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PubMed2006

Eating disorders and attitudes in Maltese and Italian female students.

BACKGROUND: No study to date has investigated the frequency of eating disorders (ED) in Malta. The aim of the present study was to provide a cross-cultural comparison between Malta and Italy as regards the frequency of ED and problematic eating attitudes among female students. SAMPLING AND METHODS: 128 Maltese and 135 Italian female students aged 16-20 were surveyed. Subjects underwent a structured clinical interview and completed some self-reported questionnaires: the Eating Attitudes Test, the Inventory for the Screening of Eating Disorders and the Eating Disorders Examination-Screening Version. RESULTS: The rates of ED are very similar in the two samples with the exception of the frequency of binge eating disorder which is zero in the Italian sample and 4% among Maltese students. Maltese female students weighed significantly more than their Italian counterparts. They also reported more frequent dieting, fear of fatness and experience of low self-esteem related to body shape and weight. CONCLUSIONS: Despite the fact that Maltese female students have a greater tendency to be overweight and display more problematic eating and body attitudes, their risk of developing ED, with the exception of binge eating disorder, is similar to that of their Italian counterparts.

Adolescent↗

PubMed1997

Eating disorders in Austrian men: an intracultural and crosscultural comparison study.

BACKGROUND: We compared 30 male university students with eating disorders and 30 male comparison subjects without eating disorders recruited by advertisement at Innsbruck University, Austria. METHODS: Subjects were interviewed using instruments that we had previously used in a controlled study of college men with eating disorders in the United States. RESULTS: The Austrian men with eating disorders differed sharply from Austrian comparison subjects, but closely resembled their American counterparts, on prevalence of personal and familial psychopathology, adverse family experiences, and scores on rating scales for eating disorder. Interestingly, dissatisfaction with body image was consistently greater among American subjects regardless of eating disorder status. CONCLUSIONS: Our data suggest a weak association between eating disorders and homosexual or bisexual orientation in men and no consistent association between eating disorders and childhood sexual abuse.

Adolescent↗

PubMed2005

Identifying dieters who will develop an eating disorder: a prospective, population-based study.

OBJECTIVE: The aims of the study were to identify the characteristics of the dieters most at risk of subsequently developing an eating disorder and to evaluate the feasibility of using a brief questionnaire to identify such dieters in advance. METHOD: A general population cohort of 2,992 young women who were dieting was identified. On four occasions over the subsequent 2 years, this cohort was sent a questionnaire concerning eating habits and attitudes. Participants whose responses suggested that they had developed an eating disorder were interviewed to establish their true case status. The baseline questionnaires of those who did and did not subsequently develop an eating disorder were compared to identify features that predicted future case status. RESULTS: One hundred four of the dieters developed an eating disorder of clinical severity during the 2 years of follow-up. Their baseline questionnaire scores differed in many respects from those who had not developed an eating disorder. Items associated with developing an eating disorder were selected by using three different statistical methods. A simple case-predicting instrument based on one of five items scoring above an optimal cut point had a sensitivity of 71% and a specificity of 72% (overall efficiency of 72%). CONCLUSIONS: Dieters who will develop an eating disorder within the next 2 years have distinctive features. It is feasible to identify them in advance with reasonable efficiency with a brief questionnaire. This questionnaire could be incorporated into routine health assessments, thereby identifying those at high risk.

Attitude to Health↗

PubMed2006

Eating attitudes and behaviours in South african adolescents and young adults.

We examined the presence and severity of disordered eating attitudes and behaviours in a group of 895 South Africans. The Eating Attitude Test-26 (EAT-26), the Bulimic Investigatory Test, Edinburgh (BITE) and the Rosenberg Self-esteem Scale (RSE), were administered to high-school and college students (515 White, 126 Black, and 254 'Coloured'). There were few differences between these three groups on measures of eating disorder pathology and self-esteem. A small number of participants (3.5%) were identified as at 'high risk' for an eating disorder as shown by scores in the clinical range for both the EAT-26 and BITE. Weight, self-esteem and age were predictors for this subgroup. This study suggests that ethnicity per se may not 'protect' against the development of disordered eating attitudes and behaviours in nonwestern black populations. These findings remain tentative until future survey studies employ interviews to confirm eating disorder diagnosis.

Adolescent↗

PubMed2004

Eating frequency and colon cancer risk.

