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PubMed1997

Bias in interpretation of ambiguous scenarios in eating disorders.

Eating disorders appear to be associated with biased information processing, particularly in judgments involving the self. This study investigated three possible biases. Patients with anorexia nervosa, patients with bulimia nervosa and female controls completed questionnaires designed to assess interpretation of ambiguous scenarios with either a negative or positive outcome. When events had a negative outcome the patients responded spontaneously to open-ended questions with a weight and shape interpretation. Later, in a forced-choice format, they selected the weight and shape interpretation in preference to interpretations not connected to weight and shape. In both open-ended and forced-choice format this bias was specific to judgments involving the self. When events had a positive outcome the bias was reversed and, in the two formats, it was found only in judgments involving others. In both cases, i.e. for negative self-referent events and for positive other-referent events, patients predicted that weight and shape explanations were more likely. Both groups of patients estimated that negative outcomes involving the self would be more costly. The patients with bulimia nervosa also estimated that positive outcomes involving the self would be more beneficial. Theoretical explanations and clinical implications are discussed.

Adult↗

PubMed2006

[Role of outpatient psychiatry in therapy of patients with eating disorder].

Eating disorders are common illness but the proportion of those in treatment is still low and their liability to abandon treatment is a constant danger. This is largely due to the pathology: in particular splitting and denial. Thus, the integration of various types of treatment is essential and the process of integration will be efficiently managed if a psychiatric clinic works as a center of the therapeutic network. Formerly, long-term in-patient treatment was regarded as the best choice for treating the patient thoroughly. Nowadays such treatment is not recommended due to the large cost involved in such treatment. Also, removing the patient from a community environment and confining them to an institution over a long period is now regarded as discouraging independence. Thus, the focus of treatment has shifted from in-patient to out-patient treatment. A new model for multi-disciplinary work is now needed because sharing patient information between professionals is more difficult at the outpatient clinic than on an in-patient ward with shared case notes. In order to make the treatment network functional, patients themselves are expected to possess a clear understanding of the illness and its treatment. The application of motivational enhancement theory is useful in this respect. It is the responsibility of psychiatric clinics to encourage the continuous improvement of patient motivation for treatment and to make patients tolerant towards changes in treatment settings.

Ambulatory Care Facilities↗

PubMedDate not supplied

Disordered eating behaviors in youth with type 1 diabetes.

Eating disorders are a significant health problem for many adolescents and are described as occurring along a spectrum of symptoms including disordered eating behaviors and clinical eating disorders. Poor self-esteem and body image, intense fear of gaining weight or refusal to maintain weight, and purging unwanted calories are clinical features of some eating disorders. Type 1 diabetes is a chronic illness with marked insulin deficiency. Chronic hyperglycemia creates a state of glucosuria with subsequent weight loss. Diabetes treatment focuses on intensive daily management of blood glucose by balancing insulin, food intake, and physical activity. Insulin omission offers an easy method for the purging of unwanted calories. The combination of these 2 illnesses is potentially deadly and also leads to an increased risk of poor diabetes outcomes. This includes poor metabolic control (measured by elevated hemoglobin A1C), increased risk of diabetic ketoacidosis, and microvascular complications such as retinopathy and nephropathy. Diabetes clinicians should be aware of the potential warning signs in an adolescent with diabetes as well as assessment and treatment options for eating disorders with concomitant type 1 diabetes. This article reviews the available data on the prevalence, screening tools, assessment guidelines, and treatment options for eating disorders in youth with type 1 diabetes.

Adolescent↗

PubMed2005

Eating disorders and eating problems among adolescents with type 1 diabetes: exploring relationships with temperament and character.

