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PubMed1999

Characteristics of eating in anger, fear, sadness and joy.

The influences of emotions on eating were investigated. One-hundred and seven female and 103 male subjects were asked to report how various characteristics of eating could change during the emotions of anger, fear, sadness and joy. Subjects completed a questionnaire of 33 items for each emotion and a food deprivation condition. A factor analysis of the items answered with respect to food deprivation yielded four factors which were labelled hunger, impulsive eating, sensory eating and hedonic eating. ANCOVAs showed main effects of emotions upon each factor. Single comparisons showed that: (1) subjects reported to experience higher levels of hunger during anger and joy than during fear and sadness; (2) impulsive eating and sensory eating were rated higher during anger than during the other emotions; and (3) hedonic eating was rated higher during joy than during the other emotions. Results did not indicate any differential influences upon eating between fear and sadness. Women reported to experience higher tendencies of impulsive eating and sensory eating than men during anger and sadness. Eating scores of negative emotions correlated low and positive with body mass index, low and negative with dietary restraint. The differential effects of emotions on characteristics of eating may be due to differences of the examined emotions in frequency of occurrence, physiological correlates and motivational properties.

Adult↗

PubMed2006

Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders.

It is the position of the American Dietetic Association that nutrition intervention, including nutritional counseling, by a registered dietitian (RD) is an essential component of the team treatment of patients with anorexia nervosa, bulimia nervosa, and other eating disorders during assessment and treatment across the continuum of care. Diagnostic criteria for eating disorders provide important guidelines for identification and treatment. However, it is thought that a continuum of disordered eating may exist that ranges from persistent dieting to subthreshold conditions and then to defined eating disorders, which include anorexia nervosa, bulimia nervosa, and binge eating disorder. Understanding the complexities of eating disorders, such as influencing factors, comorbid illness, medical and psychological complications, and boundary issues, is critical in the effective treatment of eating disorders. The nature of eating disorders requires a collaborative approach by an interdisciplinary team of psychological, nutritional, and medical specialists. The RD is an integral member of the treatment team and is uniquely qualified to provide medical nutrition therapy for the normalization of eating patterns and nutritional status. RDs provide nutritional counseling, recognize clinical signs related to eating disorders, and assist with medical monitoring while cognizant of psychotherapy and pharmacotherapy that are cornerstones of eating disorder treatment. Specialized resources are available for RDs to advance their level of expertise in the field of eating disorders. Further efforts with evidenced-based research must continue for improved treatment outcomes related to eating disorders along with identification of effective primary and secondary interventions.

Anorexia Nervosa↗

PubMed2001

Development and validation of a screening tool to identify eating disorders in female athletes.

OBJECTIVE: To develop and validate a screening tool to identify eating pathology in women athletes. DESIGN: Three cross-sectional subject groups were established: college women athletes diagnosed with eating disorders; college women athletes without eating pathology; college women who did not participate in athletics but were diagnosed with an eating disorder. The Female Athlete Screening Tool (FAST), and 3 valid psychometric measures were administered to subjects in all groups. Internal reliability, discriminant and concurrent validity were established. SUBJECTS/SETTINGS: Women college students between the ages of 18 and 23 years (n=41) from the University of Connecticut and St Joseph College were recruited. The athletes were screened for eating disorders by a sports medicine team. STATISTICAL ANALYSIS: Cronbach's alpha, one-way analysis of variance, and correlation analyses. RESULTS: Reliability analysis indicated a high internal consistency of the FAST (Cronbach's alpha = 0.87). Athletes with eating disorders scored significantly higher on the FAST as compared with athletes without eating pathology and nonathletes with eating disorders (P<.001), which demonstrated discriminant validity. Correlation analyses showed that the FAST was strongly correlated to the Eating Disorder Examination-Questionnaire (0.60, P<.05) and Eating Disorder Inventory (0.89, P<.001). APPLICATIONS/CONCLUSIONS: Early detection of eating disorders can help prevent the onset or severity of a clinical eating disorder. By using the screening tool that has been validated for use in women athletes, dietetic professionals can quickly identify those athletes who need assistance with their aberrant eating habits.

Adolescent↗

PubMed1996

Epidemiology of eating behaviour and weight distribution in 14- to 19-year-old Swiss students.

