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PubMed2006

Father-daughter relationship and eating psychopathology: the mediating role of core beliefs.

OBJECTIVE: The study aimed to establish the relationships between recalled paternal rearing behaviours, core beliefs and eating symptomatology and to test whether core beliefs play a mediating role between the father-daughter relationship and eating psychopathology. DESIGN: Associations between eating psychopathology, core beliefs and recalled parental rearing behaviours were examined in women with and without eating disorders. Regression analyses were used to test whether core beliefs played a mediating role in the relationship between paternal rearing behaviours and eating psychopathology. METHOD: Sixty-six eating-disordered women and fifty female controls completed three self-report questionnaires measuring parental rearing behaviours, core beliefs and eating psychopathology. RESULTS: In eating-disordered women, paternal rejection and overprotection were found to predict aspects of eating psychopathology via the mediating role of abandonment, defectiveness/shame and vulnerability to harm core beliefs. DISCUSSION: Core beliefs relating to feelings of abandonment and inherent defectiveness appear to be important in the relationship between unhealthy father-daughter relationships and eating disorder symptoms.

Adolescent↗

PubMed2002

Caloric intake and eating behavior in infants and toddlers with cystic fibrosis.

OBJECTIVE: Infants and toddlers with cystic fibrosis (CF) are at risk for poor growth. Controlled behavioral assessment studies have not focused on this population. This study compared calorie intake, percentage of Recommended Daily Allowance (RDA) per day and per kilogram, and percentage of calories from fat, protein, and carbohydrates between infants and toddlers with CF and healthy peers. Also, eating behaviors, such as meal duration, bites and sips per minute, percentage of meal spent eating, children's problematic eating behaviors, and parents' perceptions of mealtime behaviors were compared between infants and toddlers with CF and controls. Five hypotheses were tested. 1) Infants and toddlers with CF would be comparable to controls on the number of calories consumed per day and the percentage of calories from fat. 2) Infants and toddlers with CF would not meet the CF dietary guidelines for the percentage of RDA for calories or the percentage of calories from fat. 3) Infants and toddlers with CF would have longer meal durations than healthy peers, but would not differ on the pace of eating, the number of calories consumed during the meal, or the percentage of time spent eating during the meal. 4) Parents of infants and toddlers with CF would perceive more problematic mealtime behavior than controls. 5) Parents' perceptions of children's mealtime behavior would positively correlate with meal duration and negatively correlate with the number of calories consumed during the meal. DESIGN: A 2-group comparison study. SETTING/SAMPLE: A clinical sample of 35 infants and toddlers with CF (M = 18.6; standard deviation = 8.1 months; range = 7-35 months) and a community sample of 34 healthy peers matched for age, gender, socioeconomic status, and number of parents and siblings present during mealtimes. MEASUREMENT AND MAIN RESULTS: Children's calorie intake was measured using 3-day diet diaries. The 2 groups did not differ on the total number of calories consumed per day, the percentage of calories derived from fat, or the percentage of RDA consumed per day. Infants and toddlers with CF were not meeting the CF dietary recommendations of 120% to 150% RDA for energy with 40% of calories coming from fat. Using the Dyadic Interaction Nomenclature for Eating, a behavioral coding system, videotaped recordings of children's dinner meals were scored for meal duration, number of bites and sips per minute, number of calories per bite or sip, and the percentage of 10-second intervals with bites and sips. The CF sample had significantly longer mealtimes (20.2 minutes) than the control group (16.4 minutes), but did not differ on calories consumed at the meal, bites and sips per minute, calories per bite and sip, or time spent eating during the meal. On the Behavioral Pediatrics Feeding Assessment Scale, a measure of parental perceptions of mealtime behavior that was completed by a subset of families (39 families), parents of infants and toddlers with CF endorsed a greater number of mealtime behaviors as problems and a higher occurrence of problems than did parents of controls. Examples of these behaviors for the CF sample included problems with their child's willingness to try new foods (48%), eat vegetables (48%), and observations that their child has a poor appetite (32%) and would rather drink than eat (32%). Parents of children with CF chose a greater number of mealtime strategies and feelings as problems and reported more frequently using problematic strategies at mealtimes than did parents of controls. Examples of problematic strategies and feelings for parents of infants and toddlers with CF included feeling anxious/frustrated when feeding their children (37%), not feeling confident that their child eats enough (32%), and using coaxing to get their child to take a bite (26%). For the entire sample, a positive correlation of 0.29 was found between the number of mealtime behavior problems reported by parents and meal duration, suggesting the co-occurrence of problematic mealtime behavior with longer meal duration. No relationship was found between the number of child mealtime behavior problems reported by parents and the number of calories consumed during the filmed meal. For the CF sample, a correlation of -0.26 between children's weight percentile for age and the filmed meal duration was found, suggesting a tendency for meal duration to increase as children's weight for age decreases. Post-hoc analyses were conducted comparing infants and toddlers with previously reported samples of preschool and school-aged children on meal duration. Results demonstrated that in each group, children with CF had longer meals than age-matched controls. CONCLUSIONS: Our findings reveal significant deficits in achieving dietary recommendations for many families of infants and toddlers with CF. Only 11% of infants and toddlers with CF met the CF dietary recommendation of at least 120% of the RDA/day for energy. In addition, infants and toddlers were found to derive only 34% of their daily calories from fat, compared with the recommended 40% needed for a moderate to high fat diet. These results underscore the need for intervention in families of infants and toddlers with CF, who in addition to being at increased risk for malnutrition, may also experience a hastening in the decline of their pulmonary status because of poor nutritional status. Currently, there is limited programmatic research on nutritional and feeding interventions for toddlers and infants with CF. One study, which used a hospital-based behavioral education program to increase the caloric intake of 3 children (ages 10-20 months) who were below the fifth percentile for weight for length, found at least a 54% increase in calories for each child after treatment. Similarly, preliminary findings of 2 parent-based interventions, a nutrition education curriculum and a nutrition education plus behavior parent-training curriculum, found a 22% and 32% increase in daily calories, respectively, at treatment completion. A large-scale clinical trial is needed to evaluate the efficacy of any nutritional intervention before widespread dissemination. Additional assessment-focused research is also needed to identify patients' who may be at greatest risk for malnutrition and to guide the development of interventions to treat them.

