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PubMed2006

The relationship between disordered eating behavior and drinking motives in college-age women.

Previous research has documented that alcohol use disorders and eating disorders often co-occur. One possible reason for these high rates of co-occurrence is that problematic eating and alcohol use serve similar functions for the persons engaging in them. In particular, both have been hypothesized to serve an avoidant coping function. This study was designed to examine the relationships between drinking motives and disordered eating in a sample of college-age women. A total of 257 women completed the Eating Attitudes Test-26 (EAT-26), Rutgers Alcohol Problems Index (RAPI), and Drinking Motives Measure (DMM). As hypothesized, problematic eating and problematic drinking were positively correlated. Also, regression analyses indicated a strong relationship between problematic eating and the coping scale of the DMM, which measures avoidant coping. This study extends previous research and provides support for the idea that problematic eating and problematic drinking serve similar avoidant coping functions. This line of research may hold important implications for treatment interventions targeting comorbid alcohol use disorders and eating disorders.

Adult↗

PubMed2006

Development of a measure to assess invalidating childhood environments in the eating disorders.

OBJECTIVE: The role of childhood abuse is well recognised within the eating disorders. However, the impact of parental invalidation of the child's emotional needs has not been investigated. Such invalidation is potentially important because it appears to be associated with the difficulties in tolerating distress that are often seen in adults with eating disorders. This study aims to develop a measure of childhood invalidating environments (Invalidating Childhood Environments Scale; ICES). It also investigated the relationship between childhood experiences, levels of distress tolerance and eating pathology. METHOD: Seventy-three eating-disordered women and 62 non-eating-disordered women completed a newly developed measure of invalidating environments (ICES), the Eating Disorders Inventory, and a Distress Tolerance Scale. RESULTS: The ICES had acceptable psychometric and clinical validity. Women who scored highly on the ICES had greater levels of eating disturbance. Within the clinical sample, the data were compatible with a model where difficulties in tolerating distress partially mediate the relationship between perceived invalidation by the father and eating pathology. CONCLUSIONS: Parental invalidation is a potentially important construct in the eating disorders. This paper demonstrates that the ICES is a valid measure of that construct. This study suggests a clear framework for working with patients, where evidence of an invalidating childhood environment indicates a need to work with patients on their capacity to tolerate distress.

Adaptation, Psychological↗

PubMed2006

Smoking in eating disorders.

OBJECTIVE: Smoking has been reported as an appetite and weight control method in eating disorders; however, few studies have explored patterns of smoking across subtypes of eating disorders. The aim of this paper was to explore the patterns and prevalence of smoking behavior in 1,524 women from two of the multisite Price Foundation Genetic studies. METHOD: Smoking behavior was assessed in 306 individuals with anorexia nervosa-restricting type (RAN), 186 with anorexia nervosa-purging type (PAN), 180 with anorexia nervosa and bulimia nervosa (ANBN), 107 with anorexia nervosa-binging type (BAN), 71 individuals with purging type-bulimia nervosa (PBN), and 674 female community controls. We compared smoking prevalence and smoking behaviors across eating disorder (ED) subtypes and in comparison to controls using the Fagerstrom Test of Nicotine Dependence (FTND). RESULTS: Overall, women with eating disorders reported higher rates of smoking and greater nicotine dependence than controls. Women with binge/purge subtypes of eating disorders reported the highest rates of smoking of all of the subtypes. Smoking in eating disorders was related to impulsive personality traits. CONCLUSIONS: Women with eating disorders appear to be at increased risk for smoking, particularly those who binge eat and/or purge and display impulsive personality characteristics. Given the high prevalence, the impact of ongoing smoking on maintenance of eating disorders symptoms is worthy of both clinical and research attention.

Adult↗

PubMed2005

Follow-up evaluation of a high school eating disorders screening program: knowledge, awareness and self-referral.

