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Child and adolescent predictors for eating disorders in a community population of young adult women.

OBJECTIVE: This study investigated early predictors for developing eating disorders by young adulthood in a community sample of women participating in a 22-year longitudinal study. METHOD: Twenty-one women were identified at age 27 with lifetime full or partial eating disorders. These women were compared with 47 women with no history of eating disorders on predictive factors from three broad domains. RESULTS: The women with eating disorders had more serious health problems before age 5 and mother-reported anxiety-depression at age 9. At 15, mothers described them as having more behavior problems. Before age 15, families of the eating disorder group had more histories of depression, eating problems and changes in family financial circumstances. DISCUSSION: This study identifies early predictors distinguishing girls who develop eating disorders. Findings point to the need for continued research in the area of early health to comprehensively examine the biologic, behavioral, and environmental risks for eating disorders.

Adolescent↗

Diabetes and eating disorders in primary care.

OBJECTIVE: To determine the relationship between diabetes and eating disorders among primary care patients. METHOD: Data on 3,000 patients were obtained from eight primary care and family practice settings, including the PRIME-MD Patient Health Questionnaire (PHQ), self-reported physical illness, and social functioning information. Multivariate logistic regression analyses were used to determine the association between diabetes and eating disorders. RESULTS: Diabetes was associated with an increased likelihood of eating disorders [OR = 2.3 (1.4, 3.9)], after adjusting for differences in demographic characteristics and comorbid mental disorders. This effect was specific to diabetes. Eating disorder was the only mental disorder associated with a significantly increased risk of diabetes, odds ratio (OR) = 2.4 (1.4, 4.0), after adjusting for demographic characteristics and comorbid mental and physical disorders. Patients with both diabetes and eating disorders had significantly higher levels of comorbid anxiety, panic attacks, and alcohol use disorders, compared with those with one but not both. DISCUSSION: Consistent with reports from community-based samples, these data suggest that diabetes may be associated with an increased likelihood of eating disorders among patients in primary care. Clinicians who treat patients with diabetes, a common condition in primary care, should screen for eating disorders. In addition, patients with eating disorders may be at risk for the development of diabetes. Further work is needed to determine the generalizability of these findings and to understand the mechanism of this association.

Adult↗

Comparison of assessments of children's eating-disordered behaviors by interview and questionnaire.

OBJECTIVE: In adults, interview methods may detect eating-disordered behaviors more accurately than self-report methods. However, no studies have investigated the relationships between interview and self-report assessments in children. We compared results from the Eating Disorder Examination adapted for Children (ChEDE) with the Adolescent version of the Questionnaire on Eating and Weight Patterns (QEWP-A) and with the Children's Eating Attitude Test (ChEAT) in a nontreatment sample of overweight and normal weight children. METHOD: The ChEDE, QEWP-A, and ChEAT were administered to 46 overweight (body mass index [BMI] at or above the 85th percentile) and 42 normal weight (BMI at the 15th-85th percentile) children, 10 +/- 1.8 years, recruited from the community. RESULTS: The ChEDE and QEWP-A were not concordant for the number or type of eating episodes that occurred in the past month. Compared with the ChEDE, the QEWP-A was reasonably specific, but it was not sensitive for the presence of objective (17 % sensitivity, 91% specificity) or subjective bulimic episodes (0 % sensitivity, 89 % specificity) during the past month. ChEDE and ChEAT global scores were significantly related (Kendall's tau = 0.286, p <.001), but specific items assessing guilt in relation to eating and preoccupation with food were not. DISCUSSION: Although self-report methods of eating disorder assessment in children may provide some general information regarding eating psychopathology in non-treatment-seeking children, they do not accurately reflect the results of a structured interview.

Absorptiometry, Photon↗

Disordered eating and the transition to college: a prospective study.