Age Factors↗

PubMed2003

Citalopram in the treatment of binge-eating disorder: a placebo-controlled trial.

BACKGROUND: Binge-eating disorder is a newly recognized eating disorder characterized by recurrent episodes of binge eating without compensatory weight loss behaviors. It commonly co-occurs with depressive disorders and obesity. Citalopram is a highly selective serotonin reuptake inhibitor antidepressant. The purpose of this study was to assess the efficacy and safety of citalopram in the treatment of binge-eating disorder. METHOD: Thirty-eight outpatients with a DSM-IV diagnosis of binge-eating disorder were enrolled in the study between August 2000 and July 2001 and were randomly assigned to receive either citalopram (N = 19) or placebo (N = 19) in a 6-week, double-blind, flexible-dose (20-60 mg/day) study. The primary measure of efficacy was frequency of binge-eating episodes. Secondary measures included frequency of binge days, body mass index (BMI), weight, Clinical Global Impressions-Severity of Illness scale scores, Yale-Brown Obsessive Compulsive Scale Modified for Binge Eating (YBOCS-BE) scores, Hamilton Rating Scale for Depression (HAM-D) scores, and response categories. The outcome measures were analyzed using 2 random regression methods, with a time trend analysis (primary analysis) and an endpoint analysis. In addition, response categories were analyzed using an exact trend test. RESULTS: Compared with placebo-treated subjects, subjects receiving citalopram (mean dose of 57.9 mg/day) had a significantly greater rate of reduction in frequency of binge eating (p =.003), frequency of binge days (p <.001), BMI (p <.001), weight (p <.001), severity of illness (p =.028), and YBOCS-BE score (p =.007) and a marginally significant rate of reduction in HAM-D score (p =.053). Differences between groups in response categories were marginally significant (p =.068 for intent-to-treat analysis). CONCLUSION: In a 6-week, placebo-controlled, flexible-dose trial, citalopram was efficacious in reducing binge-eating frequency, weight, and severity of illness and was generally well tolerated in subjects with binge-eating disorder.