PURPOSE: To conduct a regional, follow-up evaluation to assess the implementation and effectiveness of the National Eating Disorders Screening Program (NEDSP), conducted in high schools nationwide in the spring of 2000. METHODS: Four New England high schools participated in a postscreen evaluation 1 to 2 months after implementation of NEDSP. A 35-item, self-report postscreen survey was administered to students in classrooms with assistance from school health staff and teachers. School staff involved in the screening were also interviewed. Logistic regression was used to estimate the odds that students talked to an adult or peers about their screening score. RESULTS: Data from 592 girls and 435 boys were included in the analysis in the four high schools participating in the program evaluation. NEDSP helped to identify students at risk and encouraged students to speak to others about their screening score and eating disorder symptoms. One-quarter of girls and one-fifth of boys reported talking with at least one adult about their EAT-26 screening score. Girls felt more strongly than boys that the program helped them learn about eating disorders, change their thinking related to eating disorders and body image, and talk to friends about eating disorders. Overall, the students felt that the program was helpful and would recommend it to their friends. CONCLUSIONS: Early detection of eating disorders in adolescents may shorten the interval between onset of symptoms and treatment, which has the potential to reduce the length of illness and morbidity associated with untreated eating disorders. Our findings suggest that high-school-based screening may be an effective way to facilitate early detection of eating disorder symptoms in adolescents.

Adolescent↗

PubMed2001

Position of the American Dietetic Association: nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS).

More than 5 million Americans suffer from eating disorders. Five percent of females and 1% of males have anorexia nervosa, bulimia nervosa, or binge eating disorder. It is estimated that 85% of eating disorders have their onset during the adolescent age period. Although Eating Disorders fall under the category of psychiatric diagnoses, there are a number of nutritional and medical problems and issues that require the expertise of a registered dietitian. Because of the complex biopsychosocial aspects of eating disorders, the optimal assessment and ongoing management of these conditions appears to be with an interdisciplinary team consisting of professionals from medical, nursing, nutritional, and mental health disciplines (1). Medical Nutrition Therapy provided by a registered dietitian trained in the area of eating disorders plays a significant role in the treatment and management of eating disorders. The registered dietitian, however, must understand the complexities of eating disorders such as comorbid illness, medical and psychological complications, and boundary issues. The registered dietitian needs to be aware of the specific populations at risk for eating disorders and the special considerations when dealing with these individuals.

Anorexia Nervosa↗

PubMedDate not supplied

Eating style in seasonal affective disorder: who will gain weight in winter?

Patients with seasonal affective disorder (SAD) selectively eat more carbohydrates (CHO), particularly sweets but also starch-rich foods, during their depression in winter. The Dutch Eating Behaviour Questionnaire (DEBQ) was administered to female SAD patients, healthy female controls, and female medical students to determine their eating style, together with the modified Seasonal Pattern Assessment Questionnaire (SPAQ+). SAD patients showed higher values for "emotional" (EMOT) eating than the students, and these in turn had higher values than the controls. In comparison to controls, SAD patients and students head high values for the factor "external" (EXT) eating, but there was no difference between the groups with respect to "restraint" (REST) eating. This is in strong contrast to patients with bulimia and anorexia nervosa, who are high REST eaters, indicating that SAD patients do not have a similar eating disorder. Additional items showed that SAD patients selectively eat sweets under emotionally difficult conditions (when depressed, anxious, or lonely). Configural frequency analysis showed that seasonal body weight change (SBWC) is high in subjects with high EMOT and REST eating together with a high body mass index (BMI). This result is in accordance with the concept of disinhibition of dietary restraint in extreme emotional situations, e.g., the depressive state.

Alcohol Drinking↗

PubMed1999

Leptin in women with eating disorders.

The aim of the present study was to determine the factors controlling leptin secretion and to clarify the role of leptin in eating disorders. The subjects were 152 eating-disordered women with different fat mass, eating behavior, and endocrine abnormalities and 24 age-matched control subjects. The body fat mass, eating behavior score, and plasma leptin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), triiodothyronine (T3), free thyroxine (T4), insulin, and cortisol levels were evaluated for each subject. In patients with eating disorder, logarithmic values for leptin were significantly correlated with the body fat mass (r = .828, P < .001), eating behavior score (r = .777, P < .001), and LH (r = .465, P < .001), FSH (r = .440, P < .001), T3 (r = .572, P < .001), insulin (r = .410, P < .001), and cortisol (r = -.389, P < .001) levels. After adjusting for fat mass, the partial correlations of log leptin with LH, FSH, insulin, and cortisol were not statistically significant, but log leptin remained correlated with T3 (r = .390, P < .01). Stepwise regression analysis showed that the body fat mass and eating behavior score were significant determinants of leptin levels. These results suggest that eating behavior, as well as the body fat mass, is the control factor for leptin secretion in eating disorders.

