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PubMed2001

Validating the Eating Disorder Inventory-2 (EDI-2) in Sweden.

OBJECTIVE: To validate the Eating Disorder Inventory-2 (EDI-2) on a Swedish population by investigating differences between 1) young women with eating disorder symptoms (patients and non-patients), and normal controls and 2) patients with different eating disorder diagnoses, regarding symptom load and psychological characteristics. Another objective was to update EDI as a screening instrument METHOD: Patients (n=194) with DSM-IV confirmed eating disorder diagnoses (anorexia nervosa AN; bulimia nervosa BN; eating disorder not otherwise specified, EDNOS) were compared vvith each other and with randomly selected and matched controls consisting of young women with self-reported eating disorder symptoms (n=51) and women without such symptoms (n=188). RESULTS: In general, women vvith eating disorderproblems, whether or not they were patients, scored significantly higher on both symptoms and personality characteristics compared to normal controls. Patients with DSM verified eating disorders did not differ from women with self-reported eating disorders symptoms on body dissatisfaction, perfectionism and impulsiveness. Women with self-reported symptoms did not differ from women without symptoms on interpersonal distrust and maturity fears. Amongst the patient groups, BN patients scored highest, and AN patients lowest, on self-reported pathology. Most of the EDI-2 scales and all the three indexes had acceptable specificity and sensitivity. CONCLUSION: EDI-2 discriminates well between women with eating disorder symptoms and normal controls, but responses from patients with AN should be interpreted with care. The EDI-2 indexes are especially recommended for screening purposes.

Adolescent↗

PubMed2005

Night eating syndrome: evaluation of two screening instruments.

The purpose of the present study was to determine whether night eating syndrome was associated with treatment outcomes during a brief weight loss intervention for self-identified night snackers, and to evaluate the diagnostic utility of a screening question and the Night Eating Syndrome Questionnaire (NESQ) for the detection of night eating syndrome. Participants enrolled in a 4-week randomized clinical trial for obese and overweight persons who self-identified as night snackers were administered a structured clinical interview, a night eating screening question, and the NESQ. Treatment outcomes included adherence and weight loss. Results showed that night eating syndrome diagnoses were not associated with treatment outcomes. The screening question had adequate sensitivity but poor specificity. The night eating questionnaire was positively correlated with increasingly stringent definitions of night eating syndrome. Night eating syndrome is not the equivalent of night snacking. The definition of night eating syndrome must be expanded to include a sleep disturbance component accompanied by night eating.

Adult↗

PubMed2005

The specific content of core beliefs and schema in adolescent girls high and low in eating disorder symptoms.

The specific content of core beliefs and schema in adolescent girls high and low in eating disorder symptoms was investigated using the Eating Disorder Belief Questionnaire (EDBQ)-negative self-beliefs sub-scale and Young Schema Questionnaire (YSQ). Girls with high Eating Attitude Test (EAT) scores had higher scores on both measures (using total and sub-scale scores) than girls with low EAT scores. However, all scores were related to eating disorder as well as depressive symptoms. Analysis of individual items on the EDBQ and YSQ found that scores on all EDBQ, but not all YSQ items, differed between the two groups, with higher scores in the high EAT group. However, a number of individual items (on both measures) in the high EAT group, as well as in the low EAT group, were related specifically to eating disorder symptoms and not also to depressive symptoms.

Adolescent↗

PubMed2005

Disordered eating attitudes and symptomatology among adolescent girls in the United Arab Emirates.

OBJECTIVE: To ascertain the prevalence and correlates of disordered eating attitudes and symptomatology in a school-based Arab population. METHODS: A representative stratified random sample of 495 adolescent girls completed the Eating Attitudes Test (EAT-40) in the United Arab Emirates (UAE). A randomly selected subgroup from the those who scored above the recommended cut-off of 30 on the EAT-40 and an equal number of those who scored below 30 were interviewed in stage 2 by a psychiatrist, blind to the EAT scores, using the Schedule for Affective Disorders and Schizophrenia (KSADS) and DSM-IV criteria for the presence of eating disorders. RESULTS: 116 girls (23.4%) scored above the recommended cut-off on EAT. High EAT score was associated with age, BMI, internalization of thin ideal and drive for thinness, knowing someone on a weight loss strategy, having a family member with weight-related or mental health problem and watching western TV programs. Using clinical interview of 100 girls in stage 2, half of those who scored above the cut-off on EAT were found to have a propensity for anorexic behavior, while 2% met the criteria for the full clinical syndrome. CONCLUSIONS: Thin body preoccupation as well as family and social factors are important in the development of abnormal eating attitudes among adolescents in this Arabian Gulf country.

