Biomedical subjects

Pamela K Keel

Publications and source records attributed to Pamela K Keel.

At least 19 recordsLinked to original sources

PubMed2007

Relationships between perfectionism and specific disordered eating behaviors.

OBJECTIVE: Perfectionism has been reported as a specific risk factor for anorexia nervosa and bulimia nervosa, but not binge eating disorder. This study examined whether these differences are due to differential associations between perfectionism and specific eating disorder behaviors. METHOD: Participants (N = 2,482) completed the eating disorders inventory perfectionism scale and a questionnaire assessing eating disorder symptoms. RESULTS: Perfectionism was associated with an array of disordered eating behaviors in women. However, associations were strongest for fasting and purging. Further, the association between binge eating and perfectionism was statistically mediated by fasting. In men, perfectionism was significantly associated only with fasting, and this association was greater than associations with other disordered eating behaviors. CONCLUSION: Results explain why previous studies have reported weak or inconsistent associations between perfectionism and binge eating and may inform etiological models of EDNOS characterized by fasting or purging.

Adult↗

PubMed2006

Ovarian hormones and binge eating in bulimia nervosa.

BACKGROUND: Symptom fluctuation in bulimia nervosa (BN) is related to menstrual cycle phase. However, the relationship between bulimic symptoms and ovarian hormones (estrogens and progesterone) has not been examined directly in women with BN. METHOD: Regularly menstruating women with DSM-IV BN (n=9) and regularly menstruating controls (n=8) collected hormone samples and recorded mood and bulimic symptoms daily for 35 consecutive days. Estradiol and progesterone were measured by radioimmunoassay. Within-subject analyses examined prospective longitudinal associations between changes in ovarian hormones and changes in binge frequency in women with BN. Analyses controlled for the possible influence of negative affect on binge frequency as well as the influence of progesterone when examining estradiol associations and the influence of estradiol when examining progesterone associations. Between-subject analyses examined whether women with BN were more likely to have disrupted hormonal profiles than controls. RESULTS: Increases in binge eating were significantly associated with both decreases in estradiol and increases in progesterone in BN women with intact menstrual cycles. Although BN women were more likely to have disrupted hormone profiles than controls, this difference did not reach statistical significance, and mean estradiol and progesterone levels did not differ between bulimic and control groups. CONCLUSIONS: The results are consistent with those from experimental animal studies and suggest that decreases in estradiol and increases in progesterone may contribute to increases in binge eating. Ovarian hormone function represents a promising candidate for unraveling the neurobiological mechanisms of binge eating.

Adult↗

PubMed2006

Suicidality in eating disorders: occurrence, correlates, and clinical implications.

This review summarizes the published studies on suicide and suicide attempts in individuals with eating disorders, highlighting rates of occurrence, clinical correlates, and implications for practitioners. Multiple studies find high rates of suicide in patients with anorexia nervosa (AN) [Standardized Mortality Ratio (SMR) for suicide range from 1.0 to 5.3], whereas suicide rates do not appear to be elevated in bulimia nervosa (BN). In contrast, suicide attempts occur in approximately 3-20% of patients with anorexia nervosa and in 25-35% of patients with bulimia nervosa. Clinical correlates of suicidality in eating disorders include purging behaviors, depression, substance abuse, and a history of childhood physical and/or sexual abuse. Patients with eating disorders, particularly those with comorbid disorders, should be assessed routinely for suicidal ideation, regardless of the severity of eating disorder or depressive symptoms.

Adolescent↗

PubMed2006

Drug abuse in women with eating disorders.

OBJECTIVE: Drug abuse in women with eating disorders has received relatively little attention. The frequency of drug use disorder (DUD) by specific drug type was examined in the current longitudinal study. METHOD: In a prospective study, women diagnosed with either anorexia nervosa (AN; n = 136) or bulimia nervosa (BN; n = 110), were interviewed and assessed for research diagnostic criteria (RDC) DUD every 6-12 months over 8.6 years. RESULTS: Forty-two (17%) women in the current longitudinal study had a lifetime history of DUD, with 19 prospective onsets over the course of the study (9 AN and 10 BN). The most commonly abused illicit drugs were amphetamines, cocaine, and marijuana, and rates of DUD did not differ between intake diagnoses of AN and BN. CONCLUSION: Drug abuse in women with eating disorders is an area of clinical concern and should be monitored routinely throughout the treatment process.