Adipose Tissue↗

PubMed1998

H2 histaminergic control of inhibition of eating induced by intragastric NaCl in rats.

A role for endogenous histamine and histamine receptor subtypes in mediating the inhibition of eating induced by intragastric (i.g.) hypertonic NaCl was examined in adult male Sprague-Dawley rats surgically equipped with a chronic gastric catheter. The i.g. infusion of 2 mL 900 or 1,800 mOsm/kg of NaCl inhibited: 1) ingestion of pellets in rats eating after 24-h food deprivation; and 2) ingestion of cookies in rats eating without prior deprivation. The H1 receptor antagonists dexbrompheniramine (DXB; 1 mg/kg) and pyrilamine (PYR; 4 mg/kg) did not attenuate the inhibitory effects of i.g. 900 or 1,800 mOsm/kg of NaCl for rats eating pellets and for rats eating cookies. The H2 antagonists cimetidine (CIM; 16 mg/kg) and metiamide (MET; 16 mg/kg) attenuated the inhibitory effects of i.g. 1,800 mOsm/kg of NaCl upon ingestion of cookies, but intracerebroventricular (i.c.v.) infusion (through a chronic indwelling cannula) of 100 microg of CIM did not mimic this effect of intraperitoneal (i.p.) CIM. The i.p. CIM failed to attenuate the inhibition of eating cookies produced by i.p. octapeptide of cholecystokinin (CCK-8; 3 microg/kg). The H3 antagonist thioperamide (TH; 10 mg/kg i.p.) and the H3 agonist R-alpha-methylhistamine (RAM; 3 mg/kg i.p.) did not alter the inhibitory effect of i.g. 1,800 mOsm/kg of NaCl for rats eating cookies. Combined treatments of systemic DXB plus CIM, and DXB plus CIM plus thioperamide (TH) did not reverse the inhibitory effects of i.g. 1,800 mOsm/kg of NaCl upon ingestion of cookies. Finally, i.p. DXB, but not CIM, attenuated the ability of i.g. 900 mOsm/kg of NaCl to increase water intake; conversely, i.p. CIM, but not DXB, attenuated the ability of i.g. 900 mOsm/kg of NaCl to inhibit eating of cookies. These findings demonstrate a double dissociation of effects upon ingestive behavior: H1, but not H2, antagonism attenuates the effect of i.g. hypertonic NaCl on water intake, whereas H2, but not H1, antagonism attenuates the inhibition of eating produced by i.g. hypertonic NaCl. These results demonstrate that different subtypes of peripheral and/or central histamine receptors contribute to different behavioral consequences of postprandial gastrointestinal osmotic loads in rats.

Animals↗

PubMed2003

The spectrum of eating disorders: prevalence in an area of Northeast Italy.

This study aims at exploring the prevalence of eating disorders in a sample of adolescents living in a community in Northeast Italy. It takes into account age and gender differences in a mixed male-female sample of 1000 school-aged adolescents corresponding to 10% of the young population aged 15-19 years of the district. The study was based on self-reported questionnaires, including the Eating Attitudes Test (EAT), the Bulimic Investigatory Test of Edinburgh (BITE), and the Body Attitudes Test (BAT). The cases at risk were identified on the basis of the suggested validated cutoff for a clinically relevant syndrome. Females scored higher than males at all ages, body mass index levels, and socio-economic status levels. We found 100 females (15.8%) and 8 males (2.8%) scoring higher than the suggested cutoff for caseness on the EAT (cutoff=30); 26 females (4.1%) and 1 male (0.3%) scoring higher than the suggested cutoff for caseness on the BITE (cutoff=20); 287 females (45.5%) and 24 males (8.6%) scoring higher than the suggested cutoff for caseness on the BAT (cutoff=36). We did not find any gradient between age and socioeconomic status and the scores on the eating disorder inventories. BAT scores predicted with sharp precision the presence of an abnormal psychometric pattern on the EAT and the BITE. The prevalence of psychometric patterns that indicate an eating disorder seems in our adolescent sample higher than those reported in previous similar studies carried out in the North of Italy. The use of self-report inventories is a limitation in drawing definitive conclusions on the rates of eating disorder in this area; however, bodily dissatisfaction seems to be psychologically linked to abnormal eating patterns.