Adolescent↗

PubMed2005

Role of brain-derived neurotrophic factor in eating disorders: recent findings and its pathophysiological implications.

Eating disorders, which include anorexia nervosa (AN) and bulimia nervosa (BN), are disorders characterized by abnormal patterns of weight regulation and eating behaviors, and by disturbances in attitudes and perceptions toward weight and body shape. Brain-derived neurotrophic factor (BDNF) plays a critical role in regulating neural survival, development, function, and plasticity in the brain. Recent findings using heterozygous BDNF (+/-) knock-out (reduced BDNF levels) mice have provided evidence that BDNF plays a role in regulating eating behaviors. Recently, we found that serum levels of BDNF in patients with eating disorders are significantly decreased compared with normal controls. In addition, an association between the BDNF gene polymorphism and eating disorders has been demonstrated. We reviewed the role of BDNF in the pathophysiology of eating disorders and the BDNF gene as a susceptibility gene for eating disorders. Considering the low levels of BDNF in patients with eating disorders, using drugs that increase the BDNF levels and/or BDNF gene therapy are possible novel therapeutic approaches. Providing confirmation that the BDNF gene is the true susceptibility gene for eating disorders could lead to rapid therapeutic progress in treating these disorders. In addition, a more complete understanding of the signal transduction pathway via the p75 neurotrophin receptor (p75NTR) and TrkB receptors would provide new perspectives for treating eating disorders.

Animals↗

PubMedDate not supplied

Eating behavior and pregnancy outcome.

The association between clinical eating disorders, maternal body weight, shape, and eating concerns, and the birth of low-birth-weight infants (LBW; less than 2500 g) was investigated using a retrospective case-control study. Eighty-eight women delivering LBW infants were interviewed and then divided into two groups--those delivering term, small-for-gestational-age infants (SGA; 37 or more completed weeks, n = 34) and those delivering premature infants (less than 37 completed weeks, n = 54). There were 86 reference women (CTRL) matched for age, parity, and health insurance status, who delivered babies with birth weights greater than 2500 g. In the week postpartum, women delivering term SGA, premature (PREM), and CTRL infants were interviewed using a semistructured interview. One section of this interview included a modified version of the Eating Disorder Examination (EDE), which retrospectively generated, over the previous 12 months, diagnosis of an eating disorder and maternal "normative" weight and shape concerns. In the 3 months before pregnancy, 32% of SGA women, 9% PREM women, and 5% of reference women were diagnosed as having a clinical eating disorder. Women with a past history of an eating disorder had no greater risk of delivering a low-birth-weight infant. Women delivering SGA infants, reported elevated eating disorder psychopathology postdelivery (Eating Disorders Inventory, EDI) and more disturbances in eating behavior before and during pregnancy. Unique predictors for delivery of a LBW term SGA infant were: low maternal prepregnancy body weight, smoking, low maternal weekly weight gain, and elevated EDI (Bulimia subscale). Unique predictors for delivery of a LBW premature infant were: lower maternal occupational status, vomiting in pregnancy, and lower dietary restraint. Women with disordered eating were shown to be at greater risk of delivering term SGA infants. Predictors of term growth retardation are partly determined by maternal behavior.

Adult↗

PubMed2000

Detection and management of eating disorders during pregnancy.

Eating disorders such as anorexia nervosa and bulimia nervosa are associated with potential negative consequences during pregnancy, including higher rates of miscarriage, low birth weight, obstetric complications, and postpartum depression. Women with eating disorders are reluctant to disclose symptoms to health care providers, so it is important for obstetric clinicians to be aware of warning signs and assessment techniques to identify them. Signs suggestive of eating disorders include lack of weight gain, hyperemesis gravidarum, and a history of eating disorders. Recent studies showed that the Eating Disorder Examination, a newly developed assessment tool, can ascertain whether someone has an eating disorder. Questions from the Eating Disorder Examination about body image, food avoidance, food rules, and dieting behaviors have successfully differentiated women with eating disorders from healthy controls. We offer an approach to the clinical care of individuals identified or suspected of having eating disorders. We recommend a team approach that emphasizes ongoing communication and clear goal setting for the care of pregnant women with eating disorders.