A sample consisting of 1944 Swiss students of both sexes was investigated with regard to distribution over weight categories based on BMI age percentiles and eating behaviour (EAT-26) in relation to age, sex and socio-economic status (SES). In addition, the relationship between BMI and Eating Attitudes Test scores was analysed. More subjects than expected were found to be in the obese weight categories. No clear effect of age and sex on the distribution of the sample across the five BMI classes was observed. There was an inverse relationship between BMI and socio-economic status. On the EAT scale girls scored twice as high as boys. Age had no effect on the EAT scores in females, although it did in males. Socio-economic status and EAT scores were inversely associated. Three risk categories based on the EAT scores were described: EAT 0-9 = no risk (77.5% girls, 93.0% boys), EAT 10-19 = low risk (14.1% girls, 5.5% boys), and EAT > or = 20 = high risk (8.3% girls, 1.5% boys). With regard to both aspects, weight and eating behaviour, female students showed more disturbed eating behaviour and fewer instances of deviation from normal weight. In male subjects there were more deviations from normal weight than instances of disturbed eating behaviour.

Adolescent↗

PubMed1996

Relationship between disturbed eating behavior and other psychosomatic symptoms in adolescents.

BACKGROUND: There has been relatively little research on subthreshold eating disorders and factors which might promote their transition to eating disorders. METHODS: A sample consisting of 1,944 Swiss adolescents of both sexes, 14-19 years of age, was investigated for eating behavior (EAT-26), psychological (SCL-90-R) and physical symptoms (GSCL-C). In addition, the relationship between eating behavior and other psychosomatic symptoms was analyzed. RESULTS: The results revealed significantly higher scores for females than males on all except one scale of the questionnaires. Three categories of disturbed eating behavior based on the EAT scores were described: EAT 0-9 = not disturbed (77.5% girls, 93.1% boys), EAT 10-19 = moderately disturbed (14.1% girls, 5.5% boys), and EAT > or = 20 = severely disturbed (8.3% girls, 1.5% boys). With regard to the three aspects, eating habits, psychosomatic symptoms and suicidality a significant correlation between disturbed eating behavior and concurrent psychological and physical symptoms was found in female but not in male subjects. CONCLUSIONS: The results emphasized that disordered eating behavior has to be seen as part of a broader psychopathological syndrome, especially in young women.

Adolescent↗

PubMed2002

Latent structure of eating disorder symptoms: a factor analytic and taxometric investigation.

OBJECTIVE: The latent structure of eating disorder symptoms, as defined by DSM-IV, was tested in a group of 341 women with and without an eating disorder diagnosis. METHOD: The study group consisted of 201 participants with a diagnosis of anorexia nervosa, bulimia nervosa, binge eating disorder, or eating disorder not otherwise specified; 24 comparison subjects who were obese but did not have an eating disorder diagnosis; and 116 normal-weight comparison subjects. The presence and severity of DSM-IV eating disorder symptoms was assessed with the semi-structured Interview for the Diagnosis of Eating Disorders-IV. The study group was randomly divided into two subgroups for factor analytic studies, and the data were subjected to exploratory and confirmatory factor analysis. Pilot taxometric analyses were used to examine whether the obtained factors represented true dimensions or latent discrete classes. RESULTS: In exploratory factor analyses with data from subgroup 1, three factors were found to account for 66% of the variance in eating disorder symptoms: binge eating, fear of fatness/compensatory behaviors, and drive for extreme thinness. Confirmatory factor analysis cross-validated this factor structure with data from subgroup 2. The eating disorder groups and comparison groups were found to differ on at least one of the three factors. The results of the taxometric analyses were inconsistent with a strictly dimensional model of eating disorders and suggested that some features may be dimensional whereas others may be taxonic (discrete). DISCUSSION: The eating disorders, as defined by DSM-IV, can be conceptualized as having three latent features. Taxometric tests found empirical support for conceptualizing bulimia nervosa and binge eating disorder as discrete syndromes.

Adult↗

PubMed2004

Thought-shape fusion in eating disorders.