Adolescent↗

PubMed2004

Zonisamide in the treatment of binge-eating disorder: an open-label, prospective trial.

BACKGROUND: Binge-eating disorder is characterized by recurrent episodes of uncontrollable overeating without compensatory weight-loss behaviors. It commonly co-occurs with obesity. Zonisamide is a novel antiepileptic drug associated with weight loss. The purpose of this study was to preliminarily assess zonisamide in the treatment of binge-eating disorder. METHOD: Fifteen outpatients with DSM-IV-TR binge-eating disorder were enrolled from Jan. 25, 2002, through Sept. 10, 2002, in an open-label, prospective, 12-week, flexible dose (100-600 mg/day) study of zonisamide. The primary outcome measure was binge-eating episode frequency. Secondary measures included binge day frequency, body mass index (BMI), weight, Clinical Global Impressions-Severity of Illness scale (CGI-S) scores, Yale-Brown Obsessive-Compulsive Scale Modified for Binge Eating (YBOCS-BE) scores, Three Factor Eating Questionnaire (TFEQ) scores, and Hamilton Rating Scale for Depression scores. Safety measures included adverse events, routine blood chemical and hematology laboratory values, urinalyses, plasma zonisamide levels, physical examination findings, and electrocardiograms. Outcome measures were analyzed by a repeated-measures random regression analysis using all data and an endpoint analysis using last observation carried forward. RESULTS: Eight subjects completed the 12 weeks of treatment. The mean (SD) zonisamide daily dose at endpoint evaluation was 513 (103) mg/day. Both the random regression and endpoint analyses found a highly significant decrease in binge-eating episode frequency, binge day frequency, BMI, weight, CGI-S scores, YBOCS-BE total scores, and TFEQ hunger and disinhibition scores (p <.0001 for all measures in both analyses except p =.001 for endpoint analysis of binge eating frequency, p =.0001 for endpoint analysis of TFEQ disinhibition, and p =.0008 for endpoint analysis of TFEQ hunger). The 7 subjects who discontinued zonisamide prematurely did so due to lack of response (N = 1), protocol non-adherence (N = 2), and adverse events (N = 4). CONCLUSION: Zonisamide was effective in reducing binge-eating frequency, severity of illness, and weight and was generally well tolerated in an open trial of binge-eating disorder. Controlled trials appear warranted.

Administration, Oral↗

PubMed1999

Collegiate coaches' knowledge of eating disorders.

OBJECTIVE: To assess, through exploratory research, 1) collegiate coaches' knowledge of eating disorders, 2) the confidence of collegiate coaches in their response correctness to questions about eating disorders among athletes, and 3) demographic data related to prior education about eating disorders and the role of the athletic department in providing such educational experiences. DESIGN AND SETTING: We distributed a 2-part questionnaire to 258 NCAA Division I-A coaches from 5 universities selected by sampling convenience. SUBJECTS: One hundred thirty-eight collegiate coaches responded to the questionnaire for a response rate of 53.5%. MEASUREMENTS: Our survey consisted of 30 true-false questions that tested knowledge of eating disorders overall and in 5 domains. These domains included etiology, identifying signs and symptoms, management and treatment, risk factors, and education and prevention of eating disorders. Coaches indicated their level of certainty in their responses by rating their confidence level on a 4-item Likert-type scale. Demographic data focused on educational programs attended by coaches and teams. Descriptive statistics were used to analyze all data. RESULTS: Our results suggest a need for coaches to achieve a greater knowledge of eating disorders in all domains. Evidence showed that educational programs about eating disorders were not often sponsored by the athletic department for coaches or athletes. There seemed to be poor communication between athletic departments and coaches regarding the availability of eating disorder educational resources. CONCLUSIONS: Data suggested coaches could benefit from comprehensive education in all domains of eating disorders; however, further study is needed to validate these findings, to determine the actual effectiveness of education in the prevention of eating disorders, and to differentiate coaches' knowledge specific to sport coached and to coach and team sex.