OBJECTIVE: A longitudinal study was conducted to examine whether the transition to college changed eating disorder symptoms and related attitudes. METHOD: Participants were 342 women who completed an in-depth survey in the spring of their senior year of high school and again during their first year of college. We assessed changes in body self-perception, eating-related attitudes, and disordered eating classification (nondieter, dieter, problem dieter, subclinical eating disordered, or eating disordered on the basis of criteria for bulimia nervosa in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders). RESULTS: Although participants viewed themselves as significantly heavier in their first year of college, dieting frequency and disordered eating classification in college did not differ from high school assessment. DISCUSSION: Evidence from this study indicates that disordered eating symptoms and attitudes are established before college. However, our findings also reveal that poor self-image, dieting behaviors, and eating disorder symptoms are common among many young women, both before and during college.

Adolescent↗

Barriers to treatment for eating disorders among ethnically diverse women.

OBJECTIVE: This study examined barriers to treatment in an ethnically diverse community sample of women with eating disorders. METHOD: Participants were 61 women (22 Hispanics, 8 Asians, 12 Blacks, 19 Whites) with eating disorders. Diagnosis was determined using the Eating Disorder Examination. Treatment-seeking history, barriers to treatment seeking, ethnic identity, and acculturation were assessed. RESULTS: Although 85% of the sample reported wanting help for an eating problem, only 57% had ever sought treatment for an eating or weight problem. Individuals who had sought treatment reported being significantly more distressed about their binge eating than those who had not sought treatment and having begun overeating at a younger age. Of those who had sought help, 86% had not received any treatment for their eating problems. The main barriers to treatment seeking were financial reasons. CONCLUSION: Women from minority groups who have eating disorders are underdiagnosed and typically not treated.

Adult↗

The role of stress in the association between low self-esteem, perfectionism, and worry, and eating disorders.

OBJECTIVE: Several theorists have hypothesized that stressful situations may trigger abnormal eating and even eating disorders in predisposed people. The purpose of the current study was to assess whether a stressful situation would reveal an association between perfectionism, low self-esteem, worry, and body mass index (BMI) and measures of eating disorder symptoms in female high school students. METHOD: A sample of 145 female high school students completed the Eating Disorder Inventory, the Multidimensional Perfectionism Scale, the Penn State Worry Questionnaire, and the Self Liking and Competence Scale three times--on an average school day, on the day of an examination, and on the day the subjects received the results of that examination. Linear regression analysis was performed to verify whether the dimensions of perfectionism were associated with the measures of eating disorders. RESULTS: Low self-esteem, worry, and parental criticism (a dimension of perfectionism) were associated with the measures of eating disorders only during the stressful situation, whereas concern over mistakes (another dimension of perfectionism) was associated in both stressful and nonstressful situations. DISCUSSION: The results suggest that in nonclinical female individuals, stress might bring out a previously absent association between some psychological predisposing factors for eating disorders and an actual desire or plan to lose weight. Such a finding suggests that stress may stimulate behaviors related to eating disorders in a predisposed personality.

Body Mass Index↗

Ethnic differences in the prediction of eating and body image disturbances among female adolescent psychiatric inpatients.

OBJECTIVE: The current study examined predictors of eating and body image disturbances in psychiatrically hospitalized female adolescents and investigated whether the predictors differ by ethnicity. METHOD: Participants were 427 (320 Caucasian, 53 Latina, 54 African American) female adolescent psychiatric inpatients. Predictors of eating disorder features (dietary restraint, binge eating, and purging) and body image dissatisfaction (BID) were tested separately for the three ethnic groups. In addition to the eating and BID variables, the following predictor variables were considered: depression, anxiety, impulsivity, negative self-esteem, peer insecurity, and abuse. RESULTS: Caucasians reported significantly higher levels of dietary restraint and BID than Latinas and African Americans, whereas reports of binge eating did not differ by ethnicity. Regression analyses revealed that the predictor variables accounted for significant and substantial amounts of the variance in the four eating and body image domains. Different psychological and social variables predicted eating disorder symptoms and BID across ethnic groups. DISCUSSION: These findings suggest, for psychiatrically hospitalized adolescent females, that different patterns of factors may contribute to the maintenance of eating and body image disturbances across ethnic groups. Future research testing models of the etiology or maintenance of these disturbances needs to include ethnicity to ascertain whether the hypothesized components operate differently by ethnicity.

Adolescent↗

Relationships between perfectionism and specific disordered eating behaviors.