OBJECTIVES: The aims of the present study were (1) to examine the association between a cognitive distortion ('thought-shape fusion') and eating disorder psychopathology and (2) to examine the degree of thought-shape fusion in people with eating disorders and a non-eating-disorder control group. DESIGN: Associations between thought-shape fusion and eating disorder psychopathology were examined and the degree of thought-shape fusion was compared between people with and without clinical eating disorders. METHOD: Forty-two women with clinical eating disorders and a group of 42 age-matched women with no self-reported history of an eating disorder completed self-report questionnaires to assess thought-shape fusion, eating disorder symptoms, body checking and body avoidance, and depression. RESULTS: Thought-shape fusion was significantly associated with eating disorder psychopathology. The majority of the associations remained significant when controlling for levels of depression. Patients with eating disorders showed significantly more thought-shape fusion than the non-clinical controls. CONCLUSIONS: Thought-shape fusion is a cognitive distortion associated with eating disorders. It may be a direct expression of the overevaluation of eating, shape and weight. It is recommended that thought-shape fusion be tackled directly in cases where it is a barrier to changing the core psychopathology of eating disorders.

Adolescent↗

PubMed2005

The validity and 4-year test-retest reliability of the Brazilian version of the Eating Attitudes Test-26.

In a cross-sectional study conducted four years ago to assess the validity of the Brazilian version of the Eating Attitudes Test-26 (EAT-26) for the identification of abnormal eating behaviors in a population of young females in Southern Brazil, 56 women presented abnormal eating behavior as indicated by the EAT-26 and the Edinburgh Bulimic Investigation Test. They were each matched for age and neighborhood to two normal controls (N = 112) and were re-assessed four years later with the two screening questionnaires plus the Composite International Diagnostic Interview (CIDI). The EAT results were then compared to diagnoses originating from the CIDI. To evaluate the temporal stability of the two screening questionnaires, a test-retest design was applied to estimate kappa coefficients for individual items. Given the prevalence of eating disorders of 6.2%, the CIDI psychiatry interview was applied to 161 women. Of these, 0.6% exhibited anorexia nervosa and 5.6%, bulimia nervosa (10 positive cases). The validity coefficients of the EAT were: 40% sensitivity, 84% specificity, and 14% positive predictive value. Cronbach's coefficient was 0.75. For each EAT item, the kappa index was not higher than 0.344 and the correlation coefficient was lower than 0.488. We conclude that the EAT-26 exhibited low validity coefficients for sensitivity and positive predictive value, and showed a poor temporal stability. It is reasonable to assume that these results were not influenced by the low prevalence of eating disorders in the community. Thus, the results cast doubts on the ability of the EAT-26 test to identify cases of abnormal eating behaviors in this population.

Adolescent↗

PubMed2006

[Eating and affective disorders: a comparative study].

BACKGROUND: The relationship between eating disorders and affective disorders still remains unclear. Eating disordered patients may have affective disorders and vice versa, depressed and maniac patients may experience eating problems. AIM: To compare eating symptoms, attitudes and behaviors in patients with affective disorders and normal subjects. SUBJECTS AND METHODS: A structured clinical interview, the Eating Attitudes Test (EAT-40) and the Eating Disorder Inventory (EDI) were administered to 194 patients that fulfilled the DSM-IV diagnostic criteria for eating disorders, to 45 patients with affective disorders and to 82 normal female students. RESULTS: Patients with eating disorders ranked significantly higher on the EAT-40 and on the EDI and its factors (p <0.001). Patients with affective disorders ranked between eating disordered patients and the students (p <0.001). Compulsive-purgative type of anorectics and purgative type of bulimics showed the highest scores on these measures (p <0.001). Restrictive type of anorectics scored significantly highest on EDI maturity fears item (p <0.001). Not significant difference was observed on the EDI ineffectiveness item, between purgative bulimics and depressive patients and between the latter and compulsive-purgative anorexics, on the EDI interpersonal distrust item. CONCLUSIONS: Compulsive-purgative type of anorectics and purgative type of bulimics showed the more severe psychological and behavioral disturbances. Restrictive types of anorectics were the most immature. Both purgative bulimics and depressive patients showed feelings of general inadequacy, and both compulsive-purgative anorexics and depressive patients displayed an interpersonal distrust. As a whole, patients with affective disorders did not show the core eating disordered behaviors and attitudes as seen in patients suffering from eating problems.

