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PubMed1999

Eating disorders.

Eating disorders are common among adolescent girls and young women and are associated with potentially serious medical complications, yet they often go undetected and untreated. All patients with eating disorders should be evaluated and treated for medical complications of the disease at the same time that psychotherapy and nutritional counseling are undertaken. Pharmacologic agents are often useful as adjuncts to psychotherapy for bulimia nervosa or binge-eating disorder; in the case of anorexia nervosa, psychotropic medication is generally reserved for patients with a concurrent psychiatric illness or those who have recovered some weight.

Body Weight↗

PubMed2006

The impact of client race on clinician detection of eating disorders.

Eating disorders are thought to occur less among African-American women than among women of other ethnic groups. Ninety-one clinicians read 1 of 3 passages (differing only with regards to the girl's race: African-American, Caucasian, or Hispanic) describing disturbed eating patterns of a fictional character named Mary. Participants were then asked to indicate if they thought Mary had a problem and to rate her anxiety, depression, and eating disorder symptoms based upon the passage they had read. The results suggest that clinicians may have race-based stereotypes about eating disorders that could impede their detection of symptoms in African-American girls.

Adolescent↗

PubMedDate not supplied

Cardiovascular complications of eating disorders.

Eating disorders (anorexia nervosa and bulimia) are associated with the highest mortality rate of any psychiatric disorder. Much of this mortality and morbidity stem from cardiovascular complications such as arrhythmia related to a prolonged QTc interval and/or electrolyte disorders, hypotension, and bradycardia. Structurally, the heart in patients with eating disorders is atrophic, which may relate to longstanding hypovolemia. These patients have low cardiac output and demonstrate increased peripheral vascular resistance despite the presence of hypotension. The treatment of eating disorders is incremental caloric feeding, which can have its own intrinsic cardiovascular risk (refeeding syndrome) manifested by arrhythmia, tachycardia, congestive heart failure, and sudden cardiac death. Patients will require close monitoring and slower refeedings to minimize the risk of these complications.

Anorexia Nervosa↗

PubMed2001

The consequences and costs of the eating disorders.

Eating disorders are severe, relatively chronic conditions that are associated with comorbid psychopathology and adverse medical conditions. The death rate for patients with AN is the highest among psychiatric conditions, with high suicide rates and deaths from physiologic causes. In addition, the costs of therapy for AN are higher than those for schizophrenia. Although somewhat less chronic, BN and binge-eating disorder are costly conditions to treat, similar to or more expensive than the costs for the treatment of OCD. Although antidepressant medication seems to be the most cost-effective treatment in the short term, given the higher relapse rates with antidepressants, it seems that, in the end, CBT may be the most cost-effective approach to the treatment of BN. It is possible that similar figures would occur for binge-eating disorder. The issue of the comparative cost-effectiveness of various treatments for psychiatric disorders has been neglected in the research literature to date. It is important that large-scale RCTs add a sophisticated cost-effectiveness analysis to the design so that physicians can better choose the most effective and cost-effective sequence of therapies for their patients.

Cost of Illness↗

PubMed1998

Functional gastrointestinal disorders and eating disorders. Relevance of the association in clinical management.

BACKGROUND: As functional gastrointestinal disorders (FGID) are common in eating disorder patients, we aimed to assess past eating disorders in patients referred for current FGID. METHODS: One hundred and twenty-seven consecutive FGID outpatients and 163 patients with gallstone disease (GD) were enrolled. All patients were interviewed to detect GI symptoms (by means of the GI Symptom Rating Scale), lifetime eating disorders (on the basis of DSM-IV criteria), and current psychologic distress (on the Hospital Anxiety and Depression Scale). RESULTS: Past eating disorders were significantly more prevalent in FGID (15.7%) than in GD patients (3.1%) (chi-square = 14.6, P < 0.001). FGID patients with past eating disorders were significantly younger, more educated, more psychologically distressed, more dyspeptic, and more were women than FGID patients without past eating disorders. CONCLUSIONS: This study confirms the previously found association between functional GI symptoms and eating disorders and shows that functional GI symptoms may still persist even after the recovery from eating disorders, particularly in psychologically distressed patients.

Abdominal Pain↗

PubMed2002

Virtual food in virtual environments for the treatment of eating disorders.

Eating disorders (Eds) are one of the problems with higher social repercussion in the last years. Sometimes, these clinical syndromes, which are characterized by an altered eating behavior, can have dramatic consequences. In eating disorders, one of the more critical situations, in addition to other of equal or more importance, is the patient's confrontation with food: the visual confrontation, the eating process and the repercussion on his weight. Virtual Reality (VR) technology has been used in psychology, as a therapeutic help tool for the treatment of different psychological problems, for several years now. Their helpfulness is increasingly being recognized. Some developed virtual environments (VE) and their corresponding published studies endorse the efficiency of this tool. Nevertheless, in order to increase the possibilities of success, it is very important to obtain a complete patient immersion in the VE: visual, auditory and interactive. Sometimes there are processes or actions of reality, which are difficult to simulate virtually, and simulating them coarsely would result in the patient lack of immersion in the VE, thus seriously decreasing the possibilities of success. The eating process is an example, since it consists of several steps, some of which (biting, chewing, etc.) don't have an evident virtual solution. This article shows how food and eating process have been simulated virtually in the development of a virtual environment for the treatment of eating disorders.