Increased exposure of the colon to bile acids, as a result of increased eating frequency, might promote the development of colon cancer. Our aim was to evaluate the association between eating frequency and colon cancer. We used data from a population-based case-control study of colon cancer in North Carolina. Eating frequency (a combination of meals and snacks) was categorized as fewer than three, three or four, or more than four eating episodes per day. Multivariate logistic regression was used to calculate odds ratios (ORs) for the association between eating frequency and colon cancer, adjusting for confounders. We also performed stratified analyses to evaluate for differences by sex, coffee intake, or tumor site. Six hundred thirty-six participants with colon cancer and 1,048 control participants were included. The effect of eating frequency on colon cancer differed by sex. Among men, participants in the lowest group of eating frequency had approximately half the risk of colon cancer compared with the middle group (adjusted OR = 0.53; 95% confidence interval, CI = 0.30-0.92). Compared with the middle group, men in the highest group had no greater risk of cancer (adjusted OR = 1.03; 95% CI = 0.74-1.44). No significant associations were detected among women. Decreased eating frequency was associated with a lower risk of colon cancer among men but not women.

Adult↗

PubMed2003

Interpersonal profiles in eating disorders: ratings of SASB self-image.

INTRODUCTION: Although evidence suggests that interpersonal psychotherapy may be an efficacious treatment for eating disorders, there is surprisingly little systematic knowledge about the interpersonal world of these patients. METHOD: SASB self-image ratings were used to explore interpersonal profiles in a large heterogeneous sample of eating disorders (N = 830), matched normal controls (N = 105) and a small group of controls with subclinical depression (N = 26). RESULTS: Eating disorder patients clearly presented with significantly more negative interpersonal profiles compared to controls. Within the eating disorder group, anorexics were characterized by high self-control, self-blame and self-attack. Patients with binge eating disorder expressed the least negative self-image, and were significantly more self-affirming than bulimics and less self-controlling than patients with atypical eating disorders. CONCLUSIONS: Eating disorder patients may have distinct interpersonal profiles that increase the risk of negative therapeutic reaction. Better knowledge of interpersonal processes in eating disorders may help to improve both diagnostic assessment and treatment.

Adolescent↗

PubMed2002

Identification and treatment of eating disorders in women with type 1 diabetes mellitus.

A series of case reports in the early 1980s and prevalence studies in the 1990s highlighted the serious medical consequences of coexisting eating disorders and diabetes mellitus. Diabetes-specific treatment issues, such as the need to carefully monitor diet, exercise, and blood glucose, may contribute to the development of eating disorder symptoms among women with diabetes mellitus. The attention to food portions and bodyweight that is part of routine diabetes mellitus management parallels the rigid thinking about food and body image found in women with eating disorders who do not have diabetes mellitus. Additionally, intensive insulin management of diabetes mellitus, the current standard of care, has been shown to be associated with bodyweight gain. Following from this, it may be that the very goals of state-of-the-art diabetes mellitus care increase the risk for developing an eating disorder. Once an eating disorder and recurrent insulin omission becomes entrenched, a pattern develops which is hard to break - one of chronic hyperglycemia, depressed mood, fear of bodyweight gain, and frustration with diabetes management. Eating disorders predispose women with diabetes mellitus to many complex medical risks. For example, insulin omission and reduction, eating disorder symptoms unique to diabetes mellitus, are strongly associated with an increased risk of diabetic ketoacidosis and with microvascular complications of diabetes mellitus such as retinopathy. For this reason, it is critical that diabetes mellitus clinicians understand more about eating disorders so as to improve the likelihood of early detection, appropriate treatment, and prevention of acute and long-term medical complications within this high-risk group of women.

Adolescent↗

PubMed1997

Subclinical and clinical eating disorders in IDDM negatively affect metabolic control.

OBJECTIVE: To characterize the relationship of subclinical and clinical eating disorders to HbA1c values in women with IDDM. RESEARCH DESIGN AND METHODS: Ninety women with IDDM (18-46 years of age) were recruited from diabetes clinics throughout Connecticut and Massachusetts. Subjects were categorized into one of three groups according to the Diagnostic Statistical Manual of Mental Disorders (DSM-III-R) criteria for eating disorders as follows: the clinical group (n = 14), the subclinical group (partially fulfilling the diagnostic criteria; n = 13), and the control group (n = 63). Group differences in the degree of dietary restraint, binge eating, and bulimic behaviors and weight, shape, and eating concerns were assessed with the Eating Disorder Examination (EDE) and the Bulimia Test Revised (BULIT-R). RESULTS: Women with subclinical and clinical eating disorders had clinically elevated HbA1c results and more diabetes-related complications, compared with the control subjects. The severity of bulimic behaviors, weight concerns, reduced BMI, and decreased frequency of blood glucose monitoring were associated with elevated HbA1c. CONCLUSIONS: HbA1c may have clinical utility in the identification of eating disorder behavior in females with IDDM. Health care professionals should be aware of the potent effect of subclinical and clinical eating behaviors including insulin misuse in weight-conscious women with IDDM who have poor glycemic control.

