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An empirical analysis of eating disorders and anxiety disorders publications (1980-2000)--part I: Research methods.

OBJECTIVE: The current study compared the eating disorder and anxiety disorder literature in terms of research design and methodologic features in 1980, 1990, and 2000. METHOD: Computer literature searches were conducted using PubMed and PsychInfo databases to identify relevant eating disorder and anxiety disorder articles published at each of the three time points. A total of 456 articles were randomly selected, including 228 articles from the eating disorder literature and the anxiety disorder literature. Within each specific literature, one third (76) of the articles were selected from each of the three time points (1980, 1990, 2000). Two raters, from a team of eight trained raters, were randomly assigned to independently rate each article in terms of 75 separate methodologic features. Disagreements in ratings were resolved via consensus. Ratings were tabulated separately for eating disorders and anxiety disorders across the three time points. RESULTS: Although there were some differences between anxiety disorders and eating disorders, most of the variables did not substantially differ between these two fields. There was a consistent trend for both fields to show increases in more rigorous methodologies over time. However, both the eating disorder literature and the anxiety disorder literature were characterized by a pervasive absence of many recommended methodologic procedures across the past two decades. CONCLUSION: Although the eating disorder literature and the anxiety disorder literature are increasingly characterized by improved reporting of rigorous methodologic procedures, there is still a pervasive absence of such procedures in both literatures, which limits the strength of inference in these studies.

Anxiety Disorders↗

Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders.

OBJECTIVE: The study examined treatment seeking for eating disorders in Mexican American and European American women. METHOD: One hundred forty-five women with eating disorders (76 Mexican American, 69 European American) were diagnosed using the Structured Clinical Interview for DSM-IV-TR (SCID-IV) and Eating Disorder Examination (EDE). RESULTS: Only 28% of the sample reported having sought treatment for their eating problems and only 17% had received treatment. Both groups were equally likely to believe they have significant eating problems and to want help. However, Mexican Americans were less likely to have sought treatment and, having sought help, were less likely to have been diagnosed or treated. European Americans were more likely to have utilized psychotherapists, psychiatrists, and psychotropic medications, whereas Mexican Americans largely had sought help from general practitioners for weight concern. The two groups endorsed similar barriers to treatment seeking. CONCLUSION: Results support clinical impressions that eating disorders largely go undetected and untreated. Nonspecialists may be likely to fail to detect eating disorders.

Acculturation↗

Eating ability in head and neck cancer patients after treatment with chemoradiation: a 12-month follow-up study accounting for dropout.

BACKGROUND: Head and neck cancer patients treated with chemoradiation have difficulty eating a normal diet. This study was designed to characterize eating ability over 12 months after chemoradiation treatment. Analyses take patient dropout into account. METHODS: Two hundred fifty-five patients with head and neck cancer treated with chemoradiation were followed for 12 months. Eating ability was analyzed using generalized linear model methods that accounted for non-ignorable dropout. RESULTS: Eating ability was compromised immediately after treatment and improved over 12 months to near pretreatment levels. Ability to eat at most 50% of the diet orally did not return to baseline levels (p <.05). However, the percent of patients eating a normal diet did return to baseline levels. Accounting for dropout modified the results, but the pattern of significance was similar. CONCLUSIONS: Treatment of head and neck cancer with chemoradiation has a significant effect on eating ability, which improves after 12 months after treatment.

Adult↗

Exercise-induced nausea is exaggerated by eating.

This study was conducted to determine whether and under what circumstances exercise causes nausea. Twelve healthy volunteers (20-37 years), including six athletes, participated in the study. Subjects were studied on seven occasions. Each subject performed low and high-intensity exercise without eating, immediately after eating a beef patty and 60 min after eating. Besides these exercise experiments, effect of meal on nausea was studied in each subject for 180 min without exercise. Exercise was done on a bicycle ergometer for 60 min at 40-50% maximal heart rate reserve and 20 min at 70-80% maximal heart rate reserve. Subjects were tested for nausea by visual analogue scales. Both low and high-intensity exercise caused nausea. Scores for nausea were greater during exercise at fasting state and immediately after eating than those without exercise (p<0.05 during low-intensity exercise, and p<0.01 during high-intensity exercise). Immediately after eating, scores for nausea were greater during high-intensity exercise than during low-intensity exercise (p<0.05). During high-intensity exercise, scores for nausea were greater immediately after eating than without eating (p<0.05). There were no differences in ratings for nausea between the sexes in any of the experimental conditions. Training did not decrease exercise-induced nausea. In conclusion, exercise causes nausea, the severity of which is related to exercise intensity and food intake, but not sex differences nor physical training.

