Food Addiction and Bulimia Nervosa: New Data Based on the Yale Food Addiction Scale 2.0

Previous research on ‘food addiction’ as measured with the Yale Food Addiction Scale (YFAS) showed a large overlap between addiction‐like eating and bulimia nervosa. Most recently, a revised version of the YFAS has been developed according to the changes made in the diagnostic criteria for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders fifth edition. The current study examined prevalence and correlates of the YFAS2.0 in individuals with bulimia (n = 115) and controls (n = 341). Ninety‐six per cent of participants with bulimia and 14% of controls received a YFAS2.0 diagnosis. A higher number of YFAS2.0 symptoms was associated with lower interoceptive awareness, higher depressiveness, and higher impulsivity in both groups. However, a higher number of YFAS2.0 symptoms was associated with higher body mass and weight suppression in controls only and not in participants with bulimia. The current study is the first to show a large overlap between bulimia and ‘food addiction’ as measured with the YFAS2.0, replicating and extending findings from studies, which used the previous version of the YFAS. Compensatory weight control behaviours in individuals with bulimia likely alleviate the association between addiction‐like eating and higher body mass. Thus, the large overlap between bulimia and ‘food addiction’ should be taken into consideration when examining the role of addiction‐like eating in weight gain and obesity. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.     

Food Addiction in a Spanish Sample of Eating Disorders: DSM‐5 Diagnostic Subtype Differentiation and Validation Data

Although the concept of ‘food addiction’ (FA) has raised growing interest because of evidence for similarities between substance dependence and excessive food intake, there is a lack of studies that explore this construct among the wide spectrum of eating disorders (EDs). Besides providing validation scores of a Spanish version of the Yale FA Scale (YFAS‐S), this study examined the prevalence of ‘FA’ among ED subtypes compared with healthy‐eating controls (HCs) and the association between ‘FA’ scores, eating symptomatology and general psychopathology. A sample of 125 adult women with ED, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders 5 criteria, and 82 healthy‐eating women participated in the study. All participants were assessed with the YFAS‐S, the ED Inventory‐2 and the Symptom Checklist‐Revised. Results showed that the internal structure of the one‐dimensional solution for the YFAS‐S was very good (α = 0.95). The YFAS‐S has a good discriminative capacity to differentiate between ED and controls (specificity = 97.6% and sensitivity (Se) = 72.8%; area under receiver operating characteristic curve = 0.90) and a good Se to screen for specific ED subtypes. YFAS‐S scores were associated with higher levels of negative affect and depression, higher general psychopathology, more severe eating pathology and greater body mass index. When comparing the prevalence of ‘FA’ between ED subtypes, the lowest prevalence of ‘FA’, measured with the YFAS‐S, was for the anorexia nervosa (AN) restrictive subtype with 50%, and the highest was for the AN binge–purging subtype (85.7%), followed by bulimia nervosa (81.5%) and binge eating disorder (76.9%). In conclusion, higher YFAS‐S scores are associated with bingeing ED‐subtype patients and with more eating severity and psychopathology. Although the ‘FA’ construct is able to differentiate between ED and HC, it needs to be further explored. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Food Addiction in Overweight and Obese Adolescents Seeking Weight‐loss Treatment

Some forms of overeating closely resemble addictive behaviour. The Yale Food Addiction Scale (YFAS) was developed to measure such addiction‐like eating in humans and has been employed in numerous studies for examining food addiction in adults. Yet, little is known about food addiction in children and adolescents. Fifty adolescents were recruited at the beginning of treatment in a weight‐loss hospital and completed the YFAS among other questionnaires. Nineteen participants (38%) received a YFAS diagnosis, who did not differ in age, body mass and gender distribution from those not receiving a diagnosis. However, those with food addiction reported more binge days, more frequent food cravings, higher eating, weight and shape concerns, more symptoms of depression and higher attentional and motor impulsivity. Eating restraint and nonplanning impulsivity did not differ between groups. Results replicate findings from studies in obese adults such that food addiction is not related to age, gender, body mass or eating restraint, but to higher eating pathology, more symptoms of depression and higher impulsivity. Furthermore, results highlight that particularly attentional impulsivity is related to ‘food addiction’. Addiction‐like eating appears to be a valid phenotype in a substantial subset of treatment‐seeking, obese adolescents. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Food Addiction and Bulimia Nervosa