OBJECTIVE: Perfectionism has been reported as a specific risk factor for anorexia nervosa and bulimia nervosa, but not binge eating disorder. This study examined whether these differences are due to differential associations between perfectionism and specific eating disorder behaviors. METHOD: Participants (N = 2,482) completed the eating disorders inventory perfectionism scale and a questionnaire assessing eating disorder symptoms. RESULTS: Perfectionism was associated with an array of disordered eating behaviors in women. However, associations were strongest for fasting and purging. Further, the association between binge eating and perfectionism was statistically mediated by fasting. In men, perfectionism was significantly associated only with fasting, and this association was greater than associations with other disordered eating behaviors. CONCLUSION: Results explain why previous studies have reported weak or inconsistent associations between perfectionism and binge eating and may inform etiological models of EDNOS characterized by fasting or purging.

Adult↗

Associations among family-of-origin food-related experiences, expectancies, and disordered eating.

OBJECTIVE: The study reported here integrates research on family-of-origin learning experiences and adult eating/thinness expectancies in the study of risk for eating disordered behavior. METHOD: A sample of women manifesting a wide range of eating disordered behaviors (n = 66) were compared in their retrospective reports of family learning, current eating and dieting expectancies, and current eating disordered behaviors. RESULTS: History of food-related teasing from friends and family, negative maternal modeling, and friends' criticism of eating all related to both adult disordered behavior and adult eating and thinness expectancies. Tests of mediation supported the putative mediation by expectancies of the relationships between early experiences and adult disordered behavior. CONCLUSION: Family-of-origin learning experiences may influence adult eating disordered behavior by contributing to the formation of expectancies for reinforcement from eating and from thinness.

Adolescent↗

Review of nocturnal sleep-related eating disorders.

This review provides a historical background on sleep-related eating disorders, summarizes findings from a series of 38 adults, and presents a current classification. The "night-eating syndrome" was first reported in 1955; only nine reports on this syndrome appeared during the next 36 years, seven being single-case studies and two containing the objective monitoring of sleep, that is, polysomnography. In 1991 our sleep center reported on 19 cases, and in 1993 on 38 cases, diagnosed by polysomnography and clinical evaluations. Mean age was 39 years, mean duration of night-eating was 12 years, 66% were women, 68% had nightly binge eating, and 44% were overweight from night-eating. Sleepwalking was the predominant disorder responsible for night-eating; restless legs syndrome, obstructive sleep apnea, and various other conditions (including two cases of anorexia nervosa) were also identified. Cognitive-behavioral therapies were ineffective, but pharmacotherapy was very effective in controlling night-eating and inducing loss of excess weight, and often consisted of a dopaminergic agent taken with codeine at bedtime. Thus, sleep-related eating can be an occult but often treatable cause of obesity. Further research, utilizing polysomnography, is encouraged.

Adolescent↗

Self-efficacy in overweight individuals with binge eating disorder.

OBJECTIVE: To evaluate the relationship between self-efficacy judgments in obese individuals with binge eating disorder, "borderline" binge eating disorder, and no binge eating problems. RESEARCH METHODS AND PROCEDURES: Before participation in a residential weight management program, 79 male and female subjects were administered the Weight Efficacy Lifestyle Questionnaire (WEL) and the Binge Eating Scale (BES). Based on DSM-IV diagnostic questions, subjects were categorized as BED, Borderline BED, or non-BED. RESULTS: Krusal-Wallace Rank-Order analysis of variance revealed significant negative associations between binge eating and total WEL scores as well as the subscales of Negative Emotions, Social Pressure, Physical Discomfort, and Positive Activities. Differences were significant between the BED and the Borderline BED groups with the exception of the Social Pressure scale and the Total WEL scores. BED diagnosis as well as severity of binge eating were strongly associated with low self-efficacy ratings. DISCUSSION: These results indicate that obese individuals with binge eating disorder demonstrate lower self-efficacy than those without this condition and that self-efficacy is related to the severity of binge eating.

Body Mass Index↗

Population-based prevention of eating disorders: an application of the Rose prevention model.

