Binge-eating and polycystic ovaries.
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Bulimia↗
Biomedical subjects
J H Lacey
Publications and source records attributed to J H Lacey.
Pre-menarchal bulimia nervosa.
Although pre-pubertal anorexia nervosa has been well described, pre-pubertal bulimic behaviour in the context of this disorder appears to be uncommon. There have been no published reports of pre-pubertal bulimia nervosa occurring independently. Of 323 patients with bulimia nervosa attending an eating disorders research clinic between 1980 and 1989, the authors identified six patients who described pre-menarchal binge eating in the absence of a concurrent history of anorexia nervosa or massive obesity. Three (0.93%) of these patients described a pre-menarchal onset of bulimia nervosa, but there was no evidence that they were pre-pubertal. The implications of these findings are discussed.
Adolescent↗
Severe disturbance occurring during treatment for depression of a bulimic patient with fluoxetine.
We report on a 32-year old woman with bulimia nervosa treated with fluoxetine for depression. Fluoxetine is the only drug currently recommended for the treatment of bulimia. The patient became severely disturbed with tension, irritability, self-damage by cutting and violent, intense, suicidal and paranoid ideation qualitatively different to previous symptoms in the course of her illness. Clinical impression was of a striking association between fluoxetine and these symptoms. We suggest caution when using fluoxetine in bulimic patients with depression who have additional impulsive behaviours such as self-cutting, alcohol and/or drug abuse and shop-lifting.
Adult↗
Stealing in bulimia nervosa.
This clinical study examines the prevalence of stealing and the personal and behavioural factors which distinguish stealing and non-stealing behaviour in a population of 312 female normal-weight bulimics. Bulimic patients who stole had poorer early interpersonal relationships, earlier onset of sexual feelings with greater subsequent sexual activity and increased illicit drug use. The suggestion is made that stealing is a marker of severity. In addition, bulimics who stole appeared to exhibit more obsessional qualities with increased ritualisation.
Adult↗
Anorexia nervosa in a patient with XY gonadal dysgenesis.
This is the first report of a case of anorexia nervosa in a woman with XY gonadal dysgenesis. Anorexia nervosa is a potential complication of gonadal dysgenesis, stemming not only from the disorder itself but from its investigation and treatment.
Adult↗
Anorexia nervosa and XY gonadal dysgenesis.
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Adult↗
Homogamy: the relationships and sexual partners of normal-weight bulimic women.
This study reports the demography, weight, and alcohol and psychiatric histories of the sexual partners of 112 consecutive patients with bulimia nervosa, all from an urban catchment area. Seventy-three patients (65%) had a current sexual partner. The partners were of similar social background, but slightly older. On average, partners were overweight (110% of MMPW) and over 27% reported having an eating or weight problem. A quarter of the partners had been treated for a psychiatric or emotional disorder. Nearly 40% drank more than 36 units of alcohol a week, and 14% had received treatment or consulted a doctor for alcohol-related problems. Heavy-drinking partners and multi-impulsive bulimics sought out each other. A quarter of partners had themselves been raised in a nuclear family in which a member had received psychiatric treatment; 12% had had a mother or sister with an eating disorder. Thirty-seven per cent of patients used a 'safe man', their fear of being hurt stemming from low self-esteem and a general sense of 'failure', and for 11% the relationship was abusive.
Adaptation, Psychological↗
Multiple self-damaging behaviour among alcoholic women. A prevalence study.
Among patients being treated for specific behaviour-control problems, there exists an important subgroup of 'multi-impulsive' patients whose treatment might be facilitated if the full range of their problems were recognised and dealt with as one general issue of impulse control. In women in particular, loss of control of eating may be prevalent and easily concealed from staff, and may thwart treatment. This survey of 50 women attending an alcoholic-treatment unit explored the prevalence of behavioural-control problems other than those of alcohol. Three-quarters of the women also had other behavioural problems. Over half the sample had thought of taking an overdose and just under half had actually taken one; about a quarter had cut themselves deliberately; half described impulsive physical violence; half acknowledged a period of 'promiscuity'; and at least 16% had had a clinically diagnosable eating disorder. More research is needed but we believe that all self-damaging behaviour should be addressed simultaneously to prevent 'revolving door' relapses as emotional distress is transferred from one behaviour to another.
Adult↗
Sociocultural aspects of eating disorders.
Eating disorders, though recognized for centuries, are increasing in prevalence. The increase in rate is particularly remarkable over the last 30-40 years. The article considers how social function stems from biological function and evolution, and how biological function may hamper social development to the detriment of individuals. Social and cultural influences relevant to this change are examined, especially the changing position of women within society as a whole and the multiplication of conflicting roles which women find themselves balancing. Reference is made to the representation of women in the arts and media. Reference is also made to the role of those external agencies which have historically controlled populations (both men and women), such as religious bodies and governments, but which to some extent have been rejected. Evidence from in-depth studies of women with eating disorders and from transcultural studies are included to support the authors' ideas.
Adult↗
Bulimia nervosa: family size, sibling sex and birth order. A catchment-area study.
Family size, sex of siblings and birth order were examined in 225 bulimic patients of normal weight, all stemming from the same circumscribed catchment area. Although bulimia can occur in any size family, all-female sibships were significantly over-represented. In small families at least, the bulimic patient was highly likely to be the only or eldest daughter. In small sibships, a bulimic who was first-born was significantly more likely to have a younger sister; if second-born she was more likely to have an elder brother. Despite the very large sample size, no final conclusion can be made on birth order.