Journal Article↗

PubMed1999

Problem eating attitudes and behaviors in young children.

OBJECTIVE: The factor structure of the Children's Eating Attitudes Test (ChEAT) and the predictors of problem eating were examined in young boys and girls. METHODS: Two hundred and twenty eight children from Grades 2 and 4 completed questionnaires which examined problem eating attitudes and behaviors, body image, and self-concepts. RESULTS: Four factors were found for girls and boys. The girls' four factors, Dieting, Food Preoccupation, Social Pressure to Eat, and Restricting and Purging, corresponded closely to previous studies with older girls and women. Four different factors were found for the boys, Global Problems, Dieting versus Purging, Dieting and Food Preoccupation, and Emotional Eating. However, dieting behaviors in both girls and boys were predicted by poorer body image and in boys emotional concerns about eating were predicted by poorer body image and lower self-concepts. DISCUSSION: There is still relatively little research that has examined problem eating attitudes and behaviors of boys and men. As boys tend to report infrequent dieting, we may need to focus more on the emotional concerns about eating and becoming overweight as a potential indicator of eating problems in boys.

Attitude to Health↗

PubMed1992

Prevalence of eating disorders among dietetics students: does nutrition education make a difference?

Several studies have indicated that college students majoring in dietetics have more problems associated with food than do students majoring in other disciplines. If this is true, dietetics students may need more counseling and education on eating disorders, especially because many will eventually be counseling others professionally. To assess the prevalence of negative eating behaviors among college dietetics majors, surveys based on the Eating Pattern Questionnaire were distributed to college women with majors in dietetics and other selected disciplines at a medium-sized California university. Two surveys were administered 1 year apart; the first was distributed to junior and senior women only, and the second was distributed to women of all class levels. Results from the first survey revealed that the incidence of eating disorders was not greater among the dietetics majors than among the other selected majors. In fact, dietetics majors often had more positive responses to questionnaire items, which suggests that dietetics students have better eating habits and fewer eating disorders. The results of the second survey, however, indicated that dietetics majors had significantly more negative eating patterns than did students from other majors. When separated by class, junior and senior dietetics majors had significantly more positive eating habits than did freshmen dietetics majors. These findings imply that junior and senior dietetics majors may have more positive eating patterns than freshmen dietetics majors as a result of their increased exposure to nutrition information.

Adult↗

PubMed2000

The natural course of bulimia nervosa and binge eating disorder in young women.

BACKGROUND: Little is known about the relative course and outcome of bulimia nervosa and binge eating disorder. METHODS: Two community-based cohorts were studied prospectively over a 5-year year period. One comprised 102 participants with bulimia nervosa and the other 48 participants with binge eating disorder (21% [9/42] of whom had comorbid obesity). All participants were female and aged between 16 and 35 years at recruitment. The assessments were at 15-month intervals and addressed eating disorder features, general psychiatric symptoms, and social functioning. RESULTS: Both cohorts showed marked initial improvement followed by gradual improvement thereafter. Between half and two thirds of the bulimia nervosa cohort had some form of eating disorder of clinical severity at each assessment point, although only a minority continued to meet diagnostic criteria for bulimia nervosa. Each year about a third remitted and a third relapsed. The outcome of the binge eating disorder cohort was better, with the proportion with any form of clinical eating disorder declining to 18% (7 of 40) by the 5-year follow-up. The relapse rate was low among this cohort. There was little movement of participants across the 2 diagnostic categories and few sought treatment. Both groups gained weight, with 39% of the binge eating disorder cohort (14 of 36) meeting criteria for obesity at 5-year follow-up. CONCLUSIONS: These findings suggest that, among young women in the community, bulimia nervosa and binge eating disorder have a different course and outcome. Whereas the prognosis of those with bulimia nervosa was relatively poor, the great majority of those with binge eating disorder recovered.