BACKGROUND: Several decades of concerted research on eating disorders have generated a broad range of proposed causal influences, but much of this etiologic research does not elucidate practical avenues for preventive interventions. Translating etiologic theory into community health interventions depends on the identification of key leverage points, factors that are amenable to public health intervention and provide an opportunity to maximize impact on the outcome of interest. Population-based preventive strategies, elaborated by epidemiologist Geoffrey Rose, can maximize the impact of public health interventions. In the case of eating disorders, Rose's model is instructive: Dieting stands out as risk behavior that may both fit Rose's model well and be a key leverage point for preventive intervention. METHODS: Grounded in Rose's work, this article lodges a theoretical argument for the population-based prevention of eating disorders. In the introductory section, existing research on the epidemiology of dieting is reviewed, showing that it is extremely common among adolescent girls and women and that the behavior has been implicated as a causal factor for disordered eating. Next, new evidence is offered to build a case for how a population-wide reduction in dieting may be an effective strategy for prevention of eating pathology. Finally Rose's prevention framework is used to introduce a unique and provocative perspective on the prevention of eating disorders. RESULTS: Dieting is a normative behavior in our culture with psychological and physiological effects in the causal chain leading to eating pathology. This behavior may represent an ideal target for population-based prevention. CONCLUSIONS: Theoretical and empirical evidence suggests that a population-wide reduction in dieting may be a justifiable and effective strategy for prevention of eating pathology.

Adolescent↗

Eating attitudes and behaviors in pregnancy and postpartum: global stability versus specific transitions.

Global changes in eating attitudes were examined prospectively across pregnancy and 4 months postpartum in a sample of 90 women. In addition, specific changes in dieting behavior and weight/shape satisfaction were assessed at 4 months postpartum for concurrent and retrospective time points. Measures included the Eating Attitudes Test (EAT) and weight/shape satisfaction in pregnancy and at 4 months postpartum, as well as prepregnancy, pregnancy, and postpartum weight loss efforts. While global EAT scores were stable across time, dieting scores (Factor I) increased between pregnancy and postpartum. Weight/shape satisfaction was higher in pregnancy, and satisfaction was related to EAT scores at 4 months postpartum but not during pregnancy. Prepregnancy dieters and nondieters were best discriminated by higher weights, elevated pregnancy dieting scores, and lower postpartum weight/shape satisfaction. Results emphasize the importance of looking beyond changes in global eating attitudes and behaviors to more specific eating concerns or behaviors. Lastly, the results have implications for identifying women at risk for eating- and weight-related concerns during this period of rapid physical change.

Adaptation, Psychological↗

Nutritional aspects of eating episodes followed by vomiting in Brazilian patients with bulimia nervosa.

BACKGROUND: The clinical aspects of bulimia nervosa (BN) are similar in countries with different sociocultural backgrounds, but less is known about dietary composition in patients from developing countries. Little is also known about the role that nutritional aspects may play in behaviours aimed at counteracting the effects of binge eating. OBJECTIVES: To describe the daily energy intake and eating behaviour of BN patients in Brazil and compare the dietary patterns of the patients who terminated eating episodes by vomiting and those patients who did not. METHODS: Thirty patients from an eating disorders programme in a university-affiliated hospital completed a 14-day dietetic diary; the data were analysed using nutritional software. RESULTS: Mean age and BMI of the patients were respectively 27.2 +/- 9.6 years and 25.5 +/- 6.7 Kg/m2. The patients in the vomiting subgroup ate more irregularly and consumed a more variable number of meals per day than those in the non-vomiting subgroup. The daily energy intake of the patients as a whole was 2,202 kcal, with a macronutrient composition of 53% carbohydrates, 31% fats and 17% proteins. The mean energy intake of the eating episodes followed by vomiting was 1,331 kcal with a macronutrient profile of 51% carbohydrates, 36% fat and 14% protein. Intake and eating patterns were characterised by between- and within- individual variability, and so no significant differences were found in the subgroup comparisons. Foods with a high energy density were preferred during the eating episodes followed by vomiting. CONCLUSIONS: The results indicate that patients who vomit have a more irregular and variable eating pattern than those who do not vomit, but their daily nutrient content is comparable.

Adult↗

Socio-cultural and cognitive predictors of eating disorder symptoms in young girls.

