiety. RESULTS: Immunoglobulin G and A autoantibodies against alpha-melanocyte-stimulating hormone, neuropeptide Y, agouti-related protein, ghrelin, leptin, and some other neuropeptides or peptide hormones involved in appetite control were present in healthy humans and rats. Animal models including active and passive transfer showed that alpha-melanocyte-stimulating hormone autoantibodies are involved in the regulation of feeding and anxiety. Sequence homology was found between neuropeptides and proteins from some members of intestinal microflora, whereas germ-free rats showed altered levels of autoantibodies directed against several neuropeptides. CONCLUSION: Autoantibodies directed against appetite-regulating neuropeptides and peptide hormones are emerging as important participants in the peptidergic mechanisms controlling motivated behavior. Furthermore, these autoantibodies could provide a link in the gut-brain axis and may represent new biological targets for the diagnosis and treatment of eating disorders.     

"Not all my fault": Genetics, stigma, and personal responsibility for women with eating disorders

Medical researchers and clinicians increasingly understand and present eating disorders (anorexia and bulimia nervosa) as biologically-based psychiatric disorders, with genetic risk factors established by high heritability estimates in twin studies. But there has been no research on interpretation of genetic involvement by people with eating disorders, who may hold other views. Their interpretations are particularly important given the frequent presumption that biogenetic framing will reduce stigma, and recent findings that it exacerbates stigma for other mental illnesses. To identify implications of genetic framing in eating disorders, I conducted semi-structured interviews with 50 US women with a history of eating disorders (half recovered, half in treatment; interviewed 2008-9 in the USA). Interviews introduced the topic of genetics, but not stigma per se. Analysis followed the general principles of grounded theory to identify perceived implications of genetic involvement; those relevant to stigma are reported here. Most anticipated that genetic reframing would help reduce stigma from personal responsibility (i.e., blame and guilt for eating disorder as ongoing choice). A third articulated ways it could add stigma, including novel forms of stigma related to genetic-essentialist effacing of social factors. Despite welcoming reductions in blame and guilt, half also worried genetic framing could hamper recovery, by encouraging fatalistic self-fulfilling prophecies and genetic excuses. This study is the first to elicit perceptions of genetic involvement by those with eating disorders, and contributes to an emerging literature on perceptions of psychiatric genetics by people with mental illness.     

The comparative utility of statistically derived eating disorder clusters and DSM-IV diagnoses: relationship to symptomatology and psychiatric comorbidity at intake and follow-up

INTRODUCTION: The classification of eating disorders has been a matter of considerable debate. The present paper extends previous work and aimed to compare the utility of statistically derived clusters of eating disorders and conventional diagnoses. METHODS: Adult female eating disorder patients who had previously been classified on the basis of cluster analysis of key diagnostic variables were examined on measures of eating disorder symptomatology and psychiatric comorbidity at intake (N=601) and subsequent follow-up after 6 and 36 months (N=349, N=322, respectively). RESULTS: Compared to DSM-IV diagnoses, clusters demonstrated greater utility in terms of more distinct between-group differences and higher effect sizes in relation to a wide range of variables. The greater utility of clusters was in important respects due to the reallocation of EDNOS patients to more relevant alternative categories and to a greater emphasis on psychological and behavioural features of eating disorders. CONCLUSIONS: In order to achieve a better classification of eating disorders, it will be important to place increased emphasis on common psychological features. There is a need to move away from increased use of subtypes and toward a definition of eating disorder per se.     

Inpatient treatment for eating disorders: outcome at discharge and 3-month follow-up

There have been few studies of inpatient treatment for eating disorders. Existing studies have mostly examined small samples of either anorexic or bulimic patients. The current study evaluated large samples of anorexic and bulimic inpatients at intake, discharge, and a 3-month follow-up. At discharge, patients in both groups showed substantial and statistically significant improvements on self-report measures of depression and eating disorder symptomatology. Treatment gains were largely maintained at follow-up. Correlational analyses found consistent inverse relationships between degree of change experienced during and after hospitalization. More favorable outcome during treatment was associated with less favorable outcome after treatment. Implications of these findings for the assessment and treatment of eating disorders are discussed.     

Season of birth and eating disorders: patterns across diagnoses in a specialized eating disorders service

OBJECTIVE: In view of inconsistent findings from previous studies, the aim was to investigate possible seasonal variation in month of birth in patients with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. METHOD: We examined the month of birth in a cohort of 1,305 adult patients with a DSM-IV eating disorder diagnosis at first presentation to a specialized eating disorders service. RESULTS: When compared to general population data, we found no evidence of significant variation in month or season of birth in anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified. CONCLUSION: The authors question whether people who develop eating disorders differ from the general population in their season of birth. Caution is expressed about further speculation regarding the etiological significance of season of birth in eating disorders.     

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.     

Eating disorders and substance use. An examination of behavioral associations

The association between the eating disorders of anorexia nervosa (AN) and bulimia nervosa (BN) and substance use disorder (SUD) has been widely investigated, however, our understanding of the relationship between the disorders remains unclear. Explanatory models have tended to focus on behaviors, yet, little is currently known about the patterns of association among disordered eating and substance use behaviors. In this exploratory study, a behavioral approach was used to investigate the cooccurrence of seven disordered eating and three substance use behaviors in women meeting current DSM-III-R criteria for AN (n=12), subthreshold AN (n=14), BN (n=29), and subthreshold BN (n=24). Results suggest that disordered eating behaviors are differentially associated with substance use behaviors. The most robust finding was that diuretic use positively predicted the current level of alcohol use regardless of diagnostic group. The findings for marijuana and tobacco use were less consistent. Results suggest that rather than being pervasive in all eating disordered women, higher levels of alcohol use may be found in those women who use diuretics.     