Adolescent↗

PubMed2003

Commensal eating patterns: a community study.

Commensality is eating with other people, and commensal eating patterns reflect the social relationships of individuals. This study examined usual meal partners in commensal units and frequency of eating with others in commensal circles among 663 adults responding to a mailed questionnaire in one community. Meal partner data revealed that most respondents ate alone at breakfast, alone or with co-workers at lunch, and with family members at dinner. Commensal frequency data revealed some eating at the homes of other family members, little eating at friends' homes, and almost no eating at neighbors' homes. Few demographic variations existed in commensal eating, except that unmarried individuals more often ate breakfast and dinner alone and more often ate with friends. These finding suggest that contemporary work-oriented society may lead people to eat alone during the day but share evening meals with family, and that people maintain commensal relationships primarily with family members rather than friends or neighbors. Peoples' social worlds appear to be focused on the nuclear family, and family members are also the people they usually eat with.

Adolescent↗

PubMed2003

[Risk factors related with eating disorders in a community of adolescents].

OBJECTIVE: To detect risk factors related with eating disorders. DESIGN: Descriptive, cross-sectional study. SETTING: 5 secondary schools in the Virgen de Rocío health area in Seville, Spain. PARTICIPANTS: 789 students enrolled in the first and second years of compulsory secondary school, and their families. MAIN MEASURES. Body mass index, risk behaviors related with food and exercise, influence of the mass media on models of desirable body types, and family climate. Data were obtained with three validated questionnaires: the Eating Attitudes Test (EAT-40), the CIMEC-26, and the Family Environment Scale (FES). RESULTS: In 6.9% of the participants, BMI was between 15 and 17, reflecting slight malnutrition. On the EAT scale, 68 participants (8.8%) had scores that were indicative of illness or risk of illness, and 25 (3.3%) could be diagnosed as having eating behavior disorder according to DSM-IV criteria. According to the CIMEC questionnaire, 104 participants (13.5%) were found to be significantly vulnerable to media pressures, and 85 (11.1%) were considered highly vulnerable. Parents' comments on eating behavior were related with the results on the EAT-40 CIMEC questionnaires (P=.01). No statistically significant relationship was found between family climate scores and the scores on the EAT-40 or CIMEC questionnaires. Students in rural or suburban area schools scored higher on the EAT-40 (P=.04) and CIMEC (P=.01) than students in urban or city center schools. CONCLUSION: The identification of persons considered at risk will allow us to use primary prevention programs more efficiently.

Adolescent↗

PubMed2003

Relationships between attitudes towards eating disorders and mood.

The purpose of the present study was to examine whether gender moderates the relationship between mood and attitudes toward eating disorders in athletes. 165 athletes (Male = 99; Female = 66) completed the Eating Attitudes Test (EAT), the Profile of Mood States-A (POMS-A), and the Hospital Anxiety Depression Scale (HADS). To test the proposed moderating effect, multisample structural equation modelling was used with equality constraints placed on relationships between mood and EAT scores. Results indicated that relationships between mood and EAT scores did not differ significantly between males and females (CFI = .988), thereby demonstrating that gender did not have a moderating effect. Mood significantly accounted for 38% of the variance in EAT scores in males and 29% of the variance in females, with depressed mood scores showing the strongest relationship with EAT scores. Findings support the use of mood profiling in applied work, and suggest negative mood, particular depressed mood, might be masking a disordered eating attitude. It is suggested that follow-up interviews should be conducted with athletes who report symptoms of depressed mood to ascertain its cause and that further research is needed to investigate the nature of disordered eating attitudes in athletes.