There is some evidence for a relationship between socio-cultural variables and the development of disordered eating or concerns. However, the role of individual cognition in adding to this relationship has not yet been investigated. The current study therefore had two main questions. Firstly, which of the socio-cultural factors investigated (parental, peers and the media) predict girls' eating disorder related symptoms? Secondly, do individuals' cognitions add to this prediction? Thirty-eight girls participated in the study. They completed the Eating Attitudes Test (EAT), Eating Disorder Belief Questionnaire (EDBQ), measures of parental, peer and media influence, and a measure of their awareness and internalisation of societal standards of attractiveness. The results indicated that several of the socio-cultural factors were related to girls' EAT score. The belief that being thinner would make boys like them more was the most significant predictor in the whole sample (and in younger girls). Individual cognitions added significantly to this prediction in the whole sample but not in the younger girls. For older girls, the importance of magazines as a source of information about beauty and ideals was the strongest predictor of EAT score, and their cognitions added significantly to this prediction. It is concluded that peer and media influences are important determinants of girls' eating disorder related symptoms. However, individual cognitions add to this relationship, particularly in older girls. The implications and limitations of the study are discussed.

Adolescent↗

Fluid intake, personality and behaviour in patients with eating disorders.

OBJECTIVE: To examine psychological and behavioural variables associated with the disordered fluid intake of 112 eating disorder patients. METHOD: Fluid intake history for previous seven days, and standardized psychological and behavioural measures of eating disorders, mood, personality and health, were completed on admission to hospital. RESULTS: Only behaviours associated with eating disorders were associated with fluid intake. Greater amounts of total and energy-free fluids are consumed if patients report overeating, binge eating and dieting between overeating more frequently, drinking more caffeine-containing energy free drinks, vomiting and using laxatives. Energy-containing fluid intake is higher if patients feel their body weight is less important and if they binge eat. There is a significant difference in the amount of fluid drunk (ml or ml/kg) by patients with bulimia nervosa (BN) when compared to patients with no current diagnosis but not compared with anorexia nervosa (AN) or eating disorders not otherwise specified (EDNOS) patients. DISCUSSION: Fluid intake is associated with eating disorder behaviour rather than personality and psychological variables. Patients eating more drink more.

Adolescent↗

Establishing a useful distinction between current and anticipated bodily shame in eating disorders.

Previous research has suggested a role for bodily shame in the development of bulimia. The purpose of the present study was to extend this research by exploring a temporal perspective on bodily shame and eating pathology. Specifically, we were interested in whether bodily shame associated with the possibility of future weight gain was important in determining eating disorder symptoms independently of any association with bodily shame associated with current body size. A brief questionnaire designed to measure bodily shame was developed for the purposes of this study and administered to four samples (total n=428) of eating disordered and non-eating disordered women who also completed a number of measures of eating pathology. Factor analysis of the bodily shame scale identified three sub-scales, two measuring feelings of bodily shame (one measuring shame associated with current body size and one measuring shame that is anticipated should the individual gain weight) and a third measuring the perceived unattractiveness of being overweight. Anticipated bodily shame made a significant additional contribution to predicting eating disorder symptoms over and above that made by current bodily shame. A focus on feelings of bodily shame as they are currently experienced may limit the usefulness of this construct in eating disorder research. Since shame can be both punishing and prohibitive, consideration of the anticipation of shame as a consequence of weight gain may be a useful addition to understanding eating disordered behaviours, particularly in relation to symptoms concerning the prevention of weight gain rather than just the achievement of weight loss.

Adult↗

The eating attitudes test: twenty-five years later.

This manuscript reviews the literature involved with the Eating Attitudes Test (EAT), first developed in the late 1970s as a self-report, indicative of the symptoms of eating disorders. The EAT has good psychometric properties of reliability and validity, and reasonable sensitivity and specificity for the eating disorders, but very low positive predictive value because eating disorders are relatively uncommon. In addition they exist on a continuum, because of denial and social desirability, the results of a self-report instrument may be affected. A very large literature has documented the use of the EAT in a variety of cultures. It is used to screen eating disturbances in general as the first part of a two-part diagnostic screen, as an ability to compare across groups and to measure change between groups and over time.

Adolescent↗