Adolescent↗

PubMed2000

Shame and guilt in women with eating-disorder symptomatology.

The relationship of shame and guilt to eating-disorder symptomatology was investigated in a sample of 97 Australian women. In terms of the objective of predicting the severity of eating disturbance, the study explored the predictive utility of proneness to shame and guilt in a global sense, shame and guilt associated specifically with eating contexts, and shame associated with the body. The study also sought to determine if shame is a more prominent emotion than guilt among women who have eating difficulties. Shame associated with eating behavior was the strongest predictor of the severity of eating-disorder symptomatology. Other effective predictors were guilt associated with eating behavior and body shame. Eating disturbance was unrelated to proneness to shame and guilt in a global sense. Discussion of these findings focuses on the issue of determining whether self-conscious affects are best regarded as causes or as consequences of eating disturbance.

Adolescent↗

PubMed1996

Eating disturbances before and after vertical banded gastroplasty: a pilot study.

OBJECTIVE: We interviewed 24 female patients who had undergone vertical banded gastroplasty (VBG) to examine what effect eating disturbances have on weight loss outcome after VBG. METHOD: Subjects were recruited from 120 patients who had undergone VBG in the last 3 1/2 years. Subjects were asked questions relating to past and present weight status, weight loss methods, eating behaviors, and psychiatric status. RESULTS: Eating disturbances before VBG in the form of binge eating disorder (BED), bulimia nervosa (BN), night eating syndrome, and drinking large quantities of fluids were very common (75%), and they tended to persist after VBG. Although VBG led to varying weight loss, some patients exhibited a weight regain as postoperative time increased. Patients currently diagnosed with an eating disturbance were more likely to exhibit weight regain than people without these disturbances. VBG did not affect psychiatric status. DISCUSSION: VBG appears to be successful in producing weight loss in the morbidly obese, but less successful in altering eating behavior or psychiatric status. Future studies should aim to clarify the role of eating behavior in determining the outcome of bariatric surgery and examine whether treatments such as cognitive behavior therapy targeted specifically at the eating disturbance can improve surgical outcome.

Adult↗

PubMed1996

Assessment of eating disorders: interview versus questionnaire.

OBJECTIVE: This study assessed the validity of the Eating Disorder Examination--Questionnaire (EDE-Q) in identifying eating disorder symptoms in female substance abusers. METHOD: Subjects were assessed for the presence of eating disorder behaviors and attitudes using the Eating Disorder Examination (EDE), a semistructured interview, and the EDE-Q. The results of the two measures were then compared. RESULTS: Results showed that the EDE-Q does identify eating disorders in this population. It is more accurate in assessing purging than the more complex features of binge eating and dietary restraint. DISCUSSION: Eating disorders and substance abuse co-occur at a higher rate than expected by chance, and recent findings indicate that eating disorders often go undetected among patients with substance abuse. The EDE-Q appears to be an effective screening instrument for detecting the presence of eating disorder symptoms in this population.

Adolescent↗

PubMed1997

The night eating syndrome in the general population and among postoperative obesity surgery patients.

OBJECTIVE: To determine the prevalence of night-eating syndrome in the general population and among a new sample of obesity surgery patients. METHODS: Night-eating syndrome was defined by presence of morning anorexia, excessive evening eating, evening tension and/or feeling upset, and insomnia. A randomly selected sample of 2,097 adults (survey sample) answered structured interview questions on night-eating syndrome. A self-report form was completed by 111 patients who had received gastric restriction surgery for obesity at a patient reunion (patient sample). RESULTS: Prevalence of night-eating syndrome in the survey sample was 1.5% (31 of 2,097). Prevalence in the patient sample was 27% (30 of 111). Weights for subjects in each sample, with and without the syndrome, were comparable. DISCUSSION: Prevalence of night-eating syndrome was higher in the patient sample than in the survey sample. Within each sample, presence of the syndrome was not related to weight. Prevalence in the survey sample was within the range reported for binge-eating disorder. Night-eating syndrome may warrant consideration as a distinct eating disorder.