Adaptation, Psychological↗

PubMed1993

Whose body is it anyway? Understanding and treating psychosomatic aspects of eating disorders.

Eating disorders can be understood as psychosomatic illnesses in which the body is pitted against the psyche. The author explores a variety of theoretical principles that aid understanding of the eating disorders and inform treatment interventions. She explains various therapeutic interventions and discusses countertransference difficulties that may hinder work with eating disorder patients. A theoretical understanding of the nature of psychosomatic dissociation in these patients enables treaters to understand why treatment often takes a very long time and is met with strong resistance even as the patient clamors for help.

Adolescent↗

PubMed2002

The spectrum of self-injurious behavior in eating disorders.

Eating disordered patients display a spectrum of self-harming behaviors that can only partially be defined as suicidal. Even some specific symptoms of eating disorders (EDs), like weight control practices, can be considered self-aggressive or a form of self-punishment. The present paper is a review of the findings of recent studies that explored the dimensionality of the self-injurious behaviors in eating disorders and the clinical correlates of the emerging dimensions. These studies have found that EDs have a specific relationship with self-injurious behaviors. These behaviors should be taken into account by the therapist in the assessment and treatment of both anorexia nervosa and bulimia nervosa patients.

Journal Article↗

PubMed1995

Eating attitudes and behaviors of pre- and postpubertal females: clues to the etiology of eating disorders.

Eating disorders are most likely to occur in females in early adolescence. In the hope of identifying the nature of the changes occurring across puberty which may predispose adolescents to eating disorders three groups, 30 prepubertal girls, 28 postpubertal girls, and 28 adult women matched on height and weight to the postpubertal group were compared for meal pattern characteristics and food intake regulation, as well as changes in eating attitudes and behaviors. They completed a set of psychometrics measuring their eating attitudes, body image, and disposition and also maintained 7-day diaries of everything they ingested, time of ingestion, and subjective and social conditions. Neither the overall intakes nor the meal sizes significantly differed between age groups. The prepubertal females ate the most relative to body weight, ate with more other people present and earlier in the day. They were relatively happy, calm, slightly hungry, unrestrained, satisfied with their bodies and depression was associated with lower intake. The postpubertal group, on the other hand, were relatively restrained, ate faster, and ate only 76.5% of the recommended amount. They had a more negative body image, greater dissatisfaction with their bodies, and greater restraint of eating than the prepubertal group, and depression was associated with higher intake. These changes may leave the young woman extremely vulnerable and under the appropriate conditions or with the appropriate personality type may lead to the development of an eating disorder.

Adolescent↗

PubMed2005

Binge eating disorder and night eating syndrome: a comparative study of disordered eating.

The authors compared eating patterns, disordered eating, features of eating disorders, and depressive symptoms in persons with binge eating disorder (BED; n = 177), with night eating syndrome (NES; n = 68), and in an overweight comparison group without BED or NES (comparison; n = 45). Participants completed semistructured interviews and several established measures. Depressive symptoms were greater in the BED and NES groups than in the comparison group. NES participants ate fewer meals during the day and more during the night than BED and comparison participants, whereas BED participants ate more during the day than the comparison participants. BED participants reported more objective bulimic and overeating episodes, shape/weight concerns, disinhibition, and hunger than NES and comparison participants, whereas NES participants reported more eating pathology than comparison participants. This evaluation provides strong evidence for the distinctiveness of the BED and NES constructs and highlights their clinical significance.

Adult↗

PubMed2006

Comorbidity of body dysmorphic disorder and eating disorders: severity of psychopathology and body image disturbance.

OBJECTIVE: The current study examined comorbidity and clinical correlates of eating disorders in a large sample of individuals with body dysmorphic disorder (BDD). METHOD: Two hundred individuals with DSM-IV (4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; 1994) BDD completed reliable interviewer-administered and self-report measures, including diagnostic assessments and measures of body image, symptom severity, delusionality, psychosocial functioning, quality of life (QOL), and history of psychiatric treatment. RESULTS: A total of 32.5% of BDD subjects had a comorbid lifetime eating disorder: 9.0% had anorexia nervosa, 6.5% had bulimia nervosa, and 17.5% had an eating disorder not otherwise specified. Comparisons of subjects with a comorbid lifetime eating disorder (n = 65) and subjects without an eating disorder (n = 135) indicated that the comorbid group was more likely to be female, less likely to be African American, had more comorbidity, and had significantly greater body image disturbance and dissatisfaction. There were no significant group differences in BDD symptom severity, degree of delusionality, or suicidal ideation or attempts. Functioning and QOL were notably poor in both groups, with no significant between-group differences. However, a higher proportion of the comorbid eating disorder group had been hospitalized for psychiatric problems. This group had also received a greater number of psychotherapy sessions and psychotropic medications. CONCLUSION: Eating disorders appear relatively common in individuals with BDD. BDD subjects with a comorbid eating disorder differed on several demographic variables, had greater comorbidity and body image disturbance, and had received more mental health treatment than subjects without a comorbid eating disorder. These findings have important implications for the assessment and treatment of these comorbid body image disorders.