OBJECTIVE: To determine temperament and character among adolescents with type 1 diabetes with and without disordered eating. METHOD: A clinical sample of 199 adolescents from multiple centers with a mean age of 14.1 (SD, 2.5) years were screened and diagnosed for eating disorders. Assessed were temperament and character as conceptualized by Cloninger, glycemic control, and depression. RESULTS: Adolescent patients with clinical eating disorders or subthreshold eating problems had significantly higher mean scores in harm avoidance and lower mean scores in self-directedness. Harm avoidance remained significant even after controlling for depressive pathology. DISCUSSION: This study is the first to show evidence that among youths (in particular, girls) with type 1 diabetes, there is an association between low self-directedness, high harm avoidance, and the presence of eating, weight, and shape pathology. For these particular youths, important implications for clinical practice are outlined.

Adolescent↗

PubMedDate not supplied

Obsessive-compulsive personality disorder and eating disorders.

Obsessions, compulsions, and personality traits such as perfectionism and inflexibility are commonly described in eating disorder patients. A lack of precise clarification has existed in defining the presence of obsessive-compulsive disorder and obsessive-compulsive personality disorder in the various eating disorder subtypes. Research clarifying these definitions and the components of perfectionism as it pertains to eating disorders is reviewed in this article.

Journal Article↗

PubMed1986

Desire for thinness among high school cheerleaders: relationship to disordered eating and weight control behaviors.

The eating disorders of anorexia nervosa and bulimia are increasing in frequency among adolescent females. These increases have been linked to the cultural ideal in American society of thinness. Attempting to control weight is one behavioral manifestation of the desire for thinness. One particular group of adolescents, female cheerleaders, often experience pressure to attain and maintain weight that is lower than other adolescents of the same height. This study examined cheerleaders' desire for thinness in relationship to disordered eating and weight control behaviors. A Desire for Thinness Scale and selected scales from three eating disorders instruments were administered to 751 high school cheerleaders from the Midwest. Cheerleaders who scored in the upper third on the Desire for Thinness Scale were compared with those who scored in the lower third. Cheerleaders who expressed a strong desire for thinness had significantly higher scores (p less than .0001) on 7 of 8 eating disorders scales. The greater the desire for thinness, the more likely the tendency to report disordered eating and weight control behaviors associated with bulimia. Implications from this study include an awareness of how a cultural ideal of thinness may indirectly increase disordered eating and weight control behaviors by making weight loss a salient goal. A proactive approach to modifying negative aspects of the cultural emphasis on thinness is proposed.

Adolescent↗

PubMed1993

Association of sexual abuse and borderline personality disorder in eating disordered women.

It has been shown that sexual abuse is associated with the eating disorders, particularly those with a bulimic component. Existing research suggests that borderline personality disorder (or the cluster of behaviors behind this diagnosis) may be a mediating factor in that link. However, there is no evidence of specific patterns of association between the three phenomena. The present report studies these links in a case series of 115 eating-disordered women. It is shown that the links between and reported sexual abuse and borderline personality disorder vary according to the nature of the eating disorder. In particular, they were associated in anorexia of the bulimic subtype, but not in bulimia nervosa or in restrictive anorexia. The possible therapeutic implications of these findings are discussed.

Adolescent↗

PubMedDate not supplied

[Separation anxiety disorder and eating disorders].

Separation anxiety disorder (SAD) is probably the most common anxiety disorder observed in childhood. If some studies suggest that SAD may increase the risk of anxiety and mood disorders in adolescents and young people, the outcome of childhood SAD remains unclear. Because of the high mental-eating disorders comorbidity, we performed a follow-back study in 81 young patients showing anorexia nervosa (AN) or bulimia nervosa (BN) according to DSM III-R criteria. The current and lifetime psychiatric histories were assessed using structured interviews (SADS-LA and SCID) and the psychopathological profile with the SCL-90. The results showed that about 20% of young patients with AN and BN had a past history of childhood SAD. This subgroup of patients significantly differed from the other (without childhood SAD) with respect to associated anxiety and depressive disorders. These data suggest a specific association between eating disorders and childhood SAD and show that epidemiologic investigations can be helpful for planning the prevention and treatment of eating disorders.

Adolescent↗

PubMedDate not supplied

[Current and lifetime prevalence of obsessive compulsive disorders in eating disorders].