In individuals with obesity and binge eating disorder (BED), eating patterns can show addictive qualities, with similarities to substance use disorders on behavioural and neurobiological levels. Bulimia nervosa (BN) has received less attention in this regard, despite their regular binge eating symptoms. The Yale Food Addiction Scale (YFAS) was developed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for substance use disorders, and food addiction can be diagnosed when at least three addiction symptoms are endorsed and a clinically significant impairment or distress is present. Although the prevalence of food addiction diagnoses is increased in individuals with obesity and BED, recent studies which used the YFAS showed that there are also individuals with normal weight who can be classified as being ‘food addicted’. Based on self‐reported eating disorder symptoms, women with current (n = 26) or remitted (n = 20) BN, and a control group of women matched for age and body mass index (n = 63) completed the YFAS and other measures. Results revealed that all patients with current BN received a food addiction diagnosis according to the YFAS while only six (30%) women with remitted BN did. None of the women in the control group received a food addiction diagnosis. Results provide support for the notion that BN can be described as addiction‐like eating behaviour and suggest that food addiction most likely improves when BN symptoms remit. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Factor Structure and Item Analysis of the Yale Food Addiction Scale in Obese Candidates for Bariatric Surgery

Converging research suggests phenomenological and neurobiological similarities between excessive food consumption and addictive behaviour in substance dependence. Recently, the Yale Food Addiction Scale (YFAS) has been proposed for the assessment of addictive eating behaviour. The German version of the YFAS was administered to obese individuals seeking bariatric surgery (N = 96). Factor structure, internal consistency, and item statistics were analysed. Forty participants (41.70%) received a food addiction diagnosis. The one‐factorial structure of the YFAS, which has been found in non‐clinical samples, could be confirmed. All but three items had factor loadings >.50. Internal consistency was α = .82. Item analysis revealed that items related to unsuccessful attempts to cut down and consumption despite physical and emotional problems were endorsed by the majority of participants. Findings support the use of the YFAS in clinical populations, while applicability of some items differs between clinical and non‐clinical samples. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

An Investigation of Goodman's Addictive Disorder Criteria in Eating Disorders

The aim of this study was to examine how far Goodman's addictive disorder criteria were met by individuals with eating disorders according to subtypes. The study provided a cross‐sectional comparison among three samples of eating disorders [restricting anorexia nervosa (R‐AN), N = 68; purging anorexia nervosa (P‐AN), N = 42; and bulimia nervosa (BN), N = 66], a sample of substance‐related disorders (SRDs, N = 48) and a sample of matched controls (N = 201). Diagnosis of addictive disorder was made following Goodman's criteria. Addictive personality traits were assessed with the Addiction Potential Scale of the Minnesota Multiphasic Personality Inventory—2 and with the Zuckerman's Sensation Seeking Scale. Results showed that individuals with BN met Goodman's addictive disorder criteria in the same proportion as drug‐addicted individuals (65% vs 60%, p = NS). They both showed higher rates than R‐AN individuals (35%; R‐AN versus BN: F = 11.9, p < 0.001 and R‐AN versus SRD: F = 7.16, p < 0.01). Although BN and SRD showed higher rates of addictive disorders compared with P‐AN, differences were not significant. Scores on the Sensation Seeking and on the Addictive Potential scales paralleled the distribution of addictive disorders, with individuals with BN and with P‐AN showing higher levels than individuals with R‐AN. Results showed that a subgroup of individuals with an eating disorder experiences their disorder as an addiction and may deserve specific therapeutic attention. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Clusters of Personality Disorder Cognitions in the Eating Disorders

This study examined whether comorbid personality disorder pathology in the eating disorders clusters into broader patterns, and whether those clusters have clinical validity in terms of levels of eating pathology and axis 1 comorbidity. The sample consisted of 214 eating‐disordered women who completed measures of personality disorder cognitions, eating pathology and axis 1 pathology at assessment. Three clusters of eating disorder patients emerged—low levels of personality pathology overall, high levels of cognitions underpinning anxiety‐based personality pathology, and high levels of all of the dimensions of personality pathology. These groups were validated by differences in levels of eating cognitions and axis 1 pathology. Personality disorder cognitions are clinically relevant to the eating disorders, but they might best be understood as broader sets of cognitions (‘anxiety‐centred’ and ‘general’), rather than in terms of individual personality disorder comorbidity or existing DSM personality disorder clusters. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Personality disorders in patients in a day‐treatment programme for eating disorders