Birth Weight↗

PubMed2005

Preliminary evidence that gonadal hormones organize and activate disordered eating.

OBJECTIVE: Eating disorders are more common in females than in males. Gender differences may be due to organizational (i.e. prenatal) and activational (i.e. post-natal) gonadal hormone effects that influence sex differences in behavior. This preliminary set of studies examined these effects by investigating relationships between eating disorder symptoms, prenatal testosterone exposure, and adult levels of estrogen in women. METHOD: We examined organizational associations by investigating relationships between disordered eating and finger-length ratios, which are known to be somatic markers of prenatal testosterone exposure. Participants included 113 adult female twins drawn from the community. Disordered eating was assessed with the total score from the Minnesota Eating Behavior Survey (MEBS). Finger lengths were hand scored using a ruler and photocopies of both hands. We also investigated activational influences by examining associations between circulating levels of estradiol and disordered eating symptoms. Two independent samples of adult females (n's = 24 and 25) drawn from the community were used for this study. Disordered eating was again assessed with the MEBS total score, while saliva samples were used for assessing estradiol. RESULTS: Positive associations were found between disordered eating and both finger-length ratios and circulating estradiol levels. CONCLUSIONS: Findings suggest that lower levels of prenatal testosterone exposure and higher adult levels of estradiol are associated with increased eating disorder symptoms. We hypothesize that the relatively low level of testosterone before birth in females permits their brains to respond to estrogens at puberty, when the hormones activate the genes contributing to disordered eating in vulnerable girls.

Adolescent↗

PubMed2000

The health-related quality of life in eating disorders.

OBJECTIVE: This study investigated the perception of health-related quality of life (HRQoL) in ambulatory patients with eating disorders in relation to the severity of eating symptomatology and psychological comorbidity. METHODS: One hundred ninety-seven study patients were consecutively recruited at the Eating Disorders Outpatient Clinic. Short Form-36 items (SF-36), a generic HRQoL questionnaire, the Eating Attitudes Test (EAT-40), and the Hospital Anxiety and Depression Scale (HAD) were used to measure different aspects of HRQoL. The results of the SF-36 were compared with the norms of the Spanish general population for women 18-34 years of age. RESULTS: Patients with eating disorders were more dysfunctional in all areas of the SF-36 compared with women in the general population. There were no differences among the eating disorder diagnostic groups. Higher scores on the EAT-40 and the HAD were associated with a perception of greater impairment on all SF-36 subscales. CONCLUSION: The evaluation of HRQoL in these patients confirms the impact of these disorders on daily life in areas not directly related to eating disorders. The SF-36 is useful for discriminating among different levels of severity of eating disorders and other psychological comorbidities of these patients.

Adolescent↗

PubMed2005

Gender differences in associations of eating pathology between mothers and their adolescent offspring.

OBJECTIVE: To study the association of eating pathology between mothers and their adolescent offspring in a population sample. RESEARCH METHODS AND PROCEDURES: The participants were 481 women (mean age, 47+/-SD 5 years; BMI, 25+/-4 kg/m2) and their 481 adolescent children 16 to 17 years old (BMI, 21+/-3 kg/m2) of the Stockholm Weight Development Study. Assessment methods were the Three-Factor Eating Questionnaire Revised 18 and the Eating Disorder Inventory 2. RESULTS: A higher body weight was most related to cognitive restraint for adolescents and to emotional eating for adult women. A mother-daughter link could be identified for eating pathology, with the strongest link found for emotional eating. No mother-son link could be identified. Age subgroup analyses revealed a stronger mother-daughter link for body attitudes in younger mothers and for cognitive restraint in older mothers. DISCUSSION: Gender differences revealed that eating pathology was shared by mothers and daughters but not by mothers and sons. A psychological strategy such as eating as a response to negative emotions was most interrelated between mothers and daughters. Younger mothers shared more attitudes toward the body with their daughters, whereas older mothers shared more restrictive eating behaviors with their daughters. The mother-daughter links found may be due to gender-specific genetic and psychological family transmission and gender-specific environmental influences. The sons' eating behaviors seem to be more independent and would be formed by other factors than for the girls.