Adult↗

PubMed1988

Abnormal eating attitudes in London schoolgirls--a prospective epidemiological study: factors associated with abnormal response on screening questionnaires.

One thousand and ten unselected London state schoolgirls were screened by questionnaire to identify an 'at risk' cohort displaying abnormal eating attitudes and two control cohorts, one with probable general psychiatric morbidity, one without. Members of all cohorts were assessed at interview for the presence of eating disorder and for putative risk factors implicated in the development of anorexia nervosa. A prevalence rate of 0.99% was detected for clinical eating disorder and 1.78% for the partial syndrome of eating disorder. Factors specifically associated with abnormal eating attitudes were identified, in particular, current or past overweight, history of amenorrhoea and perceived stress in school and social life. Some commonly accepted risk factors for eating disorders were discovered to be associations with general psychiatric morbidity. These were perceived parental pressure to eat more, taking exercise to lose weight, perceived stress at home and reporting a family history of anxiety or depression. Other well reported putative risk factors for eating disorder, including social class, birth order, age at menarche, obsessional personality and weight related career choice were not associated specifically with abnormal eating attitudes in schoolgirls. These findings represent cross-sectional data at entry into a prospective epidemiological study.

Adolescent↗

PubMed2003

Eating disturbances in girls with diabetes: the contribution of adolescent self-concept, maternal weight and shape concerns and mother-daughter relationships.

BACKGROUND: This study examined the relative contribution of adolescent self-concept, maternal weight and shape concerns (WSC), and mother-daughter relationships to eating disturbances among girls with type 1 diabetes mellitus (DM). METHOD: Eighty-eight adolescent girls (mean = 15.0 years, S.D. = 2.2) and their mothers completed self-report measures of disordered eating and weight control behaviours, with teens also reporting on disturbed eating and body attitudes. Based on reported symptoms, adolescents were classified as highly (N = 18), mildly (N = 30) and non-eating disturbed (N = 40). Self-concept was assessed by adolescent self-report. Mother-daughter relationships were assessed by adolescent self-report and by observed mother-daughter interactions that were rated using a macroanalytic coding system that assesses intimacy and autonomy in these relationships. RESULTS: Hierarchical regressions illustrated that adolescent self-concept deficits, maternal WSC, and impaired mother-daughter relationships significantly predicted eating disturbances in girls with DM, accounting for 57% of the variance. Mothers who engaged in dieting and binge-eating were more impaired in their ability to support their daughters' emerging autonomy. The quality of mother-daughter relationships partly mediated the influence of maternal WSC on adolescent eating disturbances. Moreover, the impact of maternal WSC and mother-daughter relationships on eating disturbances was mediated by adolescent self-concept. CONCLUSIONS: Findings illustrate two pathways through which mother-daughter relationships may impact upon risk of eating disturbances in girls with DM and highlight the need to evaluate family-based interventions specifically tailored for this high-risk population.

Adolescent↗

PubMed2003

Persecutors or victims? The moral logic at the heart of eating disorders.

Eating Disorders, particularly anorexia and bulimia, are of immense contemporary importance and interest. News stories depicting the tragic effects of eating disorders command wide attention. Almost everybody in society has been touched by eating disorders in one way or another, and contemporary obsession with body image and diet fuels fascination with this problem. It is unclear why people develop eating disorders. Clinical and sociological studies have provided important information relating to the relational systems in which eating disorders are mainly found. This paper shows that their explanations are not conclusive and points out that the reasons why people develop eating disorders should not be found in the dysfunctional interactions occurring in both familial and social systems, but in the moral beliefs that underlie these interactions. Eating disorders are impossible to understand or explain, unless they are viewed in the light of these beliefs. A moral logic, that is a way of thinking of interpersonal relations in moral terms, gives shape to and justifies the clinical condition, and finds consistent expression in abnormal eating behaviour. The analysis offered here is not mainstream either in philosophy (eating disorders are in fact seldom the subject of philosophical investigation) or in clinical psychology (the methods of philosophical analysis are in fact seldom utilised in clinical psychology). However, this paper offers a important contribution to the understanding of such a dramatic and widespread condition, bringing to light the deepest reasons, which are moral in nature, that contribute to the explanation of this complex phenomenon.