Adult↗

Rigid vs. flexible dieting: association with eating disorder symptoms in nonobese women.

The correlates of rigid and flexible dieting were examined in a sample of 188 nonobese women recruited from the community and from a university. The primary aim of the study was to test the hypothesis that women who utilize rigid versus flexible dieting strategies to prevent weight gain report more eating disorder symptoms and higher body mass index (BMI) in comparison to women who utilize flexible dieting strategies. The study sample included women who were underweight (29%), normal weight (52%), and overweight (19%). None of the women were obese, as defined by BMI>30. Participants were administered a questionnaire that measures Rigid Control and Flexible Control of eating. Body weight and height were measured and measures of eating disorder symptoms and mood disturbances were administered. Our results indicated that BMI was significantly correlated with rigid dieting and flexible dieting. BMI was controlled statistically in other analyses. The study found that individuals who engage in rigid dieting strategies reported symptoms of an eating disorder, mood disturbances, and excessive concern with body size/shape. In contrast, flexible dieting strategies were not highly associated with BMI, eating disorder symptoms, mood disturbances, or concerns with body size. Since this was a cross sectional study, causality of eating disorder symptoms could not be addressed. These findings replicate and extend the findings of earlier studies. These findings suggest that rigid dieting strategies, but not flexible dieting strategies, are associated with eating disorder symptoms and higher BMI in nonobese women.

Adolescent↗

Parental bonding and separation-individuation difficulties among late adolescent eating disordered women.

This study is an exploration of both interpersonal and intrapsychic factors associated with eating disorders in late adolescent women. It examines perceived parental bonding characteristics and resolution of the second separation-individuation process for both eating and non-eating disordered subjects. Subjects were 20 late adolescent eating disordered women and 20 symptom-free late adolescent female university students. All subjects received the Eating Disorder Inventory, the Parental Bonding Inventory, and the Separation-Individuation Test of Adolescence. Late adolescent eating disordered women reported significantly higher levels of maternal overprotectiveness during childhood and had significantly higher levels of separation anxiety and lower healthy separation scores than non-eating disordered students.

Adult↗

A pharmacological analysis of the eating response induced by 8-OH-DPAT injected into the dorsal raphé nucleus reveals the involvement of a dopaminergic mechanism.

Direct injection of the 5-hydroxytryptamine (5-HT) agonist 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) into the dorsal raphé nucleus (DRN) dose dependently increased food intake in free feeding rats. The hypothesis that this effect is mediated by 5-HT1A receptors was tested by investigating the abilities of the putative 5-HT1A antagonists metergoline, propranolol and spiperone to prevent 8-OH-DPAT-induced eating. Metergoline failed to affect 8-OH-DPAT-induced eating when injected either peripherally or into the DRN. Peripherally injected propranolol and spiperone prevented 8-OH-DPAT-induced eating, but these drugs were ineffective when injected into the DRN. These results indicate that 8-OH-DPAT-induced eating may not involve 5-HT1A receptors within the DRN. The ability of peripherally injected spiperone to prevent the eating response to 8-OH-DPAT reflects its dopamine blocking activity since haloperidol was an effective antagonist of 8-OH-DPAT-eating. This result may indicate that 8-OH-DPAT produces a general behavioural activation by reducing the inhibitory influence which 5-HT normally exerts over the nigrostriatal dopamine pathway, and that this behavioural activation is expressed as eating when food is the most salient goal object present.

8-Hydroxy-2-(di-n-propylamino)tetralin↗

Differential diagnoses to consider at an eating disorders clinic.

OBJECTIVE: To determine the reasons for referral of patients without eating disorders who were within a cohort of patients referred to an adult tertiary care eating disorders program. METHODS: Cases were obtained by retrospectively reviewing all the charts of patients who had been referred to a single eating disorders program over a 20-year period from 1981 to 2000. All referred cases had been screened by a nurse using a telephone or written questionnaire. RESULTS: Thirty-three out of 987 patients (3.3%) were identified as having no eating disorders. Four subjects were males (12.1%) and 29 were females (87.9%). After investigation, 16 were found to have a psychiatric diagnosis, 8 had a medical diagnosis, and 8 had no identifiable diagnosis. CONCLUSIONS: This study shows that the screening process for referral to a tertiary care eating disorders program is highly reliable and suspicion for a patient without an eating disorder should be low; in comparison with the eating disorder population, these patients are more likely to be male and psychiatric illnesses are twice more likely than medical disorders to be diagnosed.

