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Mental health and eating behaviours: a bi-directional relation.

BACKGROUND: Variations in mental health may contribute to or impair healthy eating. The relation between eating and mental health is bi-directional: one's mood or psychological state can affect what and how much one eats, and eating affects one's mood and psychological well-being. Thus, if we want to promote and develop strategies to encourage healthy eating, it is important to understand the connections between mental health and healthy eating. METHODS: To contribute to this understanding, we examine the research on individual differences in how people respond to food, as well as mood, and emotional, social and collective influences on what and how much is eaten; we then examine the implications of these connections for mental health, with a focus on adolescents and adults. Looking at the relation between eating and mental health from the other direction, we review research investigating whether the amount that one eats or particular foods one ingests can make one feel good or bad about oneself. CONCLUSIONS: Overeating and undereating have complex effects, sometimes contributing to improved feelings of well-being and at other times leaving the individual feeling guilty, deprived, depressed and anxious. We attempt to identify both what we know and the gaps in our knowledge.

Adolescent↗

PubMed1992

Eating patterns and energy and nutrient intakes of US women.

A longitudinal multivariate analysis was used to determine whether differences in energy and nutrient intakes were present for women classified into different eating patterns. Ten multidimensional eating patterns were created based on the proportion of energy consumed at home and at seven away-from-home locations. Data were from 1,120 women aged 19 through 50 years who were surveyed up to six times over a 1-year period as part of the 1985 Continuing Survey of Food Intake by Individuals, US Department of Agriculture. Data from 5,993 days were analyzed. To examine differences in energy and nutrient intakes, longitudinal multivariate analyses were used to control for eating pattern and factors such as demographics, season, and day of week. Younger women in the Fast Food eating pattern consumed the greatest intakes of energy, total fat, saturated fat, cholesterol, and sodium. Well-educated, higher-income women in the Restaurant pattern consumed diets with the highest overall fat density. Nutrient densities for dietary fiber, calcium, vitamin C, and folacin were particularly low in away-from-home eating patterns. In contrast, moderately educated, middle-aged and middle-income women in the Home Mixed eating pattern (70% at home, 30% away from home) consumed the most healthful diets. We conclude that knowledge of demographics such as income and education is not enough to target dietary interventions. Rather, educational efforts must consider both demographics and the location of away-from-home eating. This will allow development of behavioral change strategies that consider food choices dictated by the eating environment as well as personal knowledge and attitude factors related to adoption of healthful food choices.

Adult↗

PubMed2005

Disordered eating in elderly female patients diagnosed with chronic schizophrenia.

BACKGROUND: Data about the association between disordered eating and schizophrenia is limited and inconclusive. The aim of the present study was to evaluate disordered eating in elderly female patients diagnosed with chronic schizophrenia. METHODS: The Eating Attitudes Test-26 (EAT-26) was completed by 30 female inpatients diagnosed with chronic schizophrenia (mean age 70 +/- 6.5 years), and the Geriatric Depression Scale (GDS) and Positive and Negative Symptom Scale (PANSS) were completed by their treating psychiatrists. The height and weight of the patients were also recorded. RESULTS: Four patients (13.3%) had pathological scores on the EAT. These patients had lower body mass index scores and longer duration of hospitalization compared with the other patients. Their eating-related disturbance was anorectic-like in nature. There were no between group differences in the GDS, whereas the schizophrenic illness of the four patients with pathological EAT, as rated with the PANSS, appeared somewhat more active. CONCLUSIONS: Disordered eating of an anorectic-restrictive nature--not related to depression or negative schizophrenic symptomatology--may be found in a relatively high percentage of elderly female inpatients diagnosed with chronic schizophrenia.

Aged↗

PubMed1991

Eating disorders. Highlights of nursing assessment and therapeutics.