Adult↗

PubMed2006

Stigmatization of anorexia nervosa.

OBJECTIVE: The current study examined the perceptions about an individual with anorexia nervosa (AN) relative to perceptions about a healthy person and a person with another mental or nonmental illness. METHOD: Ninety-one participants recruited from the community completed questionnaires targeting perceptions about 4 individuals: a healthy person, a person with asthma, a person with schizophrenia, and a person with AN. RESULTS: Evaluations of personal characteristics were most negative for persons with AN. Participants believed the person with AN was most to blame for his/her condition, was best able to pull him/herself together if he/she wanted to, and was most acting this way for attention and that biological factors were least relevant in developing the illness. CONCLUSION: Negative perceptions of a person with AN fell into stigma categories of self-attribution and responsibility. These attitudes may contribute to reluctance to seek treatment among individuals with AN.

Adult↗

PubMed2006

Trans-cultural comparison of disordered eating in Korean women.

OBJECTIVE: The presence of eating disorders in non-Western cultures is often attributed to the export of Western ideals. This study examines this hypothesis by comparing disordered eating attitudes and behaviors in Korean women with differing levels of exposure to Western culture. METHOD: Second-generation Korean-Americans (n=167) and Korean immigrants (n=37) completed the Eating Attitudes Test (EAT-26), and data from native Koreans (n=937) were obtained from a previous epidemiological study, using a Korean-translated version of the EAT-26 (K-EAT-26). Korean-American and immigrant women completed the Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA). RESULTS: Korean-American women scored significantly lower on the EAT-26 than Korean immigrants and native Koreans, who did not differ from each other. Korean-Americans were more Western-oriented than Korean immigrants, and acculturation levels were not correlated with EAT-26 scores in either group. CONCLUSION: This study supports the importance of native cultural factors in the development of eating disorders in non-Western contexts.

Acculturation↗

PubMed2006

Importance of multiple purging methods in the classification of eating disorder subtypes.

OBJECTIVE: To examine two assumptions implicit in the subtyping of eating disorders: (1) purging behaviors are interchangeable, and (2) a primary distinction exists between the presence vs. absence of any means of purging. METHOD: Data from a longitudinal study of health and eating patterns were used to compare women who reported self-induced vomiting, laxative abuse, or their combination. Further comparisons were made among women who used multiple purging methods (MP), a single purging method (SP), and randomly selected controls who never purged. RESULTS: Vomiting and laxative abuse were associated with similar levels of eating pathology whereas their combination was associated with greater eating pathology. MP women reported significantly greater eating pathology compared to SP women who reported significantly greater eating pathology compared to controls. Differences were maintained at 10-year follow-up. CONCLUSION: Purging behaviors may be interchangeable but the use of multiple purging methods is associated with greater severity over time.

Adult↗

PubMed2006

Peer influence on bulimic symptoms in college students.

This longitudinal study examined the influence of peer selection and socialization on bulimic symptoms in college students. Ninety-eight participants completed measures of bulimic symptoms, self-esteem, perfectionism, and impulsivity in the spring and fall of 2003. Peer influence was assessed by examining similarity among selected peers, unselected peers, and nonpeers over time. Among selected peers, bulimic symptoms demonstrated patterns of socialization, self-esteem and perfectionism demonstrated patterns of selection, and these personality traits longitudinally predicted changes in bulimic symptoms. Unselected peers demonstrated no similarity for bulimia, self-esteem, or perfectionism, but they did evidence socialization for impulsivity. The findings support an etiological model that integrates social and individual risk factors in creating environments that influence disordered eating among college students.