Adult↗

PubMed2006

[Lack of assertiveness in patients with eating disorders].

BACKGROUND: Low self-assertion has been noted as an important feature among patients with eating disorders. AIM: To verify, in a female population, if assertiveness is related or has a predictive capacity for the development of eating disorders. SUBJECTS AND METHODS: An structured clinical interview, the Eating Attitudes Test (EAT-40) and the Rathus Assertiveness Scale (RAS) were administered to 62 patients that fulfilled the DSM-IV diagnostic criteria for eating disorders and to 120 female students without eating problems. RESULTS: Patients with eating disorders ranked significantly higher on the EAT-40 and its factors (p <0.001) and showed a lower level of assertiveness on the RAS (p <0.001). Assertiveness measured by RAS and its factors was inversely related to EAT-40 and its items (r= -0.21). The predictive capability of the lack of self-assertion in the development of an eating disorder reached 53%, when patients with eating disorders and subjects at risk were considered together and compared to students without such disorder. CONCLUSIONS: Lack of assertiveness is a significant trait in patients with eating disorders; it may worsen its outcome and even perpetuate symptoms. Low self-assertion may be considered a predictive factor in the development of an eating disorder and must be managed from a preventive or therapeutic point of view.

Adolescent↗

PubMed1997

Abnormal eating attitudes in secondary-school girls in South Africa--a preliminary study.

OBJECTIVES: To document the existence of eating attitudes that may reflect current, pre- or subclinical eating disorders. To establish preliminary prevalence figures for abnormal eating attitudes. DESIGN: Cross-sectional survey of eating attitudes. SETTING: Non-clinical, community-based. SUBJECTS: Female high-school pupils. OUTCOME MEASURES: Total score derived from a self-report questionnaire, Eating Attitudes Test (EAT-26), which measures eating attitudes. Factor profile describing dimensions of eating-related psychopathology, derived from the clustering of questions on the EAT-26. RESULTS AND CONCLUSIONS: An overall prevalence figure of abnormal eating attitudes of 21.66% was documented. Black pupils had a higher prevalence than white pupils (37.5% v. 20.67%). The factor profile of respondents with abnormal eating attitudes did not differ between the race groups, although within the total sample, black respondents had a significantly stronger drive toward thinness. A significant developmental continuum was established, with prevalence figures for abnormal eating attitudes increasing with each standard from Standard 7 onward. The study provides preliminary epidemiological data on the prevalence of adolescent girls either suffering from or at risk of the development of an eating disorder. In addition, the study also provides evidence of the need for intervention strategies that commence in the pre-teen years.

Adolescent↗

PubMed2001

Binge eating disorder and obesity.

Binge eating disorder (BED) was included in the DSM IV as a proposed diagnostic category for further study and as an example for an eating disorder not otherwise specified (EDNOS). BED is characterized by recurrent episodes of binge eating in the absence of regular compensatory behavior such as vomiting or laxative abuse. Related features include eating until uncomfortably full, eating when not physically hungry, eating alone and feelings of depression or guilt. BED is associated with increased psychopathology including depression and personality disorders. Although BED is not limited to obese individuals, it is most common in this group and those who seek help do so for treatment of overweight rather than for binge eating. In community samples, the prevalence of BED has been found to be 2-5%, in individuals who seek weight control treatment the prevalence is 30%. BED is more equal in gender ratio than bulimia nervosa. Eating disorder treatments such as cognitive behavior therapy (CBT) or interpersonal psychotherapy (IPT) improve binge eating with abstinence rates of about 50%. Antidepressants are also effective in reducing binge eating, though less so than psychotherapy. Standard weight loss treatments including bariatric surgery do not seem to exacerbate binge eating problems. Thus, both eating disorder and obesity treatments seem to be beneficial in BED. However, it is recommended today that treatment should first be directed at the disordered eating and associated psychopathology.

Bulimia↗

PubMed2006

Isn't this just bedtime snacking? The potential adverse effects of night-eating symptoms on treatment adherence and outcomes in patients with diabetes.