Adolescent↗
Polycystic ovary syndrome and bulimia.
One hundred fifty-three patients classified as suffering from polycystic ovarian syndrome (PCOS) and 109 patients who were suffering from a clear organic disorder or endocrinopathy received the bulimia investigation test (Edinburgh) (BITE) questionnaire for abnormal eating behaviors. Patients with PCOS showed a significant increase in their mean BITE score for approximately a third had abnormal eating patterns, and 6% have scores suggestive of clinical bulimia compared with only 1% of women in the group with organic endocrinopathies. The work suggests that women with PCOS should be screened for abnormal eating behaviors and raises the possibility that treatment by psychological means should be considered when abnormal eating behaviors are present.
Analysis of Variance↗
Motivational factors in women requesting augmentation and reduction mammaplasty.
This study confirms that women requesting breast reduction and breast augmentation differ beyond the anatomical. There were significantly more single and co-habiting women in the breast reduction group, and significantly more separated and divorced women in the breast augmentation group, compared to women attending an obstetric clinic. The majority of women requesting surgery agreed that to feel more confident was an important reason for seeking surgery, but those requesting breast augmentation also stressed the need to feel more feminine and less shy with men. A significantly higher percentage of the breast augmentation group had been pregnant, and they had a higher average number of pregnancies than the obstetric comparison group, together with a significantly higher experience of miscarriage. The psychodynamic proposal that women requesting breast augmentation are seeking to symbolically boost their sense of femininity and womanliness is supported by this study.
Adaptation, Psychological↗
A comparison between women seeking self-help and psychiatric treatment in anorexia nervosa and bulimia.
Thirty new members of a branch of Anorexic Aid were interviewed to determine their characteristics and compared with women seeking psychiatric treatment for anorexia nervosa and normal-weight bulimia. It was expected that the two samples would be similar and that the women in the self-help group would have also had professional treatment. Over half (53 per cent, 16) of the Anorexic Aid sample were anorectic, 40 per cent (12) were normal-weight bulimics and 7 per cent (2) could not be classified and were excluded. Demographic characteristics were similar, with both samples being mainly British, single and from social classes I-III, but the Anorexic Aid sample was significantly older. Clinical features were also similar, although there was a trend towards the Anorexic Aid anorectics being less severely ill at presentation. Nearly 90 per cent (25) of the Anorexic Aid sample had had professional treatment. The hypotheses are partially confirmed. Reasons for the differences in age and severity are discussed.
Adult↗
Incest, incestuous fantasy & indecency. A clinical catchment area study of normal-weight bulimic women.
This systematic study of 112 consecutive referrals of normal-weight bulimic women from a circumscribed urban catchment area found that eight patients (7%) reported sexual abuse involving physical contact. Four (3.6%) of these described incest, but only in two cases (1.8%) did the incest occur in childhood. Just over 5% of the sample reported unlawful sexual intercourse in childhood or gross indecency. Eighteen additional patients reported incestuous fantasies and two of these were partly acted out. The study indicates that incest and sexual abuse reported by bulimics is usually in those multi-impulsive patients who also abuse alcohol or drugs as well as food. The reported prevalences of incest and indecency in normal-weight bulimic women are only slightly higher than figures derived from general population surveys.
Adolescent↗
Eating behaviour and attitudes to weight and shape in British women from three ethnic groups.
Attitudes towards eating, weight and shape were examined in 479 Caucasian, Afro-Caribbean and Asian British women. The Asian women were found to have significantly more disordered eating attitudes than the Caucasian women, but no difference was found between the three groups in their concern with their body weight and shape. However, while in the Caucasian group disordered eating attitudes were significantly positively correlated with feelings of anxiety and depression, this was not true in the other two groups. Although the concerns of British Afro-Caribbean and Asian women are similar to those of the Caucasian women, there may be ethnic differences in the relationship between feelings about eating, weight and shape and mood.
Anorexia Nervosa↗
Family composition and social class in bulimia. A catchment area study of a clinical and a comparison group.
Many theories of the etiology of eating disorders focus on the role of the family. However, these theories are based on clinical experience and uncontrolled clinical case series. We report a study comparing 50 bulimic women with 40 non-eating-disordered women all from the same clinical catchment area. This study revealed no significant differences in social class, family size, birth position, or sibling sex ratio between the two groups. However, the parents of bulimic women were found to have been significantly older than those of the control group at the time of birth of their daughter. These findings are discussed with reference to previous family studies of eating disorders.
Adult↗
Body image and its disturbances.
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Aphasia↗
Weight and skeletal maturation - a study of radiological and chronological age in an anorexia nervosa population.
The carpal bones of 18 anorexia nervosa patients were radiographed and the X-ray age assessed by 2 different standard methods. The study demonstrates that skeletal development in anorexia nervosa patients is delayed such that there is no association between radiological assessment of age and chronological age. It is strongly suggested that bony development actually ceases when body weight falls sufficiently to stop menstruation. There was a highly significant (P = 0.001) linear relationship between radiological age and the sum of the age of onset of the illness plus any period(s) of re-feeding. Weight gain seems to re-kindle the bone maturing mechanisms: the role of weight thresholds and associated hormone activity being discussed. The findings of this study strongly support the existing evidence that the anorexia nervosa patient is biologically and psychologically immature.
Adolescent↗