Nurses providing care for individuals with eating disorders should identify and test the effectiveness of various milieu factors and nursing therapeutics employed in the treatment of these often-debilitating disorders. Nurses offer presence, role modeling, surveillance, and emotional and physiologic support while guiding reluctant patients to explore and experiment with new behaviors. Nurses provide flexibility, empathy, and rational limit setting in response to the unique and shifting needs of each patient. This interpersonal dynamic is often extremely different from that experienced in the patient's family of origin and, thus, contributes to the essential "interpersonal conditions" that are necessary for the patient to engage meaningfully in treatment. The prevalence of eating disorders suggests that nurses are likely to encounter people with eating disorders in many settings. Nurses should be skilled at spotting disordered eating among an array of clinical presentations (e.g., amenorrhea, disturbed family relationships, athletic injuries) because people engaged in disordered eating are hesitant to volunteer such information. In addition to the shame associated with disordered eating is the stigma associated with psychiatric treatment. Seeking help from a nurse may be perceived as less stigmatizing than seeking care from a psychiatrist. Thus, nurses may serve as important points of entry for the hesitant patient. The initial contact is so essential in setting the stage for the continuation and denouement of therapy. Finally, nurses and patients with disordered eating share at least one commonality. Both groups are predominantly women. The prevailing culture has been implicated repeatedly as a major factor in contributing to the prevalence of disordered eating. Nurses experience the influences of paternalism in their professional practice and confront daily the pressures of socially constructed feminine ideals. These gender-sensitive ways of knowing, which nurses bring to the treatment relationship, should be further analyzed as substantive dimensions with treatment and preventive potential.

Family↗

PubMed1994

Eating disorders and substance use: a dancing vs a nondancing population.

The association between eating disorders, substance use, and emotional distress is well recognized in the literature. To determine whether dancers who are known to be at risk for eating disorders were also at risk for other emotional disorders, the co-occurrence of eating disorders, substance use, and emotional distress among dancers (N = 50) and nondancers (N = 56) was examined. These young adult women were part of a longitudinal study of the complications of decreased bone density. Participants filled out questionnaires about eating behavior, substance use, and emotional functioning. A clinical interview determined the existence of eating disorders (DSM-III-R). Physiological data, including an assessment of current health, also were collected. There were no differences in disordered eating between the two subject groups. Associations existed within each group, however. Many associations including substance use and emotional distress were found among the nondancers, while no associations were found among the dancers. Thus, eating disorders in a group of subjects at risk because of professional pressures to remain thin revealed a profile which differed significantly from that of women developing eating disorders in the general population.

Adolescent↗

PubMed1996

Eating attitudes and body shape perceptions among elite rowers: effects of age, gender and weight category.

This study examined the influence of age, gender and weight category upon measures associated with eating disorders. Elite rowers (N = 124) participating in the 1994 Great Britain National Squad trials, completed the Eating Attitude Test (EAT) and the Body Shape Questionnaire (BSQ). Subjects were grouped according to whether they competed in the Lightweight (Female: < 59 kg, N = 31; Male: < 72.5 kg, N = 31) or Heavyweight (Female: N = 31; Male: N = 31) category. Results revealed significantly higher EAT and BSQ scores among the Lightweight group, 16.2% of whom showed EAT scores above the threshold associated with eating disorders. Females showed significantly higher BSQ scores than males. The interaction effect was significant for BSQ, indicating a much greater increase in scores from heavyweight to lightweight for females than for males. EAT and BSQ scores were inversely correlated with age. These results suggest that the risk of eating disorders among elite rowers is mediated by age, gender and weight category.

Adult↗

PubMed1997

Factors influencing eating attitudes in secondary-school girls in South Africa--a preliminary study.

OBJECTIVES: To establish factors in the environment, e.g. family, peer or media, as well as individual factors, e.g. self-perception, which may influence eating attitudes. DESIGN: Cross-sectional survey. SETTING: Non-clinical, community-based. SUBJECTS: Female high-school pupils. OUTCOME MEASURES: Responses to questions pertaining to environmental as well as individual factors for each respondent ('dieting questionnaire'; self report). Total scores derived from a self-report questionnaire pertaining to eating attitudes (Eating Attitudes Test (EAT-26)). Statistical analysis, using analysis of variance procedures, to determine significant associations between the two questionnaires. RESULTS AND CONCLUSIONS: Specific individual wishes, perceptions, behaviours and topics of conversation appear to influence as well as predict eating attitudes. Family, especially maternal, factors play a role in determining eating attitudes. Peer and media (television) factors are not significantly influential. The findings provide preliminary data on factors that influence eating attitudes in a group at risk for the development of eating disorders. The findings have implications for the formulation of preventive strategies within a comprehensive treatment approach.

Adolescent↗

PubMed2002

A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder.