Adolescent↗

PubMed1998

Shape- and weight-based self-esteem and the eating disorders.

OBJECTIVES: To determine the psychometric properties of the Shape- and Weight-Based Self-Esteem (SAWBS) Inventory in women with eating disorders, and to compare SAWBS scores in women who have eating disorders with women from psychiatric and normal control groups. METHOD: Women with eating disorders (n = 48), women with other psychiatric disorders (n = 44), and undergraduate control women (n = 82) completed the SAWBS Inventory and measures of depression, self-esteem, and eating disorder symptomatology. Twenty women from the eating disorder group completed the SAWBS Inventory a second time 1 week later. RESULTS: Similar to previous work in undergraduate samples, SAWBS scores were stable over 1 week, and demonstrated concurrent and discriminant validity in women with eating disorders. In between-group comparisons, SAWBS scores were higher among women with eating disorders than in either control group, even after controlling for age, socioeconomic status, body mass index, and self-esteem. A differing relationship between depression and SAWBS emerged as a function of group; SAWBS scores differed significantly among depressed, but not nondepressed women from the three groups. CONCLUSION: The psychometric properties of the SAWBS Inventory were established in women with eating disorders. As expected, SAWBS scores were higher in women with eating disorders than in the control groups. Clinical implications of these findings are discussed.

Adult↗

PubMed1999

The gender specificity of emotional, situational, and behavioral indicators of binge eating in a diet-seeking obese population.

OBJECTIVE: This study investigated the unique gender correlates of binge eating severity in a diet-seeking population. METHOD: This sample consisted of 288 self-admitted patients enrolled in a residential weight loss program between 1996 and 1997. Subjects were administered several questionnaires including (a) the Binge Eating Scale, (b) the Beck Depression Inventory, (c) the Rosenberg Self-Esteem Scale, (d) 5-point scales of eating related foci, and (e) 7-point scales of subject confidence in controlling their eating under various circumstances. Data were analyzed in terms of stepwise regression analyses. RESULTS: Regression results revealed that while men and women share some common predictors of binge eating severity, there are also some gender-specific correlates. Men in our sample were prone to binge eat because of negative emotions (i.e., depression and anger), while binge eating severity for women in our sample was most strongly related to diet failure and tests of moderate eating. DISCUSSION: The strength of the distinctive gender-specific regressions for binge eating severity suggests that the problems of binging in obese males and females are derivatives of differential sex role expectations. This interpretation and clinical implications are the focus of the discussion.

Adult↗

PubMed2000

Effect of Western culture on women's attitudes to eating and perceptions of body shape.

OBJECTIVE: The current study investigated the effect of culture on two factors implicated in the development of eating disorders, negative attitudes toward eating and dissatisfaction with body shape. METHOD: Hong Kong-born and Australian-born women from two Australian universities were surveyed using the Eating Attitudes Test (EAT) and the Figure Rating Scale (FRS). RESULTS: Results showed no difference between the groups in eating attitudes, but significant differences in body shape perceptions, with the Australian-born reporting greater dissatisfaction. Hong Kong-born subjects were separated into two groups based on their level of Chinese identity (Western acculturized and traditional). Their EAT and FRS scores were compared to the Australian-born, with Western acculturized Hong Kong-born subjects reporting significantly lower EAT and FRS scores than the Australian-born, whereas the more traditional Hong Kong-born subjects reported equivalent scores. DISCUSSION: Main implications center around the need for a cross-culturally sensitive definition of eating disorders, the effect of level of ethnic identity on eating attitudes and body image, and the importance of developing culturally appropriate measures.

Acculturation↗

PubMed2000

Predictors of treatment outcome for binge eating disorder.