UNLABELLED: A significant proportion of patients suffering from Eating Disorders (ED) present a comorbidity with anxiety disorders. Among the anxiety disorders, Obsessive Compulsive Disorders (OCD) are the third most frequently diagnosis observed in ED. However, prevalence rates from the literature are contradictory depending on the diagnostic criteria and evaluation tools used. Studies concerning the chronology of appearance of OCD and ED and the role played by denutrition are even rarer and equally contradictory. OBJECTIVE: The aim of this study is to bring new empirical data to the study of the correlations between OCD and ED by exploring, in a significant clinical sample, the current and lifetime OCD comorbidity in the diagnostic sub-groups and sub-types of ED as defined by the DSM IV and to study the chronology of appearance of these disorders taking into account the role played by denutrition. We make the assumption that there should be a difference in the prevalence of obsessive compulsive disorders in the various ED sub-groups and sub-types and that purging anorexics should, at equivalent levels of denutrition, exhibit higher OCD prevalence rates than the other sub-types as a result of their more severe general psychopathology. METHODS: Current and lifetime prevalence were investigated using the Mini International Neuropsychiatric Interview (MINI) and the Yale-Brown Obsessive Compulsive Scale in a sample of 89 DSM IV eating disorders in and out-patients aged between 15 and 30 (58 AN and 31 BN) and 89 matched controls. In order to increase the validity of the current diagnosis of OCD only patients presenting an OCD diagnosis on the MINI (excluding obsessions and compulsions related to food and body image) and a score of 16 or more on the Y-BOCS were included in the study. RESULTS: Current and lifetime prevalence of OCD in ED is significantly higher than in general population (15.7% and 19% vs 0% and 1.1%, p < 0.05). Anorexic and bulimic patients do not show any difference in the current and lifetime comorbidity (19% and 22.4% vs 9.7% and 12.9%, ns). Concerning the diagnostic sub-types, following our assumption purging anorexics present the higher current and lifetime prevalences (29% and 43%), followed by restrictive anorexia (16%) and purging bulimia (13%). The only significant difference is found in the lifetime prevalence of OCD between purging and non purging anorexics. In the great majority of cases (65%) OCD diagnosis precedes ED diagnosis and OCD current prevalence and Y-BOCS scores of underweight patients are not significantly higher than normal weight patients, suggesting that there are only limited links between denutrition and obsessionality. LIMITS: Some methodological limitations must be considered. First of all, the small sample size of the diagnostic sub-types of ED do not enable us to draw definitive conclusions concerning the prevalence of OCD in the clinical forms of ED. Some of the diagnostic sub-types of ED, as BN-NP, appear at different ages: in order to better investigate the prevalence of OCD in all the diagnostic sub-types, larger age ranges should be considered. Secondly, our sample of anorexics is almost made of hospitalized inpatients recrutated in a specialized university unit, whereas bulimics are all consulting outpatients. It is possible that the higher than normal rates of OCD in anorexics could be related to the severity of this sample. Comparisons with samples of consulting anorexics should be performed. Lastly, it is necessary to evoke the limitation represented by the choice of a healthy control group. OCD are rare in the general population and the differences found between the clinical and the control groups do not offer strong arguments to support the specificity of the association between OCD and ED, which would be better explored by using a pathological control group. CONCLUSIONS: So far, none of the various models proposed to explain the comorbidity observed between ED and OCD appears completely satisfactory. ED and OCD would share a genetic vulnerability to a dysregulation of serotoninergic functioning which would predispose these subjects, depending on specific clinical and biological conditions, to develop an obsessional and compulsive symptomatology more or less focused on food and body image. The knowledge of the clinical and biological specificities of the ED diagnostic sub-types presenting an OCD comorbidity could point the way towards specific therapeutic interventions in these patients. Our study of the comorbidity of OCD in ED makes a further contribution to the identification of specific links between the OCD and the various clinical forms of ED. More clinical and biological studies are needed to further explore these relationships.