BACKGROUND: Cognitive-behavioral therapy (CBT) has documented efficacy for the treatment of binge eating disorder (BED). Interpersonal psychotherapy (IPT) has been shown to reduce binge eating but its long-term impact and time course on other BED-related symptoms remain largely unknown. This study compares the effects of group CBT and group IPT across BED-related symptoms among overweight individuals with BED. METHODS: One hundred sixty-two overweight patients meeting DSM-IV criteria for BED were randomly assigned to 20 weekly sessions of either group CBT or group IPT. Assessments of binge eating and associated eating disorder psychopathology, general psychological functioning, and weight occurred before treatment, at posttreatment, and at 4-month intervals up to 12 months following treatment. RESULTS: Binge-eating recovery rates were equivalent for CBT and IPT at posttreatment (64 [79%] of 81 vs 59 [73%] of 81) and at 1-year follow-up (48 [59%] of 81 vs 50 [62%] of 81). Binge eating increased slightly through follow-up but remained significantly below pretreatment levels. Across treatments, patients had similar significant reductions in associated eating disorders and psychiatric symptoms and maintenance of gains through follow-up. Dietary restraint decreased more quickly in CBT but IPT had equivalent levels by later follow-ups. Patients' relative weight decreased significantly but only slightly, with the greatest reduction among patients sustaining recovery from binge eating from posttreatment to 1-year follow-up. CONCLUSIONS: Group IPT is a viable alternative to group CBT for the treatment of overweight patients with BED. Although lacking a nonspecific control condition limits conclusions about treatment specificity, both treatments showed initial and long-term efficacy for the core and related symptoms of BED.

Adult↗

PubMed1996

Prevalence of eating disorders among Norwegian women and men in a psychiatric outpatient unit.

OBJECTIVE: The primary purpose of the study was to establish lifetime and point prevalence of different eating disorders in a psychiatric outpatient population of both men and women. METHOD: A questionnaire was sent out to 364 patients referred to a psychiatric outpatient department. Of these questionnaires, 234 (64.3%) were completed and returned. Patient questionnaires were analyzed to assess the prevalence for different groups of eating disorders according to DSM-III-R criteria. RESULTS: In women there was a lifetime prevalence of 5.2% of anorexia nervosa (AN), 16.1% bulimia nervosa (BN), 6.5% binge eating disorder (BED), and 11.0% eating disorder not otherwise specified (EDNOS), in total 38.7%. The point prevalence was 1.9% AN, 5.2% BN, 3.2% BED, nd 8.4% EDNOS, in total 18.7%. The lifetime prevalence in men was 0% AN, 10.7% BN, 6.7% BED, and 4.0% EDNOS, in total 21.3%. Point prevalence was found to be 0% AN, 2.7% BN, 5.3% BED, and 6.7% EDNOS, in total 14.7%. Staff information yielded substantially lower rates of eating disorders among these patients. There was a significantly higher rate of eating disorders in the close family of eating-disordered patients compared to the patient group without such a disorder. DISCUSSION: The results support earlier studies indicating that younger patients have more eating disorders. The men showed frequencies of BN and BED at the same level as women, but the frequency of EDNOS was lower, and there were no cases of AN.

Adult↗

PubMed1996

Truly late onset of eating disorders: a study of 11 cases averaging 60 years of age at presentation.

OBJECTIVE: To study late-onset cases of eating disorders in order to (1) document the occurrence of these cases as truly new onset, even if postmenopausal; (2) to alert clinicians to the category of late-onset eating disorders, especially clinical features and treatment response; (3) to challenge some prevailing assumptions of etiology. METHODS: Selection of cases of eating disorders with first onset after age 40 that met DSM-IV criteria, by review of eating disorders admissions to three university hospital programs. RESULTS: Eleven patients, approximately 1% of all cases of eating disorders, had first onset of an eating disorder after age 40 and as late as 77, with an average onset of 56 and clinical presentation at 60 years. They met DSM-IV criteria for all subtypes of eating disorders. In general, concurrent medical and comorbid psychiatric symptoms made recognition and treatment more complex. DISCUSSION: Truly late-onset cases do occur, challenging etiological theories requiring adolescent age of onset, premenopausal endocrine functioning, or adolescent psychodynamic conflicts. Late-occurring cases, after accurate diagnosis, require an appreciation of psychological themes pertinent to this age group, such as bereavement or unresolved body image issues. Age by itself is no barrier to onset of eating disorders, which may occur whenever self-starvation and/or binge-purge behaviors become entrenched as sustaining behaviors for amelioration of psychodynamic conflicts, mood disorders, or interpersonal distress.

Age of Onset↗

PubMed1997

A comparison of onset of binge eating versus dieting in the development of bulimia nervosa.