Adolescent↗

PubMed2006

Characterization of obese individuals who claim to detect no relationship between their eating pattern and sensations of hunger or fullness.

OBJECTIVE: To study the phenomenon that obese subjects show considerable individual variability in their reported relationships between eating and sensations of hunger and fullness. DESIGN: A laboratory study of the relationship between eating behaviour traits and the episodic oscillations in sensations of hunger and fullness in response to obligatory, fixed energy breakfast (481 kcal) and lunch (675 kcal) meals. SUBJECTS: Obese subjects were divided into two groups based on their responses to four 'screening' questions associated with their habitual experience of hunger and fullness sensations before and after eating: those who experienced sensations of hunger and fullness related to eating (Related-R; n=20, body mass index (BMI)=42.4 kg/m(2)) and those for whom eating was not related to hunger or fullness sensations (Unrelated - UR; n=19, BMI=41.3 kg/m(2)). In addition, a control, lean group (Control - C; n=14, BMI=22.6 kg/m(2)) who experienced sensations of hunger and fullness related to eating was studied. MEASUREMENTS: The Three-Factor Eating Questionnaire (TFEQ) was used to measure the eating behaviour traits, disinhibition, restraint and hunger. Profiles of subjective appetite sensations were continuously monitored across the day using visual analogue scales. RESULTS: All groups displayed clear meal-related oscillations in subjective sensations of hunger, fullness, desire to eat and prospective consumption. In contrast, the TFEQ disinhibition and hunger scores (but not restraint scores) were significantly different (P<0.05) between the groups ((UR; D=13.5+/-0.5, H=10.0+/-0.5), R (D 7.5+/-0.6, H 6.1+/-0.4), C(D 3.7+/-0.5, H 3.7+/-0.5)). In addition, analysis of the intra-meal changes in subjective appetite sensations revealed that the UR group displayed a smaller meal-induced suppression of hunger and elevation of fullness. CONCLUSION: These data indicate that the reported relationship between eating and hunger/fullness was associated with obese individuals showing high or low disinhibition scores. In addition, the data suggest that the processes underlying disinhibition may be associated with a modulation of the recognition of meal-related satiety sensations.

Adult↗

PubMed2002

Parent and child report of family functioning in a clinical child and adolescent eating disorders sample.

OBJECTIVE: To investigate parent and self-report of family dysfunction in children and adolescents with eating disorders. Further, to investigate family functioning differences across the eating disorders diagnostic groups; anorexia nervosa, eating disorders not otherwise specified (EDNOS) and bulimia nervosa, and between the restricting and binge-purge eating disorders behavioural subtypes. METHODS: The Family Adjustment Device General Functioning Scale (FAD-GFS) was administered to 100 children and their parents who presented consecutively at an eating disorders assessment clinic. DSM-IV eating disorders diagnoses in this group included 42 children diagnosed with anorexia nervosa, 26 with EDNOS, 12 with bulimia nervosa and 20 diagnosed as having no eating disorder. RESULTS: Both the parent and child FAD-GFS report demonstrated high internal consistency supporting the suitability of this instrument for research with this sample. Parent and child reports were moderately positively correlated. Total scores for all eating disorders diagnostic categories were significantly higher than community norms. Anorexia nervosa, EDNOS and bulimia nervosa groups did not significantly differ on parent or child reports. FAD-GFS profiles for restricters and binge-purgers suggest higher levels of family dysfunction in the families of binge purgers. CONCLUSIONS: The FAD-GFS has suitable psychometric properties for use as a summary instrument with young people diagnosed with an eating disorder. However, more informative instruments assaying a greater range of constructs, especially in the impulsive, dyscontrol domain, are required to investigate differences among eating disorders diagnostic groups and behavioural subtypes.

Adolescent↗

PubMed2004

[Disturbed eating behaviour among high school and university students].