Adolescent↗

PubMed2002

[Bone metabolism and bone mass loss in eating disorders].

Eating disorders (anorexia and bulimia nervosa) are present in 1-3% of young female women. A later beginning, prolonged amenorrhea and low body mass index are risk factors of osteopenia in bulimic patients. Bone demineralization in anorexia nervosa is due to a greater resorption than bone formation leading to osteopenia, secondary osteoporosis and increased risk of pathologic fractures. Pathophysiology of bone disease includes factors as long duration of amenorrhea, deficient absorption of calcium, extreme physical exercise, 1.25 vitamin D deficiency, low creatinine clearance, increased blood and urinary cortisol and high levels of GH. Proposed treatments are nutritional improvement and weight gain (the most important), calcium supplementation, moderate exercise, estrogens, antidepressive drugs, fluoride in selected cases, byphosphonates and recombinant human IGF-1. An adequate questionnaire is essential in women with slightly decreased weight and menstrual disorders.

Anorexia↗

PubMed2000

The links between body dysmorphic disorder and eating disorders.

The aim of the study was to search for a body dysmorphic disorder (BDD) period preceding the symptoms meeting the criteria of either anorexia or bulimia nervosa, and an evaluation of the prevalence of BDD symptoms in a control group of girls without any eating disorder. Ninety-three girls (12-21 years old ) were included in the study (36 with anorexia nervosa, 17 with bulimia nervosa and 40 healthy controls). The Structured Clinical Interview (SCID), including the BDD module, and a novel questionnaire (for the presence of preceding life events) were used. We found the symptoms of BDD in 25% of anorexia nervosa sufferers for at least six months before observing a clear eating disorder picture. Moreover, other mental disorders were also present among these patients. The results may support the idea that BDD and anorexia nervosa both belong to either OCD or affective disorders spectra.

Adolescent↗

PubMed1995

Prospective analysis of personality and behavioral vulnerabilities and gender influences in the later development of disordered eating.

This article presents the 2-year findings of a prospective investigation of the precursors to the later development of an eating disorder in adolescents. The sample consisted of 852 girls and 815 boys who began to study in Grades 7-10 and participated for 3 consecutive years. For both genders, the strongest predictors of Year 3 risk status were Years 1 and 2 risk scores. When the effects of Year 1 and Year 2 risk were controlled, race (Caucasian) and poor interoceptive awareness at Year 2 were significant predictors of disordered eating at Year 3 for girls. Previous risk status was the only significant predictor of Year 3 risk for boys. Gender difference evaluations in the risk score components indicated that a significantly greater proportion of girls than boys endorsed behaviors that were similar to eating disorder diagnostic criteria. Poor interoceptive awareness may provide a vulnerability for eating disorders; possible pathways were discussed.

Child↗

PubMed1997

A comparison of the Eating Disorder Examination and a general psychiatric schedule.

OBJECTIVE: The aim of this study is to investigate the adequacy of a general interview schedule for the purpose of assessing bulimia nervosa. METHOD: In two waves of data collection 18-24 months apart, 250 women were assessed for disordered eating. The first interview was typical of that included in many psychiatric interview schedules and was used to screen women for selection in a subsequent interview. This latter interview, using the Eating Disorder Examination, represents the 'gold standard' for the assessment of disordered eating. RESULTS: While the psychiatric interview satisfactorily assessed disturbed eating in general, it seemed less capable of accurately assessing cases of bulimia nervosa in particular, the major weakness being the overestimation of binge-eating. CONCLUSIONS: Structured psychiatric interviews are suitable for screening purposes to identify women with disordered eating, but identification of bulimia nervosa requires further assessment with a suitable instrument.

Bulimia↗

PubMed2000

Comparison of the yale-brown-cornell eating disorders scale in recovered eating disorder patients, restrained dieters, and nondieting controls.