OBJECTIVE: This study further investigates the hypothesis that dieting is the precursor to the development of binge eating. METHOD: The temporal relationship of onset of binge eating and dieting is examined from retrospective self-reports collected at baseline from women participating in two bulimia nervosa (BN) treatment studies (N = 221). Twenty women were identified who reported binge eating prior to the onset of dieting ("binged first," BF). For comparison, 20 similar age individuals reporting dieting onset preceding that of binge eating ("dieted first," DF) were selected. RESULTS: A subset of women (8.8%) seeking treatment for BN endorsed the development of binge eating prior to dieting onset. The BF pattern of BN development was associated with earlier age of onset of binge eating, later onset of purging, increased desired weight, and increased actual weight. Binge eating prior to dieting onset was also associated with improved response to group cognitive-behavioral treatment at 6-month follow-up. CONCLUSIONS: This study provides support for the hypothesis that dieting is a risk factor, but not necessarily a precursor, to the development of binge eating in BN. Implications for treatment and future research are discussed.

Adult↗

PubMed1997

Initial manifestations of disordered eating behavior: dieting versus binging.

OBJECTIVE: We examined the onset of binge eating and dieting in 108 women with bulimia nervosa to determine whether (1) dieting always preceded binge eating; (2) dieting always preceded the onset of bulimia nervosa; and (3) individuals who manifested early initial binge eating differed from those whose earliest manifestation of disordered eating behavior was dieting in terms of lifetime psychopathology and temperament. METHOD: One hundred eight women were assessed at entry to a randomized clinical trial of cognitive-behavioral therapy for bulimia nervosa using structured diagnostic methodology. Retrospective recall of the onset of disordered eating behavior was used to categorize individuals as initial binge eaters or initial dieters. We then compared lifetime psychopathology and temperament across the two groups. RESULTS: Seventeen percent of women reported early binge eating prior to any dieting behavior. The mean age of onset of binging in this group was approximately 10 years. Neither the clinical picture of bulimia nervosa nor lifetime psychopathology differed between initial binge eaters and initial dieters. Individuals with early binge eating endorsed higher novelty seeking and lower harm avoidance. CONCLUSION: In a minority of women with bulimia nervosa, binge eating precedes dieting. These women display markedly higher novelty seeking and lower harm avoidance. Possible links between the dopamine system, novelty seeking, and appetitive behavior are discussed.

Adolescent↗

PubMed1998

The validity of the DSM-IV scheme for classifying bulimic eating disorders.

OBJECTIVE: This study was designed to assess the validity of the DSM-IV scheme for classifying recurrent binge eating. METHOD: A general population sample of 250 young women with recurrent binge eating was recruited using a two-stage design. Information on their eating habits and associated psychopathology was obtained by personal interviews. Subjects were reassessed 1 year later. RESULTS: The diagnosis of bulimia nervosa had good descriptive and predictive validity. On present state features it was not possible to distinguish binge-eating disorder from the nonpurging subtype of bulimia nervosa. However, these groups differed in their outcome at 1 year. Within eating disorder not otherwise specified (EDNOS), there was a subgroup of subjects with milder symptoms which were relatively unstable over time. DISCUSSION: The findings suggest that bulimic eating disorders exist on a continuum of clinical severity, from bulimia nervosa purging type (most severe), through bulimia nervosa nonpurging type (intermediate severity), to binge-eating disorder (least severe). The data on outcome support retaining a distinction between nonpurging bulimia nervosa and binge-eating disorder.

Adolescent↗

PubMed1998

Stress, coping, and crisis support in eating disorders.

OBJECTIVE: Recent research has supported the role of stress in the development and maintenance of eating disorders. However, coping and crisis support, important aspects of this stress process, have received little systematic attention. The cognitive-transactional approach to coping emphasizes the importance of the relationship between the individual and the particular problematic situation and yet most studies investigating coping in eating disorders have failed to measure situation-specific coping. METHOD: The present study used semistructured interviews to measure coping and crisis support in response to severe events and/or marked difficulties in 12 women with anorexia nervosa (AN), 21 women with bulimia nervosa (BN), and 21 women without an eating disorder (non-ED). RESULTS: Women with eating disorders were more likely to use cognitive avoidance or cognitive rumination and were less likely to downplay their problems. In addition, BN subjects were more likely to blame themselves and were less likely to receive crisis support from a core-tie. Overall, women with eating disorders were less likely to be masterful in response to crises than women without eating disorders. DISCUSSION: It is concluded that women with eating disorders are less effective in their coping than women without eating disorders.