Adolescent↗

PubMed1992

Bipolar II affective disorder in eating disorder inpatients.

We examined the association between affective disorders and eating disorders in 22 eating disorder inpatients who were interviewed using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version. The first series of 11 were interviewed as part of an interrater reliability study; the second series, done as follow-up to the first, consisted of 11 consecutive admissions. Overall, there were 15 bulimics and seven anorexics. Nineteen patients had a major affective disorder, and 13 (59%) had bipolar II affective disorder. Bipolar II affective disorder appears to be a common finding in hospitalized patients with severe persistent eating disorders.

Adult↗

PubMed2003

Eating disorders.

Eating disorders rank among the most debilitating psychiatric disturbances that affect young women. Knowledge has increased in recent years about the two major eating disorders, anorexia nervosa (AN) and bulimia nervosa (BN); however, much remains unknown. This review article will provide an overview of the epidemiology, proposed risk factors and clinical features of AN, and BN, as well as current recommendations for evaluation and treatment of these disorders.

Adult↗

PubMed1995

Primary care assessment of a patient with an eating disorder.

Eating disorders have become commoner in young Australian women over the past two decades, making their presentation in general practice more likely. Eating disorders vary considerably in severity from brief single episodes to severe disorders with prominent weight loss or maladaptive behaviours. Assessment should therefore focus on estimating the severity of the disorder to indicate the most appropriate treatment approaches.

Adolescent↗

PubMed1986

The relationship between affective disorder and eating disorders: a review of the literature.

The authors review the relationship between affective disorder and anorexia nervosa and bulimia across five lines of inquiry: clinical reports, psychometrics, family history, drug studies, and follow-up investigations. They conclude that affective disorder and eating disorders are related but that the nature of the relationship is unclear. After discussing possible mediating patterns, the authors propose an interactive, multidetermined understanding as the most appropriate model. They recommend that future research in this area attempt to identify subpopulations of patients with affective disorder and eating disorders by means of a longitudinal, multilevel strategy with serial determinations.

Adolescent↗

PubMed1993

Alexithymia in the eating disorders.

Eating disorder patients appear to have high degrees of alexithymia, a diminished capability to verbally describe feelings, although little data exist. We administered the Toronto Alexithymia Scale (TAS) to 114 females with DSM-III-R defined eating disorders. Patients, regardless of subtype, scored significantly higher than 370 college-aged females. TAS scores were significantly correlated to self-ratings of affective symptoms, but not weight or binge-purge frequency.

Adult↗

PubMed1992

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↗

PubMed1997

Disordered eating behavior and microvascular complications in young women with insulin-dependent diabetes mellitus.

BACKGROUND: Insulin-dependent diabetes mellitus (IDDM) and eating disorders are relatively common among young women in North America. Their coexistence could lead to poor metabolic control and an increased risk of the microvascular complications of IDDM. METHODS: We studied 91 young women with IDDM at base line and four to five years later to determine the prevalence and persistence of disordered eating behavior (on the basis of self-reported eating and weight-loss practices, including the intentional omission or underdosing of insulin to control weight) and the association of such eating disorders with metabolic control, diabetic retinopathy, and urinary albumin excretion. At base line, the mean age of the young women was 15+/-2 years and the duration of diabetes was 7+/-4 years. RESULTS: At base line, 26 of 91 young women (29 percent) had highly or moderately disordered eating behavior, which persisted in 16 (18 percent) and improved in 10 (11 percent). Of the 65 women with normal eating behavior at base line (71 percent), 14 (15 percent) had disordered eating at follow-up. Omission or underdosing of insulin lose weight was reported by 12 of 88 young women (14 percent) at base line and 30 (34 percent) at follow-up (P=0.003). At base line, the mean (+/-SD) hemoglobin A(1c) value was higher in the group with highly disordered eating behavior (11.1+/-1.2 percent) than in the groups whose eating behavior was moderately disordered (8.9+/-1.7 percent) or nondisordered (8.7+/-1.6 percent, P<0.001). Disordered eating at base line was associated with retinopathy four years later (P=0.004), when 86 percent of the young women with highly disordered eating behavior, 43 percent of those with moderately disordered eating behavior, and 24 percent of those with nondisordered eating behavior had retinopathy. CONCLUSIONS: Disordered eating behavior is common and persistent in young women with IDDM and is associated with impaired metabolic control and a higher risk of diabetic retinopathy.

Adolescent↗