The Minnesota Eating Behavior Survey: a brief measure of disordered eating attitudes and behaviors

This article describes details of the development and psychometric characteristics of a brief self-report inventory for assessing attitudes and behaviors symptomatic of eating disorders that is currently in use in a longitudinal study of over 700 families with 11-year-old or 17-year-old twin girls. The Minnesota Eating Behavior Survey (MEBS), formerly the Minnesota Eating Disorder Inventory, is a 30-item measure developed for use with children as young as 10 years as well as adults. An examination of the MEBS's psychometric properties in a large, community sample of girls, women, and men demonstrated good factor congruence, internal consistency reliability, three-year stability, as well as evidence of concurrent and criterion validity. This questionnaire has promise as a screening and assessment measure for eating disturbance in cross-sectional and longitudinal research involving individuals of a wide range of ages.     

Dyadic view of expressed emotion, stress, and eating disorder psychopathology

Prevailing models of the association between expressed emotion (EE) and relapse conceptualize EE as a form of stress for patients. In eating disorders (ED), there is no research addressed to evaluate the degree to which patients feel stress due to their relatives’ EE. It has been neither investigated how the EE and the subsequent stress relate to disordered behaviours and attitudes neither. Using a sample of 77 inpatients with ED, this study aimed to: (1) evaluate patients’ reported level of stress as it relates to their caregivers’ EE, particularly as associated with carer's criticism, emotional overinvolvement and warmth; (2) examine the associations of stress with the patients’ perceptions (self-reported) and the caregivers’ perspective (assessed by the Camberwell Family Interview) of the EE; and (3) study how the two views of EE (patients’ and caregivers’) and the stress due to EE relate to the ED symptoms. The findings indicate that patients judged their carers’ critical stance as the most stressful, followed by emotional overinvolvement. Secondly, patients’ perceptions of EE, whereas none of the interview indices focused on the caregivers’ perspective, were associated to the stress and to the ED symptomatology. Additionally, the patients’ stress due to criticism was positively related to the ED symptoms, while the stress associated with emotional overinvolvement and warmth was not. Clinical and research implications are discussed. Findings suggest attention to the ED patients’ view of their family environment and support the utility of assessing their appraisals of EE.     

病理性完美主义与进食障碍

本文在回顾了完美主义的定义、维度、测量工具的基础上，总结了完美主义与进食障碍关系的研究成果，并尝试从病理心理学意义的角度来理解两者的关系。     

Childhood maltreatment in adult female psychiatric outpatients with eating disorders

To explore possible relations between maltreatment in childhood and subsequent eating disorders in adult life, 107 consecutive adult psychiatric female outpatients were screened for eating disorders. They also completed questionnaires about harassment by adults and bullying by peers in childhood. The Childhood Trauma Questionnaire measured childhood abuse by parents or other adults, and the Parental Bonding Instrument captured parental coldness and overprotection. Bullying by peers was measured by an inventory used in schools. Outpatients who met the criteria for bulimia nervosa reported far more bullying by peers, more coldness and overprotection from fathers, and more childhood emotional, physical and sexual abuse. The findings suggest associations between childhood maltreatment, especially bullying by peers, and bulimia nervosa.     

Eating disorders in adolescent boys: a review of the adolescent and young adult literature

Although a number of studies have investigated eating disorders in adolescence and the topic has been thoroughly reviewed, these studies have typically focused on females, only to state that the approach and treatment should be similar in males. Recently, there have been a number of studies that have explored gender differences in eating disorders. In this article, we review the literature pertaining to two DSM-IV-defined disorders (anorexia nervosa and bulimia nervosa), a DSM-IV-defined research disorder (binge eating disorder), and two DSM-PC-defined disorders (dieting/body image and purging/binge-eating behaviors), highlighting those findings that pertain to disordered eating in adolescent boys.     

College students' mental models for recognizing anorexia and bulimia nervosa

Knowledge about eating disorders influences lay people's ability to recognize individuals with anorexia nervosa (AN) and bulimia nervosa (BN) and refer them to professional treatment. We assessed mental models (stored knowledge) of AN and BN in 106 college students. Results indicated that most students have general, but not specific, information about AN and BN's symptoms, consequences, causes, duration, and cures. They also believe that people with eating disorders tend to be young, White women. These findings suggest that lay recognition of eating disorders may be based primarily on observations of dysfunctional eating behaviors and therefore facilitated by additional knowledge.     

Nutrition entérale à domicile en cas de troubles du comportement alimentaire

Weight restoration is crucial for successful treatment of anorexia nervosa (AN). Without it, patients may face serious or even fatal complications of severe starvation. Renutrition should take into account clinical characteristics unique to these patients, such as gastroparesis and fear of gaining body weight. The efficacy of tube feeding and home-tube feeding (Home-TF) has been suggested in AN and proven in bulimia nervosa (BN). TF and home-TF allow a better body weight gain (mainly fat-free mass) in AN patients and a strong decrease in the frequency and the intensity of binge-eating/purging episodes at relatively short-term (1 year) in BN patients. In AN, home-TF does not increase anxiety, depression, or worsen the eating behavior. In BN patients, home-TF decreases anxiety and depressive state and improves the quality of life. The goal of home-TF is not to cure the patients, but only to avoid serious malnutrition and its complications and to insure a better investment of the patients for their psychotherapy. Home-TF must be associated with psychotherapy, namely cognitive behavioural therapy and family therapy in adolescents. If the fear of gaining body weight is too high, the risk of failure of home-TF, because of poor compliance, is increasing. In any case, the aims and the goals of home-TF should be extensively explained.     

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.