Adaptation, Psychological↗

PubMed1998

Bulimia nervosa, restrained, and unrestrained eaters: a comparison of non-binge eating behavior.

OBJECTIVE: This study investigated non-binge eating behavior in bulimia nervosa, restrained and unrestrained eaters. METHOD: Nine females with bulimia nervosa, 12 female restrained eaters, and 13 female unrestrained eaters were administered the Eating Disorder Inventory-2 (EDI-2), the Body Shape Questionnaire, the Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and the Revised Restraint Scale (RRS). All subjects were videotaped during a midday meal and their eating behavior was subsequently rated using the Eating Behaviour Rating Scale (EBRS). RESULTS: EBRS ratings were higher for bulimic than for unrestrained subjects. Restrained subjects' ratings did not differ from those of either bulimic or unrestrained subjects. EBRS scores were positively correlated with RRS and EDI-2 total scores. CONCLUSIONS: Bulimic subjects display aberrant eating behavior, and the extent to which subjects engage in maladaptive eating behavior is related to the degree of eating pathology. These results support the utility of the EBRS as a useful index of eating behaviors in clinical and nonclinical populations.

Adolescent↗

PubMed1998

The effect of perceived control over eating on the life satisfaction of women and men: results from a community sample.

OBJECTIVE: To test whether overweight, or perception of lack of control over eating, or both, contributed to the level of life satisfaction for women and men in a random sample of community-dwelling adults. METHOD: This study examined the effects of body mass index (BMI) and perceived control over eating on life satisfaction for women and men in a community-based sample of 1,069 women and 963 men. RESULTS: For women, both lack of perceived eating control and higher BMI were associated with less life satisfaction, and lack of control over eating was the more important predictor. For men, only lack of perceived eating control was associated with less life satisfaction. Furthermore, for both women and men, the contribution of eating control to life satisfaction was unaffected by BMI, that is, the life satisfaction of heavier people was not more affected by perceived control over eating than was the life satisfaction of lighter people. DISCUSSION: These findings suggest that psychological issues related to eating and weight can affect global aspects of well-being.

Adolescent↗

PubMed1999

Dieting and the family context of eating in young adolescent children.

OBJECTIVES: The potential for undernutrition and links with eating disorders make early dieting an issue of concern. The aim of this research was to examine the eating patterns, social circumstances of eating, and parental use of food in young adolescent dieters. METHODS: Four hundred and two 12-year-old children (200 girls, 202 boys) completed assessments of dieting, eating patterns, food-related nurturance, and parental control of eating, together with body weight, height, and self-perception. RESULTS: Current dieting (20% girls, 8% boys) was strongly associated with fasting and dietary restraint. Highly restrained children ate fewer meals and snacks and reported significantly greater parental control of their eating. However, they did not differ in the social context of eating or in food-related nurturance. Dieting status was a stronger determinant than body weight of all these differences. CONCLUSIONS: These findings suggest that 12-year-old dieters are quite serious in their nutritional intentions. They also confirm an active role for parents in their children's dieting. Both children and their parents are in need of age and gender-specific advice concerning eating and weight.

Child↗

PubMed2001

Accuracy of self-reported weight in patients with binge eating disorder.

OBJECTIVE: This study was designed to evaluate the accuracy of self-reported weight in patients with binge eating disorder. METHOD: Subjects were 108 adults who were consecutively evaluated for outpatient clinical trials and met DSM-IV criteria for binge eating disorder. Self-reported and measured weights were taken and participants were administered a battery of measures to examine correlates of reporting error. In addition, accurate reporters of weight (i.e., individuals who reported their weight within 5 lb of their measured weight) were compared to underreporters (i.e., individuals who underreported their weight by more than 5 lb) on eating disorder psychopathology and conceptually related measures. RESULTS: Overall, most binge eating disorder subjects were accurate in reporting weight: 73% were accurate within 5 lb and 82% were accurate within 10 lb. Self-reported and measured body mass index were highly correlated and the magnitude of the difference was nonsignificant. Body mass index was not significantly associated with the degree of accuracy, that is, accurate reporters weighed about the same as underreporters. Accurate reporters and underreporters did not differ on measures of overeating behaviors, eating disorder psychopathology, and conceptually related measures. DISCUSSION: These findings suggest that most patients with binge eating disorder were accurate in self-reporting weight. Unlike findings in healthy samples, heavier patients with binge eating disorder were not more likely to underreport weight. Similar to findings in patients with bulimia nervosa, eating disorder psychopathology was not related to reporting error.

Adult↗