To develop suitable preventive programs for eating disorders, it is important to examine the prevalence and severity of disturbed eating behaviour in the corresponding risk population as well as to investigate the conditions that might explain their origin and further progression. Based upon this background 736 female and male high school and university students from Eastern and Western parts of Germany were examined. Height and weight were measured objectively. In accordance with the study of Buddeberg-Fischer three groups were defined depending on the total score in the Eating Attitudes Test. 28.5 % of the women and 12.6 % of the men revealed impaired eating behaviour with female high school students being specifically affected (35.3 %). With an increasing impairment, women more often used methods to regulate their weight like diets, restrained eating, or drugs. Participants with disordered eating behaviour were also more likely to show higher scores on the subscales of the Eating Disorders Inventory and a distorted body perception. The feeling of being overweight showed a correlation with the severity of the disturbed eating. With increasing eating problems the correspondence between the real existing BMI and the subjective estimation of the weight decreased significantly. The results of this study clearly demonstrate the high prevalence of disturbed eating behaviour and concerns about weight among female adolescents and young adults. Female high school students should be a special target group for the application of preventive programs. The reported use of drugs in order to lose weight should be discussed more explicitly.

Adolescent↗

PubMed1999

The neglected link between eating disturbances and aggressive behavior in girls.

OBJECTIVES: Research has linked eating disturbances with behavioral impulsivity. Little is known, however, about whether eating disturbances and aggressive behavior have a tendency to co-occur in the same girls. This article assesses the eating disturbance-aggressive behavior association and then examines the extent to which these factors confer a risk on drug use and attempted suicide. METHOD: Survey data were gathered from 3,630 girls in grades 6 through 12 in the upper Midwest. Girls responded anonymously to questions regarding binge eating and purging, dietary restriction, aggressive behavior, drug use, and attempted suicide. Logistic regression analysis was used to assess the unique contribution of demographic variables, eating disturbances, and aggression on drug use and attempted suicide. RESULTS: Eating disturbances were significantly associated with aggressive behavior. Girls who endorsed binge eating and purging or dietary restriction had odds of aggressive behavior 2 to 4 times higher than girls who did not endorse these items. Logistic regression revealed that eating disturbances and aggressive behavior were significantly associated with both drug use and attempted suicide. CONCLUSIONS: Eating disturbances are significantly associated with aggressive conduct in adolescent girls. The constellation of eating disturbances and aggressive behavior is associated with a greater risk of drug use and attempted suicide.

Adolescent↗

PubMedDate not supplied

Psychiatric comorbidities of female inpatients with eating disorders.

OBJECTIVE: We analyze 27 point-prevalent DSM-IV Axis I comorbidities for eating disorder inpatients. METHODS: The sample included 2436 female inpatients treated between January 1, 1995, and December 31, 2000, for primary DSM-IV diagnoses of anorexia, bulimia, and eating disorder not otherwise specified. Analyses were multivariate analysis of variance and multinomial logistic regression; sociodemographics and severity-of-illness measures were controlled. RESULTS: Ninety-seven percent of patients evidenced > or = 1 comorbid diagnoses; 94% evidenced comorbid mood disorders, largely unipolar depression, with no differences across eating disorders; 56% evidenced anxiety disorders, with no differences across eating disorders; and 22% evidenced substance use disorders, with significant differences across eating disorders (p < .0001). Five specific diagnoses differed across eating disorders. Alcohol abuse/dependence was twice as likely with bulimia (p < .0001); polysubstance abuse/dependence three times as likely with bulimia (p < .0001); obsessive-compulsive disorder twice as likely with restricting and binge/purge anorexia (p < .01); posttraumatic stress disorder twice as likely with binge-purge anorexia (p < .05); schizophrenia/other psychoses three times more likely with restricting anorexia (p < .05) and two times with binge-purge anorexia (p < .05). CONCLUSIONS: New findings emerged: extremely high comorbidity regardless of eating disorder, ubiquitous depression across all eating disorders, no difference in overall rate of anxiety disorders across eating disorders, greater posttraumatic stress disorder in binge-purge anorexia, more psychotic diagnoses in anorexia. Certain previous findings were confirmed: more obsessive-compulsive disorder in anorexia; more substance use in bulimia; and a replicated comorbidity rank-ordering for eating disorder patients: mood, anxiety, and substance use disorders, respectively.