OBJECTIVE: The purpose of this study was to identify predictors of short-term treatment outcome for individuals with binge eating disorder (BED). METHOD: Fifty women who met DSM-IV criteria for BED were enrolled in a manual-based group cognitive-behavioral therapy that consisted of fourteen 1-hr sessions over an 8-week period. Baseline measures included the frequency of self-reported binge eating from the Eating Behaviors-IV (EB-IV), severity of binge eating and dietary restraint using the Binge Eating Scale (BES) and Three-Factor Eating Questionnaire (TFEQ), depressive symptoms as assessed by the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS), and self-esteem as measured by the Rosenberg Self-Esteem Questionnaire (RSEQ). RESULTS: Logistic regression analyses indicated that the baseline frequency of self-reported episodes of binge eating that were objectively large predicted the likelihood of such episodes at the end of treatment. No variables predicted the likelihood of binge eating episodes that were objectively and subjectively large at the conclusion of treatment. DISCUSSION: This study indicates that the frequency of binge eating episodes at baseline is predictive of outcome status at the end of treatment, suggesting that meaningful prognostic factors in BED are identifiable.

Adolescent↗

PubMed2003

Ethnicity and differential access to care for eating disorder symptoms.

OBJECTIVE: The impact of ethnicity on access to health care for eating disorder symptoms among participants in the 1996 National Eating Disorders Screening Program (NEDSP) was examined in two studies. METHOD: Self-report and clinician-assessed data were analyzed from 9,069 participants in an educational and two-stage screening program for eating disorders in Study I. In Study II, both cross-sectional and prospective data from a randomly selected sample of 289 participants from the same program were analyzed to investigate the impact of ethnic minority status on both help-seeking patterns and clinician referral patterns for eating disorder symptoms. RESULTS: Even after controlling for severity of self-reported eating disorder symptoms, both Latino and Native American participants in the NEDSP were significantly less likely than Whites to receive a recommendation or referral for further evaluation or care. Ethnic minority subjects with self-acknowledged eating and weight concerns were also significantly less likely than non-minority participants to have been asked by a doctor about eating disorder symptoms. Only one marginally significant difference was found between ethnic minority and non-minority respondents with respect to their help-seeking behaviors, namely, ethnic minority subjects were less likely (at the level of a trend) to seek eating disorders treatment within 1(1/2)-2 years following the NEDSP. DISCUSSION: These data suggest that clinician bias may be an important barrier to access to care for eating disorder symptoms in ethnic minority populations.

Adolescent↗

PubMed2003

Predicting the outcome of eating disorders using structural equation modeling.

OBJECTIVE: There is a need for models that predict accurately the course of mental disorders. METHOD: Eating-disordered female inpatients were assessed longitudinally at the beginning of treatment (t1), at the end of treatment (t2), at 2 or 3-year follow-up (t3), and at 6-year follow-up (t4). The sample consisted of 196 women with bulimia nervosa (BN) purging type, 103 women with anorexia nervosa (AN), and 68 women with binge eating disorder (BED; N=367). Confirmatory factor analysis and path analysis were used to predict the women's status at 6-year follow-up. RESULTS: The results for BN and BED show that the specific eating disorder pathology was influenced mainly by specific eating disorder pathology at earlier time points and not by non-eating-specific (general) psychopathology. Similarly, general psychopathology was influenced mainly by general psychopathology at earlier time points. For AN patients, both categories of psychopathology (eating specific and general) were relevant for the 6-year outcome. The potential impact of 14 factors on the level of pathology was estimated (a) at baseline (at the beginning of treatment), (b) during the course of illness (baseline controlled), and (c) on the 6-year outcome of eating disorders (baseline and course controlled). Although there were many correlations between potential factors and baseline pathology, there was only a limited number of significant correlations with the 6-year outcome. This effect was mediated largely by the level of general psychopathology. DISCUSSION: The models for outcome prediction based on structural equation modeling techniques were very similar for BN and BED. For both BN and BED, there were almost entirely separate predictions for the specific eating disorder on the one hand and non-eating-related (general) psychopathology on the other hand. This was true to a lesser degree for AN. CONCLUSIONS: The use of refined path analytic methods in follow-up studies on larger general populations will be helpful to increase our understanding of the course of illness of psychiatric disorders.

Adolescent↗