OBJECTIVE: Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) scores were assessed in recovered eating disorder patients, restrained dieters, and unrestrained nondieters. METHOD: YBC-EDS interviews were conducted with 53 recovered eating disorder patients who had no symptoms within at least 6 months, 29 restrained dieters, and 36 unrestrained controls. RESULTS: Unrestrained control subjects had no typical eating-disordered preoccupations or rituals. The majority (62%) of restrained dieters did have current eating-disordered preoccupations but only 5 had current eating-disordered rituals. Most recovered eating disorder subjects had no current eating-disordered preoccupations (66%) and 76% had no current eating-disordered rituals. Unrestrained eating controls had significantly lower Preoccupation, Total, and Motivation to Change scores on the YBC-EDS than the other groups and significantly lower Ritual scores than the recovered eating disorder group. There were no significant differences between the restrained dieters and the recovered eating disorder group. DISCUSSION: Recovered eating disorder patients who no longer meet any of the DSM-IV criteria for an eating disorder are similar in severity of eating concern to normal weight restrained eating dieters. Both of these groups have more eating and weight concerns as compared with the unrestrained eating, nondieting controls. The YBC-EDS effectively distinguishes the healthy eating controls from restrained eating dieters and recovered eating disorder patients.

Adult↗

PubMedDate not supplied

Supporting friends and family members with eating disorders: discrepancies between intentions and reality.

This study examined how female undergraduate students anticipated they would approach a friend or family member with disordered eating and what kinds of support they believed to be helpful. The relationship between eating disorder symptomatology and anticipated approaches also was examined. Participants read vignettes depicting scenarios involving a friend or family member with disordered eating and described their anticipated approach. They also rated the helpfulness of various support attempts, and completed the EDI-2. Although collaborative approaches were rated more favorably than controlling approaches, 76% of responses generated by participants fell into the latter category. Reasons for the discrepancy between support attempts offered and those that are believed to be most helpful and the implications of these findings to the treatment and prevention of eating disorders are addressed.

Adult↗

PubMed1997

Disordered eating behaviors and bone-mineral density in women who misuse alcohol.

Because lower bone-mineral density is one potential physiological consequence of eating disorders and chronic alcohol misuse, the risk for osteoporosis may be compounded in women who have both conditions. This study investigated the frequency of eating disorders in 25 women who misuse alcohol and compared bone-mineral density between those with and without multiple disordered eating behaviors. Disordered eating behaviors were assessed through the EAT-26 (Eating Attitudes Test) and a structured interview addressing binge eating, purging, and other weight-control behaviors. Bone-mineral density was measured using dual energy x-ray densitometry. Although only one woman met the DSM-III-R criteria for a current eating disorder, 12% had past histories suggestive of anorexia nervosa and 40% had multiple disordered eating behaviors with bulimic features. Bone-mineral density of the femoral neck was 9.3% greater in women with multiple disordered eating behaviors (p < or = .05).

Absorptiometry, Photon↗

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↗

PubMedDate not supplied

[Comorbidity of diabetes mellitus and eating disorders. A comparison of psychological features of eating disordered and non-eating disordered patients with diabetes mellitus].

As part of a multicentre study on the comorbidity of diabetes mellitus and eating disorders, the following paper compares the psychological features of diabetic patients with and without an eating disorder. In a sample of 663 diabetic patients (type 1: n = 341 type 2: n = 322), eating disorder related variables, self-esteem, body acceptance and emotional distress, especially depression in diabetic patients with and without an eating disorder, were compared. A possible relationship to diabetic control was investigated. Type 2 diabetics revealed more pronounced psychopathology in comparison to type 1 diabetics. According to our assumption, diabetic patients with an eating disorder and diabetic patients who deliberately reduced insulin in order to loose weight (insulin purging) revealed a much more severe psychopathology compared to diabetics without an eating disorder. The type of diabetes was of no importance. With the exception of the variable body and figure satisfaction in the sample of type 1 diabetes and the variable self-acceptance in the sample of type 2 diabetes, no relationship to diabetic control could be found.

Adult↗