Adolescent↗

PubMed2005

The relationship of disordered eating habits and attitudes to clinical outcomes in young adult females with type 1 diabetes.

OBJECTIVE: To describe the clinical outcomes of adolescent and young adult female subjects with type 1 diabetes in relation to the disturbance of eating habits and attitudes over 8-12 years. RESEARCH DESIGN AND METHODS: Patients were recruited from the registers of pediatric and young adult diabetes clinics (including nonattenders) and interviewed in the community. A total of 87 patients were assessed at baseline (aged 11-25 years), and 63 (72%) were reinterviewed after 8-12 years (aged 20-38 years). Eating habits and attitudes were assessed by a semistructured research diagnostic interview (Eating Disorder Examination). RESULTS: Clinical eating disorders ascertained from the interview and/or case note review at baseline or follow-up were found in 13 subjects (14.9% [95% CI 8.2-24.2]), and an additional 7 subjects had evidence of binging or purging, bringing the total affected to 26%. Insulin misuse for weight control was reported by 31 (35.6% [25.7-46.6]) subjects. Overall outcome was poor; serious microvascular complications were common and mortality was high. There were significant relationships between disordered eating habits, insulin misuse, and microvascular complications. CONCLUSIONS: Although the cross-sectional prevalence of clinical eating disorders in young women with diabetes is modest, the cumulative incidence of eating problems continues to increase after young adulthood, and this is strongly associated with poor physical health outcomes. The combination of an eating disorder and diabetes puts patients at high risk of mortality and morbidity. Better methods of detection and management are needed.

Adolescent↗

PubMed1998

A mediational model of social physique anxiety and eating disordered behaviors.

In the present study correlations among scores on social physique anxiety, social behavior inhibition, and eating disordered behaviors and traits were hypothesized on the basis that social physique anxiety would be correlated with personality disturbances associated with eating disorders and mediated by social inhibition and eating disordered behaviors. Subjects were 79 college-aged women (M age = 19.5 yr.), who completed the Garner's Eating Disorders Inventory, the Social Physique Anxiety Scale, and a measure of social behavior inhibition developed for this study. A mediational path analysis showed scores on social physique anxiety significantly moderately related to scores for eating disordered traits, mediated by scores on eating disordered behavior. These correlations account for 14 to 31% of the common variance, and with clinical research, support the assumption that eating-disordered behavior may begin with milder symptomatology such as high scores on social physique anxiety. Longitudinal research is required to assess the proposed causal relationship between identification of early symptoms and later eating disorders; however, present research suggests early intervention with women at risk may be useful.

Adolescent↗

PubMed2004

Alcohol use disorder comorbidity in eating disorders: a multicenter study.

BACKGROUND: Eating disorders and alcohol use disorders (AUDs) commonly co-occur, although the patterns of comorbidity differ by eating disorder subtype. Our aim was to explore the nature of the co-morbid relation between AUDs and eating disorders in a large and phenotypically well-characterized group of individuals. METHOD: We compared diagnostic and personality profiles of 97 women with lifetime anorexia nervosa only, 282 women with lifetime bulimia nervosa only, and 293 women with a lifetime history of both anorexia nervosa and bulimia nervosa or anorexia nervosa with binge eating (ANBN) (DSM-IV criteria). All individuals were participants in a multicenter study of the genetics of anorexia nervosa and bulimia nervosa. We explored pattern of onset, Axis I and II comorbidity, and personality characteristics of individuals with and without AUDs by eating disorder subtype. Personality characteristics were assessed with the Multidimensional Perfectionism Scale, the Temperament and Character Inventory, and the Barratt Impulsivity Scale. RESULTS: Alcohol use disorders were significantly more prevalent in women with ANBN and bulimia nervosa than in women with anorexia nervosa (p =.0001). The majority of individuals reported primary onset of the eating disorder, with only one third reporting the onset of the AUD first. After eating disorder subtype was controlled for, AUDs were associated with the presence of major depressive disorder, a range of anxiety disorders, and cluster B personality disorder symptoms. In addition, individuals with AUDs presented with personality profiles marked by impulsivity and perfectionism. CONCLUSIONS: Individuals with eating disorders and AUDs exhibit phenotypic profiles characterized by both anxious, perfectionistic traits and impulsive, dramatic dispositions. These traits mirror the pattern of control and dyscontrol seen in individuals with this comorbid profile and suggest that anxiety modulation may be related to alcohol use in this group.