Culture↗

PubMed1991

Mothers, daughters, and disordered eating.

We examined features of 77 mothers' attitudes and behavior that relate to disordered eating among their adolescent daughters. Mothers whose daughters reported a level of disordered eating comparable with clinical samples of bulimic patients were compared with mothers whose daughters reported a low level of eating disturbances. As hypothesized, mothers of daughters with disordered eating were more dissatisfied with the general functioning of the family system. Also, mothers whose daughters were eating disordered were themselves more eating disordered and differed in their dieting history compared with mothers of the girls who were not eating disordered. Furthermore, mothers of girls with disordered eating thought their daughters should lose more weight than mothers of girls who were not eating disordered. They also thought that their daughters were less attractive than the girls judged themselves.

Adolescent↗

PubMed2003

Vision and eating behavior in obese subjects.

OBJECTIVE: Vision is one of a number of factors influencing the amount of food consumed during a meal. The purpose of this study was to investigate the impact of vision on the microstructure of the eating behavior of obese subjects. RESEARCH METHODS AND PROCEDURES: Eighteen obese subjects with a body mass index (mean +/- SD) of 39.1 +/- 6.3 kg/m(2) twice consumed a standardized test meal in excess, once with and once without a blindfold. The microstructure of the eating behavior was registered by VIKTOR, a computerized eating monitor. Subjective motivation to eat (i.e., desire to eat, hunger, satiety, and prospective consumption) was rated by visual analogue scales (VASs) before, immediately after, and then hourly up to 3 hours after the test meals. RESULTS: The obese subjects ate 24% less food when blindfolded (359 +/- 194 g vs. 472 +/- 179 g; p < 0.01). Despite a smaller amount of food consumed when blindfolded, there were no significant differences with or without the blindfold for any of the VASs measuring subjective motivation to eat after test meals. DISCUSSION: The importance of vision in regulating our eating behavior was demonstrated in this study. The obese subjects ate 24% less food blindfolded without feeling less full. Eating blindfolded could be tested as a didactic tool to make obese subjects aware of what factors affect the termination of eating.

Adult↗

PubMed2007

Psychosocial and physical impairment in overweight adolescents at high risk for eating disorders.

OBJECTIVE: Many overweight adolescents display elevated risk for the development of eating disorders, as seen in higher rates of weight/shape concerns and disordered eating behaviors, but the extent of impairment in this subset of high-risk adolescents has not been explored. RESEARCH METHODS AND PROCEDURES: Eighty-one overweight adolescents (63% girls) presenting for an Internet-based weight loss program were assessed at baseline using the Eating Disorder Examination Questionnaire, the Depression, Anxiety, and Stress Scale, and the Pediatric Quality of Life questionnaire. Adolescents who earned elevated scores on both the Weight Concern and Shape Concern subscales of the Eating Disorder Examination Questionnaire were considered at high risk for the development of eating disorders (56.8%). RESULTS: Comparisons of high- and normal-risk groups revealed that high-risk adolescents reported higher levels of depression [F(3,76) = 5.75, p = 0.019], anxiety [F(3,76) = 5.67, p = 0.020], and stress [F(3,75) = 8.50, p = 0.005], and greater impairments in physical health [F(3,77) = 10.7, p = 0.002], emotional functioning [F(3,77) = 5.3, p = 0.024], and social functioning [F(3,77) = 10.0, p = 0.002]. There were no differences in school functioning [F(3,77) = 1.5, p = 0.219]. Among the high-risk adolescents, over half (52.2%) reported binge eating at least once in the past month. DISCUSSION: Results suggest that overweight adolescents at high risk for the development of eating disorders also experience elevated levels of negative affect, impairment in health-related quality of life, and eating disturbances, although prospective data are needed to determine the directionality between eating disorder pathology and general psychopathology. Further research is warranted to evaluate whether behavioral weight loss interventions should be enhanced for this high-risk subset.

Adolescent↗