The present study examined the prevalence of DSM‐III‐R personality disorders (PDs) and levels of depressive symptoms in patients in a day‐hospital programme for eating disorders. Sixty‐five patients diagnosed with anorexia nervosa and bulimia nervosa were administered the Personality Diagnostic Questionnaire Revised (PDQ‐R), the Eating Disorder Inventory (EDI) and the Beck Depression Inventory (BDI). In total, 49.2 per cent of all patients had at least one PD diagnosis. No significant difference was found between patients with bulimia nervosa and anorexia nervosa. Eating Disorder patients with at least one PD had higher scores on the BDI and three EDI subscales compared to patients without a PD. In general, the prevalence of Personality Disorders in the present sample tended to be closer to results quoted by studies with eating‐disordered outpatients rather than inpatients. Axis I disorders may affect personality state measures. Copyright © 2000 John Wiley & Sons, Ltd and Eating Disorders Association.     

Psychometric Evaluation of the Eating Disorder Examination Adapted for Children

The Eating Disorder Examination adapted for children (ChEDE) is the child version of the semi‐structured gold standard eating disorder interview for adults. This study was a comprehensive test statistic evaluation of the German ChEDE in a large sample of children and adolescents with anorexia nervosa, binge eating disorder, loss of control eating, overweight and obesity, as well as non‐eating‐disordered and chronically ill control probands (n = 352). Excellent inter‐rater reliability, adequate internal consistency and satisfactory stability of ChEDE indicators were demonstrated. ChEDE indicators discriminated between diverse forms of eating and weight disturbances and normative eating and were significantly correlated with conceptually related measures. Factorial validity was not convincing; a brief eight‐item scale showed the best fit. Item statistics were mostly acceptable. Overall, the ChEDE's German translation reliably and validly assesses psychopathology across the eating and weight disorder spectrum and facilitates international comparison of eating disorder research. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.     

Eating Disorders,Normative Eating Self‐Efficacy and Body Image Self‐Efficacy: Women in Recovery Homes

Although eating disorders (EDs) and ED symptoms are common among individuals in recovery for substance abuse (SA), long‐term SA treatment programmes rarely address these problems. The present study examined the prevalence of EDs among women residing in Oxford Houses—low‐cost, self‐governed recovery homes for SA. Further, among women both with and without an ED diagnosis, the association between duration of Oxford House residency and eating‐related self‐efficacy scores was examined as an indicator of potential treatment effects on ED symptoms. During a telephone assessment, participants were administered the Structured Clinical Interview for DSM‐IV‐TR Axis I Disorders and the Eating Disorder Recovery Self‐Efficacy Questionnaire. Results indicated that 12 of the 31 women analysed met criteria for an ED (bulimia nervosa, 2; ED not otherwise specified, 10). Differential findings were evident for eating‐related self‐efficacy measures depending on ED diagnostic status and duration of residency. Potential interpretations, limitations and implications are discussed. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Safety Behaviours in Eating Disorders: Factor Structure and Clinical Validation of the Brief Safety Behaviours Scale

This study examined the utility of a transdiagnostic measure of safety behaviours [Brief Safety Behaviours Scale (BSBS)] in eating disorders. Prior to treatment, a group of 102 women with eating disorders completed the BSBS and well‐validated measures of eating pathology, anxiety and intolerance of uncertainty. The BSBS had three factors, suggesting that avoidant, checking and social safety behaviours are distinct constructs in the eating disorders. This three‐scale scoring system showed greater clinical precision in correlations with eating pathology than the original two‐scale version. The pattern of safety behaviours in the eating disorders is more specific than had previously been shown in other clinical samples. While it is important to consider eating‐related safety behaviours in the eating disorders (e.g. restriction, body checking), it is also necessary to consider the role of generic safety behaviours when assessing, formulating and treating eating disorders. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Psychometric Evaluation and Norms for the Multidimensional Assessment of Interoceptive Awareness (MAIA) in a Clinical Eating Disorders Sample