Adolescent↗

PubMed2005

Point prevalence of bulimia nervosa in 1982, 1992, and 2002.

Background. Recent epidemiological data suggest a decline in bulimia nervosa (BN) incidence in primary care. We sought to examine BN point prevalence from 1982 to 2002 in a college population.Method. In 1982, 1992, and 2002, 800 women and 400 men were randomly sampled from a university for a study of health and eating patterns. Participation rates were 72% in women and 63% in men, resulting in n=2491 participants.Results. BN point prevalence decreased significantly in women over the period of observation. Eating Disorder Inventory Bulimia scores decreased across cohorts, and these decreases remained significant when male and female and Caucasian and non-Caucasian students were analyzed separately.Conclusion. These data support a decline in BN rates that cannot be attributed to changes in service utilization. Changing socio-cultural factors may explain a true decrease in BN incidence and prevalence.

Adult↗

PubMed2005

Does "excessive" or "compulsive" best describe exercise as a symptom of bulimia nervosa?

OBJECTIVE: The criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; Washington, DC: American Psychiatric Association) for bulimia nervosa include "excessive exercise" as an inappropriate compensatory behavior, suggesting that it is the quantity of the physical activity that is symptomatic, rather than its quality. The current study evaluated the hypothesis that psychological commitment to exercise (compulsive quality) will be more predictive of disordered eating attitudes and behaviors than the amount of time devoted to exercise (excessive quantity). METHOD: Female (n = 162) and male (n = 103) undergraduates completed the Eating Disorder Inventory (EDI) subscales, the Obligatory Exercise Questionnaire (OEQ), and questions to assess the duration and frequency of exercise. RESULTS: Using multivariate analysis, the OEQ score was a positive predictor of disordered eating attitudes and behaviors, and exercise time was a negative predictor. DISCUSSION: "Compulsive" may be a better description than "excessive" in characterizing exercise as a symptom of bulimia nervosa.

Adolescent↗

PubMed2005

Shared transmission of eating disorders and anxiety disorders.

OBJECTIVE: Eating disorders have high comorbidity with mood, anxiety, and substance use disorders. Using twins from the population-based Minnesota Twin Family Study (MTFS), we examined comorbidity and shared transmission between eating pathology and these disorders. METHOD: Female twins (N = 672), ages 16-18 years, completed structured clinical interviews assessing anorexia nervosa and bulimia nervosa (as described in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV; American Psychiatric Association, 1994]), as well as mood, anxiety, and substance use disorders (as described in the 3rd Rev. ed. of the Diagnostic and Statistical Manual of Mental Disorders [DSM-III-R]). Shared transmission was examined using a discordant monozygotic (MZ) twin design. RESULTS: Significant comorbidity was found between eating disorders and major depression, anxiety disorders, and nicotine dependence. Within MZ twin pairs discordant for eating disorders (n = 14), non-eating-disordered cotwins demonstrated increased risk for anxiety disorders compared with controls. Similarly, within MZ twin pairs discordant for anxiety disorders (n = 52), non-anxiety-disordered cotwins demonstrated increased risk for eating disorders compared with controls. DISCUSSION: Findings support shared transmission between eating disorders and anxiety disorders. However, the nature of this shared diathesis remains unknown.

Adolescent↗

PubMed2005

How do eating disorders and alcohol use disorder influence each other?

OBJECTIVE: Although eating disorders and alcohol use disorder (AUD) are known to co-occur, the influence of one on the other has not been studied. METHOD: In a prospective study, women diagnosed with either anorexia nervosa (AN; n = 136) or bulimia nervosa (BN; n = 110) were interviewed and assessed for Research Diagnostic Criteria (RDC) AUD every 6-12 months over 8.6 years. RESULTS: Over one fourth of the sample (n = 66 [27%]) reported a lifetime history of AUD. Ten percent of the study subjects (n = 24) developed AUD over the course of the study. AUD did not influence recovery from either eating disorder. Poor psychosocial functioning and history of substance use predicted prospective onset of an episode of AUD for both diagnostic groups. Unique predictors for AUD for women with AN were depression, overconcern with body image, and vomiting. Recovery from AUD was predicted by group therapy and hospitalization (women with AN) and individual therapy and exercise (women with BN). CONCLUSION: The influence of eating disorders on AUD appears to be greater than the reverse. A substantial number of patients who initially present with an eating disorder develop alcohol problems over the course of time, suggesting that the risk is an ongoing one that should be monitored by clinicians.