Age of Onset↗

PubMed2000

Eating disordered patients: personality, alexithymia, and implications for primary care.

BACKGROUND: Eating disorders are becoming more apparent in primary care. Descriptions of character traits related to people with eating disorders are rarely reported in the primary care literature and there is little awareness of the implications of alexithymia--a concept that defines the inability to identify or express emotion. We hypothesised that many individuals with active eating disorders have alexithymic traits and a tendency to somatize their distress. AIM: To analyse the character traits and degree of alexithymia of a selected group of women with active eating disorders and in recovery, and to recommend responses by members of the primary care team that might meet the needs of such individuals. METHOD: Letters were sent to 200 female members of the Eating Disorders Association who had agreed to participate in research. Seventy-nine women volunteered to complete four postal questionnaires. This gave a response rate of 38.5%. Responders were categorised into three groups--anorexic, bulimic, and recovered--using the criteria of the Eating Disorders Inventory (EDI-2). The results of the 16PF5 Personality Inventory (16PF5) and the Toronto Alexithymia Scale (TAS-20) were analysed using one-way analysis of variance (ANOVA) and correlated using Pearson's correlation. A biographical questionnaire was also completed. RESULTS: In all three subgroups, high scores were achieved on the 16PF5 on 'apprehension and social sensitivity', while there were significant differences in the scores for 'privateness': a scale that measures the ability to talk about feelings and confide in others. On the TAS-20, 65% of the anorexic and 83% of the bulimic group scored in the alexithymic range compared with 33% of the recovered group. There was a significant negative correlation between alexithymia and social skills such as 'social and emotional expressivity' on the 16PF5. CONCLUSION: The results of this study emphasise the difference between those with active eating disorders who achieved high scores for privacy, introversion, and alexithymia, and those who have recovered. These character traits give potential helpers an important indication of the areas that can both block and facilitate recovery, and they act as a reminder that the presenting symptoms in eating disorders and other psychosomatic conditions are the outward presentation of internal conflict. It is suggested that effective screening and needs assessment will facilitate a more appropriate and prompt therapeutic response. This may be provided in the primary care setting where appropriate training has occurred.

Adolescent↗

PubMed2002

Eating disorders.

Eating disorders are a serious concern in clients health and a challenge to oral health professionals. These illnesses, including anorexia nervosa, bulimia, binge eating, and pica, are characterized by serious disturbances in eating and effects on psychological health. Physiologic changes associated with eating disorders may be devastating and can lead to mortality. Despite the serious consequences of eating disorders on physical and psychological health and well being, these disorders are often difficult to diagnose. Even when detected, ill clients may be averse to accepting treatment. Thus, oral health professionals must be aware of the signs of eating disorders, and be prepared to collaborate with other health care providers to treat them. The purpose of this course is to review the medical and dental literature concerning eating disorders types, risk factors, systemic health consequences, oral manifestations, and treatment considerations. The role of oral health professionals as part of an interdisciplinary health team focused on addressing the needs of clients with eating disorders will be addressed.

Dental Care for Chronically Ill↗

PubMed2003

Eating disorders in Singapore: a review.

INTRODUCTION: Anorexia nervosa, bulimia and binge-eating disorder are the three best recognised eating disorders. Eating disorders have been reported to affect some 1 to 3% of adolescent females in the West. Increasing reports from Asia suggest that it is no longer possible to view these illnesses as 'Western' diseases. Eating disorders are the third most common serious medical disorder in female adolescents, after asthma and depression. It poses a tremendous burden for individuals, families and society. Historical and current studies on eating disorders in Singapore are reviewed, and discussed in the light of available regional and worldwide research. METHODS: Studies on anorexia nervosa and bulimia in Singapore were identified through a MEDLINE search (from 1979). Information from these studies were supplemented with relevant local monographs on eating disorders. RESULTS: Reports of eating disorders have increased over recent years in the local literature. The psychopathology of eating disorders in Singapore is very similar to that described in the Western literature, and in the two main current classification systems. Body dissatisfaction is prevalent among Singaporean Chinese schoolgirls and female undergraduates, with rates not dissimilar to the West. There is a link between 'Westernisation' (based on English being spoken as the main language at home) and body dissatisfaction.

Adolescent↗

PubMed2003

[Binge eating disorder (BED)--new diagnostic category].