Altered interoceptive awareness (IA) has been implicated in the pathophysiology of eating disorders; however, few comprehensive self‐report measures of IA exist in eating disorders. The present study sought to validate the Multidimensional Assessment of Interoceptive Awareness (MAIA), originally developed to assess IA in individuals practicing mind–body therapies, in an eating disorder sample. Adult and adolescent patients (n = 376) completed assessments upon admission to a partial hospital programme. Analyses examined the factor structure of the MAIA, scale means, scale–scale correlations, internal consistency and construct validity. Analyses also examined associations between MAIA subscales and eating disorder symptoms. Results supported the original eight‐factor structure of the MAIA. Internal consistency was acceptable, and the scales converged with associated measures. Importantly, Not Distracting, Self‐regulation, Body Listening and Trusting were most strongly associated with eating disorder symptoms. Results support use of the MAIA among eating disorders and provide further support for the relevance of IA in eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

The preliminary reliability and validity of the Survey for Eating Disorders (SEDs): a self‐report questionnaire for diagnosing eating disorders

The present study examined the reliability and validity of the Survey for Eating Disorders (SEDs), a self‐report questionnaire intended to assess eating disorders (ED) according to the classification in the DSM‐IV. This appraisal was conducted with a clinical sample of subjects with ED (N = 45), and a student sample (N = 124). In the clinical sample, the SEDs was validated against the Eating Disorder Examination (EDE) which is considered to be the ‘gold standard’ for the assessment of ED. In this sample, there were only two false positive cases of 45 on the SEDs, when patients were reassessed by the EDE interview. Thus, the positive predictive value was as high as 0.96. In the student sample, the SEDs was validated against the Eating Disorders Inventory (EDI) where the results showed strong evidence of concurrent and discriminant validity, and very high test–retest reliability (2 weeks). The SEDs is relatively brief and easy to administer, and these preliminary findings support its reliability and validity. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.     

Eating disorders,obesity and addiction

An addiction model of both eating disorders and obesity has received increasing attention in the popular and scientific literature. The addiction is viewed as a brain disease that must be directly targeted if treatment is to succeed. Evidence from laboratory feeding studies, epidemiology, genetic and familial research, psychopathological mechanisms, and treatment outcome research on cognitive behaviour therapy (CBT) is inconsistent with the clinical validity or utility of the addiction model of eating disorders. Neurobiological research has shown commonalities in brain reward processes between obesity and substance abuse disorders. Yet emphasis on apparent similarities overlooks important differences between obesity and drug addiction. Interest in obesity as a brain disease should not detract from a public health focus on the ‘toxic food environment’ that is arguably responsible for the obesity epidemic and related nutrition‐based chronic disease. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

French adaptation of the eating disorder recovery self‐efficacy questionnaire (EDRSQ): Psychometric properties and conceptual overview

High prevalence of Eating Disorders (EDs) and poor treatment outcome rates have urged research in the assessment of EDs. Self‐efficacy is a key motivational factor in the recovery from EDs. A self‐report measure, the Eating Disorder Recovery Self‐Efficacy Questionnaire (EDRSQ), was recently developed to assess confidence in adopting healthy eating behaviours and in maintaining a realistic body image. The objectives of this study were to (a) translate the EDRSQ to French (EDRSQ‐F), (b) assess the psychometric properties of this French version, and (c) establish normative data for a non‐clinical sample. Participants were 203 undergraduate women. They completed the EDRSQ‐F and measures of ED symptoms, depression and self‐esteem. A confirmatory factor analysis (CFA) revealed a bi‐factorial structure. Both scales demonstrated evidence of reliability and theoretically consistent evidence of construct validity. Findings support the validity of the EDRSQ‐F and suggest it is a useful instrument for the assessment of EDs. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Sensation seeking: a personality trait characteristic of adolescent girls and young women with eating disorders?