Adult↗

PubMed2005

Purging disorder: an ominous variant of bulimia nervosa?

OBJECTIVE: The current study evaluates the clinical significance and distinctiveness of purging disorder (PD), an eating disorder characterized by recurrent purging in the absence of objective binge episodes (OBE) among normal-weight individuals. METHOD: Women with PD (n = 37), bulimia nervosa (BN; n = 39), or no eating disorder (n = 35) completed clinical assessments. Women with PD (n = 23) and BN (n = 25) completed 6-month follow-up assessments. RESULTS: Compared with controls, both eating-disordered groups reported significantly higher eating, Axis I, and Axis II pathology. Compared with BN, PD was associated with significantly lower eating concerns, disinhibition, and hunger. At 6-month follow-up, rates of remission did not differ significantly between PD and BN, and crossover between disorders was rare. CONCLUSION: PD appears to be a clinically significant and potentially distinctive eating disorder.

Adolescent↗

PubMed2005

Disordered eating attitudes and behaviors in ballet students: examination of environmental and individual risk factors.

OBJECTIVE: The current study compared the prevalence of disordered eating attitudes and behaviors among adolescent ballet dancers at national, regional, and local schools. METHOD: Female ballet students (N = 239; mean age = 15.0 +/- 1.5 years) from five geographically disparate summer programs completed the Eating Dis-order Inventory (EDI) and answered questions regarding eating disorder symptoms. RESULTS: Students from both national and local schools reported significantly higher EDI total, Drive for Thinness, and Perfectionism scores compared with regional students. In contrast, national students reported significantly greater dieting scores and lifetime histories of self-induced vomiting compared with regional and local students. CONCLUSION: Eating pathology among adolescent ballet dancers may be a function of both genetic and environmental risk. Dancers who exhibit high levels of perfectionism and, perhaps consequently, place themselves in highly competitive environments, may exhibit a significantly increased risk for disordered eating in comparison to dancers who are less perfectionistic and/or place themselves in less competitive environments.

Adolescent↗

PubMed2005

Postremission predictors of relapse in women with eating disorders.

OBJECTIVE: The authors sought to evaluate patterns and predictors of relapse among women with eating disorders. METHOD: Interviews were conducted biannually to annually to assess symptoms of eating disorders, axis I disorders, treatment, and psychosocial function on a weekly basis for women diagnosed with anorexia nervosa (N=136) or bulimia nervosa (N=110) and prospectively followed for 9 years. At the last follow-up, 229 (93%) of the subjects had been retained in the study group. RESULTS: Relapse occurred in 36% of the women with anorexia nervosa and 35% of the women with bulimia nervosa. Women with intake diagnoses of anorexia nervosa, restricting subtype, tended to develop bulimic symptoms during relapse, whereas women with intake diagnoses of anorexia nervosa, binge-purge subtype, or bulimia nervosa tended to return to bulimic patterns during relapse. Greater body image disturbance contributed to a risk of relapse in both eating disorders, and worse psychosocial function increased the risk of relapse in bulimia nervosa. CONCLUSIONS: These results may explain the long-term efficacy of interpersonal therapy for bulimia nervosa and suggest that focused body image work during relapse prevention may enhance long-term recovery from eating disorders.

Adaptation, Psychological↗

PubMed2004

Application of a latent class analysis to empirically define eating disorder phenotypes.