Adolescent↗

PubMed2004

Stroke and eating difficulties: long-term experiences.

BACKGROUND: Previous studies have shown that eating difficulties after stroke are common and often associated with communication problems. These difficulties, however, have mainly been studied from a professional perspective. Although numerous aspects of dysfunction have been identified, little knowledge exists about the experiences of living with eating difficulties. AIM: To explore how people affected by stroke experience living with eating difficulties, during a prolonged period. DESIGN: Explorative, qualitative case study. METHODS: Repeated interviews and participant observations with three persons 1.5-2 years after their last stroke. Data were analysed using qualitative analysis. RESULTS: Eating difficulties after stroke were experienced as Striving to live a normal life, with the subthemes Abandoned to learn on one's own, Experiences of losses and Feeling dependent. The process of getting back to a life that resembled life before the stroke was experienced as long-lasting and hard work. The informants felt that they were abandoned to manage eating training on their own. The informants experienced a loss of functional eating ability and the ability to perform activities related to food and meals. Feelings of dependence were experienced in mealtime situations. CONCLUSION: Living with eating difficulties after stroke is a complex phenomenon. The informants felt abandoned because of lack of support from the nursing staff. They were left on their own to deal with the difficult process of adjusting to a new way of eating and losses regarding mealtime activities. The combination of repeated interviews and participant observations seemed to be an approach that should be tested in larger studies. RELEVANCE TO CLINICAL PRACTICE: This case study indicates a need for nurses to develop and use evidence-based guidelines for eating training during the continuum of care. Nurses need to assess patient's habits and desires related to eating, and to adjust environment according to patient preferences.

Aged↗

PubMed2004

Electrogastrography abnormality in eating disorders.

Eating disorders are common psychiatric disorders in young women. The aim of the present study was to evaluate the gastric electrical activity of patients with eating disorders and its relation to their symptoms. The electrogastrography (EGG) was performed before and after a water load test for outpatients with eating disorders (n = 36; 14 anorexia nervosa, 14 bulimia nervosa, eight eating disorder not otherwise specified) and healthy women (n = 19). A structured interview (Eating Disorder Examination) was used to assess clinical symptoms. The percentage of normal gastric myoelectrical power was significantly smaller in the eating disorder patients (44.5% vs 74.2%; P < 0.05), while the percentage of bradygastric power was significantly greater, both before and after the water load test compared with the control subjects (30.4% vs 10.4%; P < 0.05). In addition, moderate correlation was found between the duration of illness and the percentage of bradygastria (P < 0.05). In conclusion, it is suggested that longstanding abnormal eating in patients with eating disorders may induce disturbances to gastric motor function, resulting in their abnormal, eating-related behavior, and form a symptomatic vicious circle. The EGG may be a promising method for determining the pathophysiology of eating disorders and for developing effective therapeutic approaches.

Adolescent↗

PubMed2005

Acculturation and eating disorders in Asian and Caucasian Australian adolescent girls.

The present study aimed to compare the attitudes and psychopathology of eating disorders between Asian and Caucasian adolescent girls; and investigate the relationship between acculturation and the attitudes and psychopathology of eating disorders in subgroups of Asian girls. Two groups of non-clinical adolescent girls in Perth, Western Australia, were compared using a survey method. There were 17 Asian and 25 Caucasian adolescent girls, aged 14-17 drawn from private high schools in Perth who were screened using the Eating Attitudes Test (EAT-26), the Eating Disorders Inventory (EDI-2), and an acculturation index. The psychopathology scores for eating disorders of the Asian group were significantly higher than that of the Caucasian group in terms of total EDI-2 score, Interpersonal Distrust, Maturity Fears, Impulse Regulation and Social Insecurity subscales. Eating attitudes measured by Dieting subscale of the EAT-26 was significantly different. Within the Asian group, the less acculturated girls had higher scores on the EAT-26 and the EDI-2 than the more acculturated. Less acculturated Asian girls appeared to have unhealthier attitudes and psychopathology toward eating.

Acculturation↗