The aim of the following study was to evaluate the role of sensation seeking in eating disorders (anorexia and bulimia), taking into account the subtypes (purging versus nonpurging) and the concept of binge‐eating disorder. The study involved 141 adolescent girls and young women, aged 14 to 25 years who lived in the French speaking part of Switzerland (79 clinical subjects with eating disorders according to DSM‐IV criteria, and 62 control subjects without eating disorders from the general population). All the subjects completed the Sensation Seeking Scale (SSS, Zuckerman, 1971). The results show that subjects with bulimic behaviours characterized by recurrent episodes of binge‐eating, whatever their exact diagnosis and subtype, do not significantly differ from one another on the Sensation Seeking Scale. They all had higher scores than the control group especially on the ‘Thrill and Adventure Seeking’ dimension. In contrast, restricting anorexics had lower scores on the Sensation Seeking Scale than the control group, especially on the ‘Experience Seeking’ dimension. Copyright © 2000 John Wiley & Sons, Ltd and Eating Disorders Association.     

The rating of anorexia and bulimia (RAB) interview: development and preliminary validation

Most interviews of eating disorders have been developed on homogeneous, English‐speaking samples at particular academic institutions for research purposes, and tend to put scientific rigour before clinical utility. The present study deals with the development and preliminary validation of the Rating of Anorexia and Bulimia (RAB), a 56 item interview covering a wide range of eating disorder symptoms, related psychopathology and background variables, which can be used to generate operational DSM‐IV diagnoses. Eating disorder variables on the RAB can be compiled into four subscales: Body‐shape and Weight Preoccupation, Binge‐Eating, Anorexic Eating Behaviour and Compensatory Behaviour. The instrument was investigated among 409 patients participating in the Swedish multi‐centre study of eating disorders. Measures of internal consistency, diagnostic discrimination and correlations with the EDI‐2 suggest that the RAB is a promising measure that reliably measures important aspects of eating disorder psychopathology. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association.     

Altered Reward Reactivity as a Behavioural Endophenotype in Eating Disorders: A Pilot Investigation in Twins

Altered reward reactivity is a potential risk endophenotype for eating disorders (EDs). The aim of this study was to examine reward reactivity in female twins with EDs and compare it with a twin control group. A sample of 112 twins [n = 51 met lifetime DSM‐IV ED criteria (anorexia nervosa n = 26; bulimic disorders n = 24), n = 19 unaffected cotwins and n = 42 control twins] was administered measures assessing reward reactivity, including the Game of Dice Task, the Behavioural Inhibition/Activation (BIS/BAS) Scales and the Appetitive Motivation Scale (AMS). Within pair, correlations for monozygotic and dizygotic twins were calculated and generalised estimating equations compared probands with non‐ED cotwins and controls. The BAS and the AMS were reduced in EDs and negatively associated with restrictive symptoms. In addition, monozygotic twins pairs demonstrated significant within pair similarity for the BAS and AMS. Conversely, there was less evidence to support the BIS or risky decision‐making as measured by the Game of Dice Task as an endophenotype in EDs. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Lifetime Obesity in Patients with Eating Disorders: Increasing Prevalence,Clinical and Personality Correlates

Objectives : The aims of our study were to examine the lifetime prevalence of obesity rate in eating disorders (ED) subtypes and to examine whether there have been temporal changes among the last 10 years and to explore clinical differences between ED with and without lifetime obesity. Methods : Participants were 1383 ED female patients (DSM‐IV criteria) consecutively admitted, between 2001 and 2010, to Bellvitge University Hospital. They were assessed by means of the Eating Disorders Inventory‐2, the Symptom Checklist‐90—Revised, the Bulimic Investigatory Test Edinburgh and the Temperament and Character Inventory—Revised. Results : The prevalence of lifetime obesity in ED cases was 28.8% (ranging from 5% in anorexia nervosa to 87% in binge‐eating disorders). Over the last 10 years, there has been a threefold increase in lifetime obesity in ED patients (p < .001). People with an ED and obesity had higher levels of childhood and family obesity (p < .001), a later age of onset and longer ED duration; and had higher levels of eating, general and personality symptomatology. Conclusions : Over the last 10 years, the prevalence of obesity associated with disorders characterized by the presence of binge episodes, namely bulimic disorders, is increasing, and this is linked with greater clinical severity and a poorer prognosis. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.