OBJECTIVE: Night-eating syndrome is characterized by excessive eating in the evening and nocturnal awakening with ingestion of food. Psychosocial variables and emotional triggers may be associated with these behaviors. In patients with diabetes, such behaviors may lead to glucose dysregulation and contribute to obesity and complications. RESEARCH DESIGN AND METHODS: In 714 tertiary care patients with type 1 and 2 diabetes, we determined the proportion of patients reporting eating >25% of their daily food intake after regular suppertime. We also screened patients for major depression, childhood maltreatment histories, nonsecure attachment styles, and emotional eating triggers. We examined whether patients reporting night-eating behaviors had greater psychosocial distress, higher HbA(1c) (A1C) levels, more obesity, and more diabetes complications compared with patients without night-eating behaviors. RESULTS: Night-eating behaviors were reported in 9.7% of patients. Compared with patients without night-eating behaviors, those with these behaviors were less adherent with diet, exercise, and glucose monitoring and more likely to be depressed, to report childhood maltreatment histories, to have nonsecure attachment styles, and to report eating in response to anger, sadness, loneliness, worry, and being upset. Controlling for age, sex, race, and major depression, patients with night-eating behaviors, compared with patients without night-eating behaviors, were more likely to be obese (odds ratio 2.6 [95% CI 1.5-4.5]), to have A1C values >7% (2.2 [1.1-4.1]) and to have two or more diabetes complications (2.6 [1.5-4.5]). CONCLUSIONS: Night-eating behaviors are associated with adverse outcomes in patients with diabetes. Use of clinical screening tools may help identify patients with night-eating behaviors.

Adolescent↗

PubMed2000

[Night eating in severely obese patients].

BACKGROUND: To investigate the frequency of night eating among obese patients, its biological correlates and its relationships with binge eating. METHODS: The eating behavior of a group of patients enrolled in a weight-loss program was evaluated by Eating Inventory (EI) and by semistructured interviews designed to detect binge and night eating; in all cases body weight (BW) and energy expenditure (REE) were measured. RESULTS: Night eating was more frequent among binge eating patients, than in among non-binge ones. However, two-way ANOVA demonstrated that in binge eating patients the EI disinhibition and hunger score was higher than in their no-bingeing counterparts and in night eating individuals. Furthermore, between night eating and non-night eating patients, no differences in BW and REE were found. CONCLUSIONS: Binge eating and night eating appear to be related to different psychological constructs, the overlapping between the two behaviors, however, being quite frequent.

English Abstract↗

PubMed2007

Cultural correlates of eating attitudes: a comparison between native-born and immigrant university students in Israel.

OBJECTIVE: This study explores the association between gender and exposure to Western culture and attitudes toward eating. METHOD: Four hundred and ninety-nine university students participated in the study: 216 Israeli natives, 153 new immigrants (3 years or less since immigration) from the Former Soviet Union (FSU), and 130 veteran immigrants from FSU (4-15 years since immigration). Attitudes toward eating were measured using the Eating Attitude Test - EAT-26. RESULTS: Israeli born women had higher weight and body mass index (BMI) than did new immigrant women. Higher scores on the EAT-26 were found among women than among men. Among women only, native-born Israelis and veteran immigrants were more likely to have positive EAT-26 scores (19.6%, 18.8%) than were new immigrant women (7.9%), indicating disordered eating attitudes. Part of the differences in EAT-26 scores was explained by differences between the groups on age and BMI; however, even after adjustment the differences remained significant on the bulimia subscale. CONCLUSION: The results suggest a rapid cultural effect in attitudes toward eating that may reflect a tendency toward eating disorders as well as a difference in the proportion of obesity. It seems that the veteran immigrants have adopted Western cultural norms and eating patterns in a way that has erased the differences in tendency toward eating disorders between them and the Israeli born women.

Acculturation↗

PubMed1998

Eating disorders and Axis I psychiatric comorbidity in amenorrheic women.