Binge Eating Disorder (BED) is a proposed new diagnostic criteria in the DSM-IV, cited as an example of an eating disorder Not Otherwise Specified (NOS). The phrase Binge Eating was introduced over 35 years ago to describe problematic behavior found in a subgroup of overweight individuals, and as a subgroup of Bulimia Nervosa. The defining characteristics of BED patients are consumptions of an objectively large amount of food in discrete time periods, a lack of control during eating episodes and a lack of compensatory behavior binge. BEDs affect approximately 30% of obese individuals seeking treatment. The binge eaters represent a distinct subgroup among the obese with higher prevalence of comorbid psychiatric disturbances, as well as higher rates of eating pathology, as compared to normal obese women. Several researches suggested that individuals use binge eating as a means of coping with emotional distress. In addition, the binge eating disorder represents a distinct subgroup among bulimia nervosa with lower comorbid psychiatric disturbances, eating pathology and purging behavior. The present paper will review this proposed syndrome and will discuss the question of whether it is a distinct subgroup of obese patients or a distinct subgroup of bulimia nervosa patients, or a new diagnostic category. This diagnostic dilemma is discussed in light of clinical and empirical literature. Clinical and therapeutic implications are presented and ideas for future research are proposed.

Bulimia↗

PubMed1992

[Prevalence of eating disorders among female Israel defence force recruits].

It is assumed that the incidence of anorexia nervosa and bulimia nervosa in the general population has been increasing. Medical personnel in the IDF also believe this to be true with regard to their female soldiers. We administered the eating attitude test (EAT) to 1112 female soldiers at the beginning of their military service and determined weight and height for each. Those whose EAT scores were high or whose weights were low were then interviewed by the study psychiatrist and the author. 2 of them (0.2%) were found to be suffering from anorexia nervosa. Both were identified by their low weights; their EAT scores were both normal. 27 (2.4%) were diagnosed as having a partial eating disorder syndrome, in a third of whom it was severe. The severe cases were also identified by their weights and not by EAT scores. In addition, 4 (0.5%) had bulimia nervosa, all of whom were identified from their EAT scores. These findings are similar to those of some of the most recent studies in the field. The deficiencies of the EAT scale were more apparent in this than in other studies. Because of its relatively low PPV as well as the apparent reluctance of many subjects to answer truthfully, the scale is not effective by itself for screening purposes. As was shown in this study, measuring weight and height in addition considerably improved accuracy of screening.

Anorexia Nervosa↗

PubMed2004

Intuitive eating and the nutrition transition in Asia.

Current models of the nutrition transition focus on demographic changes and economic development. A further influence may be the adoption of western-based perceptions of beauty that lead to potentially harmful eating behaviours which contribute to overweight, obesity, and eating disorders. This paper proposes a comprehensive model of the nutrition transition that includes western influences on perceived attractiveness and subsequent eating styles. An exploratory test of this model for Asian countries explores differences in intuitive eating as a function of economic development and the adoption of western standards of beauty. The intuitive eating scale (IES), a measure of food consumption that is primarily characterized by the satisfaction of physical hunger, was used to evaluate agreement with intuitive eating principles in the US and four Asian countries (Japan, Thailand, the Philippines, and China). Although intuitive eating scores in the US and Thailand failed to follow predicted patterns on two of the four IES subscales, scores for the other two IES subscales and the total IES score followed predicted patterns for Asian countries. Intuitive eating appears to be a valid, measurable concept that is correlated with economic development and levels of western influence in Asian countries. The tentative findings of this exploratory study support further evaluation of cultural influences as an important component of the nutrition transition.

Adult↗

PubMed2004

Eating attitudes and their psychological correlates among Turkish adolescents.

This study examined the eating attitudes and psychological characteristics of Turkish late adolescents. Seven hundred eighty-three university students were administered the Eating Attitudes Test, Rosenberg Self-Esteem Scale, State-Trait Anxiety Inventory, and Social Physique Anxiety Scale. More than one in ten (9.2% of the males and 13.1% of the females) had abnormal eating attitude scores. Chi-square analysis revealed that there were no significant differences in the prevalance of abnormal eating behaviors based on gender. Analysis of covariance indicated that participants who had disturbed eating attitudes had lower self-esteem, higher social physique anxiety, and higher trait anxiety than those who had normal eating attitudes. It was concluded that the prevalence of disturbed eating attitudes was high among these Turkish late adolescents, and that disturbed eating attitudes were related to several psychological characteristics.

Adolescent↗