CONTEXT: Diagnostic criteria for eating disorders influence how we recognize, research, and treat eating disorders, and empirically valid phenotypes are required for revealing their genetic bases. OBJECTIVE: To empirically define eating disorder phenotypes. DESIGN: Data regarding eating disorder symptoms and features from 1179 individuals with clinically significant eating disorders were submitted to a latent class analysis. The resulting latent classes were compared on non-eating disorder variables in a series of validation analyses. SETTING: Multinational, collaborative study with cases ascertained through diverse clinical settings (inpatient, outpatient, and community). PARTICIPANTS: Members of affected relative pairs recruited for participation in genetic studies of eating disorders in which probands met DSM-IV-TR criteria for anorexia nervosa (AN) or bulimia nervosa and had at least 1 biological relative with a clinically significant eating disorder. Main Outcome Measure Number and clinical characterization of latent classes. RESULTS: A 4-class solution provided the best fit. Latent class 1 (LC1) resembled restricting AN; LC2, AN and bulimia nervosa with the use of multiple methods of purging; LC3, restricting AN without obsessive-compulsive features; and LC4, bulimia nervosa with self-induced vomiting as the sole form of purging. Biological relatives were significantly likely to belong to the same latent class. Across validation analyses, LC2 demonstrated the highest levels of psychological disturbance, and LC3 demonstrated the lowest. CONCLUSIONS: The presence of obsessive-compulsive features differentiates among individuals with restricting AN. Similarly, the combination of low weight and multiple methods of purging distinguishes among individuals with binge eating and purging behaviors. These results support some of the distinctions drawn within the DSM-IV-TR among eating disorder subtypes, while introducing new features to define phenotypes.

Adolescent↗

PubMed2004

Bulimia symptoms and other risk behaviors during pregnancy in women with bulimia nervosa.

OBJECTIVE: The current study examined the change in bulimic symptoms as well as alcohol, drug, and tobacco use during pregnancy in subjects with bulimia nervosa. METHOD: A self-report questionnaire was used to collect retrospective data on eating disorder symptoms and substance use during pregnancy from 129 participants in a long-term study of bulimia nervosa. Follow-up data were collected for a total of 322 pregnancies occurring over a 10-15-year period. RESULTS: Overall, subjects reported that body dissatisfaction worsened, but binge eating and purging improved during pregnancy. However, the number of women completely abstinent from bulimic symptoms did not change significantly with pregnancy. Body esteem often worsened with pregnancy, particularly for women with active bulimia symptoms. Self-reported alcohol use significantly declined with pregnancy. DISCUSSION: In general, bulimia nervosa symptoms decreased during pregnancy, although the number of women completely abstinent did not change significantly.

Adult↗

PubMed2004

Personality characteristics of women before and after recovery from an eating disorder.

BACKGROUND: Previous studies of personality characteristics in women with eating disorders primarily have focused on women who are acutely ill. This study compares personality characteristics among women who are ill with eating disorders, recovered from eating disorders, and those without eating or other Axis I disorder pathology. METHOD: Female participants were assessed for personality characteristics using the Temperament and Character Inventory (TCI): 122 with anorexia nervosa (AN; 77 ill, 45 recovered), 279 with bulimia nervosa (BN; 194 ill, 85 recovered), 267 with lifetime histories of both anorexia and bulimia nervosa (AN + BN; 194 ill, 73 recovered), 63 with eating disorder not otherwise specified (EDNOS; 31 ill, 32 recovered), and 507 without eating or Axis I disorder pathology. RESULTS: Women ill with all types of eating disorders exhibited several TCI score differences from control women, particularly in the areas of novelty-seeking, harm avoidance, self-directedness, and cooperativeness. Interestingly, women recovered from eating disorders reported higher levels of harm avoidance and lower self-directedness and cooperativeness scores than did normal control women. CONCLUSIONS: Women with eating disorders in both the ill and recovered state show higher levels of harm avoidance and lower self-directedness and cooperativeness scores than normal control women. Although findings suggest that disturbances may be trait-related and contribute to the disorders' pathogenesis, additional research with more representative community controls, rather than our pre-screened, normal controls, is needed to confirm these impressions.

Adult↗