OBJECTIVE: The present study aimed to investigate the relationship between secondary amenorrhea due to different etiologic mechanisms, eating disorders, and psychiatric morbidity in a nonpsychiatric population observed in a gynecological department. METHOD: Amenorrheic women (n = 95) with hypogonadotropic, hyperandrogenic, and hyperprolactinemic features were interviewed individually using the SCID-R (Structured Clinical Interview for DSM-III-R) to diagnose Axis I disorders including mood disorders, anxiety disorders, somatoform disorders, adjustment disorders, and eating disorders. Binge eating disorder was diagnosed according to DSM-IV criteria. RESULTS: The incidence of eating disorders was significantly higher in hypogonadic women than in hyperandrogenic and hyperprolactinemic subjects (chi 2 = 23.03, p < .003). However, we also found a high percentage of hyperandrogenic women suffering from an eating disorder (40.9%) with a prevalence of binge eating disorder (27.2%), while the only eating disorder described in the hyperprolactinemic group was the not otherwise specified. In addition, a marked psychiatric comorbidity was found in amenorrheic women suffering from an eating disorder but a similar trend of pathologies was also found in amenorrheic women, without any positive SCID diagnosis for an abnormal eating disorder. DISCUSSION: Our study demonstrated that a high incidence of eating disorders, mainly anorexia and binge eating, characterizes hypogonadic and hyperandrogenic women, respectively. In addition, secondary amenorrhea displays a wide spectrum of Axis I diagnoses, without a significant comorbidity with eating disorders. Whether or not the endocrine findings related to the amenorrheic condition constitute a common background for the occurrence of psychopathology or, alternatively, the presence of psychiatric disturbances may contribute to the development of menstrual dysfunction remain to be clarified.

Adult↗

PubMed2004

Self-disclosure in eating disorders.

OBJECTIVE: Secrecy and concealment are typical behaviours in individuals with eating problems. This study explored the relationship between eating-related problems and self-disclosure. It examined whether women with greater eating related problems were less willing to disclose. Different types of self-disclosure were calculated, considering disclosure related to body appearance and to restrained eating. The role of risk factors which concur to the development and maintenance of eating symptomatology was also explored. METHOD: The Eating Symptoms Inventory was used to investigate the existence of an eventual eating symptomatology, self-disclosure was calculated through the Self-Disclosure Index, while a new scale was validated to assess a self-disclosure related to body image and eating attitudes. Other scales measured the influence of different risk factors, as body dissatisfaction, social pressure to be thin, and restrained eating. RESULTS: A significant inverse relationship was found between general self-disclosure and psychological aspects related to the practice of wrong weight control behaviours and risk factors as dieting, body dissatisfaction, and social pressure to be thin. The significant role of risk factors was confirmed in the development and maintenance of eating disturbances. Interesting results were found using the different self-disclosure indexes as mediators and moderators. Relevant differences were found between Dutch and Italians concerning to their eating attitudes and to the role of different risk factors. CONCLUSION: Some limits are the impossibility to generalize these findings and the use of a non clinical sample. Some new longitudinal studies should be done in this direction to deepen the relationship between self-disclosure and eating disorders.

Adolescent↗

PubMed2001

Abnormal eating attitudes and behaviours and perceived parental control: a study of white British and British-Asian school girls.

BACKGROUND: Previous studies have found significantly higher scores on the Eating Attitudes Test (EAT-26) which measures eating disorders among second-generation British-Asian schoolgirls in comparison to their White counterparts. Further, high EAT-26 scores (an indication of unhealthy eating attitudes and behaviours) are positively associated with parental overprotection scores on the Parental Bonding Instrument (PBI). This study aimed to replicate and extend previous findings, comparing British-Asian schoolgirls to White schoolgirls and consider 'intra-Asian' differences on the same measures, including factor scores. METHODS: Participants completed three questionnaires: EAT-26, PBI and BSS (Body Satisfaction Scale). There were 168 participants: 46 White, 40 Indian, 44 Pakistani and 38 Bengali. RESULTS: Previous findings were supported; the Asian scores were significantly higher than the White scores on the EAT-26 and PBI, but not the BSS. The Bengali sample had significantly higher EAT-26 total and 'oral control' scores than the other groups. There were no intra-Asian differences for the overprotection scores. PBI scores were not associated with EAT-26 scores. The BSS score was the only significant predictor of EAT scores, when entered into a regression along with PBI scores and the body mass index. CONCLUSION: Results demonstrated sociocultural factors in the development of eating disorders. The results suggest that there are important psychological differences between second-generation migrants from different countries on the Indian subcontinent. In line with previous studies, significant differences were found between the four ethnic groups, parenting styles, but these did not relate to actual eating disorders.

Adolescent↗