Adult↗

Abnormal eating attitudes and sexual abuse experiences in Turkish university women.

The aim of this study was to examine the direct and indirect relationship between abnormal eating attitudes and sexual abuse. The subject sample comprised 532 female Turkish undergraduate and nursing students in Istanbul. The Eating Attitudes Test (EAT), Sexual Abuse Questionnaire, the Setting Conditions for Anorexia Nervosa Scale, the Positive and Negative Perfectionism Scale and the Need for Control Scale (NCS) were the instruments of the study. The results showed that sexual abuse has a direct effect on EAT-Bulimia but not on EAT-Dieting. It also has some indirect effects on both of these through its effects on family functioning. Perfectionism, on the other hand, was independently linked with both EAT-Dieting and EAT-Bulimia but was not associated with sexual abuse.

Adolescent↗

Stress plays a role in the association between cognitive constructs and measures of eating disorders in male subjects.

OBJECTIVE: Several theorists have hypothesized that stressful situations may trigger abnormal eating and even eating disorders in predisposed people. The purpose of this study was to assess whether a stressful situation would reveal an association between perfectionism and low self-esteem, and measures of eating disorder symptoms in male high school students. METHOD: A sample of 61 male high school students completed the Eating Disorder Inventory, the Multidimensional Perfectionism Scale, and the Self Liking and Competence Scale three times: on an average school day, on the day of an exam and on the day the subjects received the results of that exam. Linear regression analysis was carried out to verify whether the dimensions of perfectionism were associated with the measures of eating disorders. RESULTS: Interoceptive awareness was associated with 'Bulimia' only during the stressful situation and with 'Drive for thinness' both in stress and non stress situations. Other results were contradictory and difficult to interpret. DISCUSSION: The results suggest that in nonclinical male individuals stress might bring out a previously absent association between some psychological predisposing factors for eating disorders and an actual desire or plan for ED related thoughts and behaviours. Such a finding suggests that stress may stimulate behaviours related to eating disorders in a predisposed personality. A central role may be played by interoceptive awareness in male subjects.

Adolescent↗

Gender differences in disordered eating and its correlates.

The goal of this study was to examine gender differences in the prevalence of disordered eating and body dissatisfaction as well as examine gender differences in several risk factors: mass media, self-esteem and perfectionism. Three hundred fifty-three undergraduates completed surveys about their body dissatisfaction, disordered eating habits, exposure to and influence of mass media, self-esteem and perfectionistic tendencies. As expected, women experienced more symptoms of disordered eating as well as body dissatisfaction than did their male counterparts. There were also gender differences in the risk factors. For women, mass media, self-esteem, and perfectionism related to disordered eating behaviors, whereas for men, only perfectionism and mass media related to disordered eating behaviors. For women, mass media and self-esteem related to body image dissatisfaction, whereas for men, mass media and perfectionism related to body image dissatisfaction. The results of the present study indicate that risk factors for disordered eating and body dissatisfaction for men and women may be different, which has implications for understanding the etiology of body dissatisfaction and disordered eating and for possible treatment interventions.

Adolescent↗

Thin-ideal internalization, body dissatisfaction and symptoms of eating disorders in Croatian adolescent girls.

The aim of this investigation was to study the relationship between unhealthy eating habits and behaviors, perception and acceptance of societal standards regarding thinness, body dissatisfaction, and family and peer pressure to be thin. One hundred and twentythree high school girls from Rijeka (Croatia) were surveyed using Eating Attitudes Test (EAT- 26), Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ), Body Esteem Questionnaire for Adolescents and Adults (BES), and Scale of perceived pressure to be thin from family and peers. The results of path analyses showed that social pressure from family and peers, experience of weight-related teasing and criticism by family members, contributed to development of eating disturbance. The acceptance of social standards related to appearance, contributed to onset of disturbed eating habits. Weight satisfaction alone influences the development of some eating disorder symptoms, but it is also a mediator of higher body mass index (BMI) and internalization of societal appearance standards. Girls with higher BMI, who accepted societal standards of thin-ideal, perceived major social pressure to be thin through direct and persuasive comments designed to establish the importance of dieting, and probably develop eating disturbed habits, or some symptoms of anorexia (AN) or bulimia nervosa (BN).

Adolescent↗

Continuum and linearity hypotheses on the relationship between psychopathology and eating disorder symptomatology.

This article discusses various notions of continuity and discontinuity relating to eating disorders, and suggests that current research on the subject is implicitly based on hypotheses on linearity. In this study, we tested these hypotheses by asking 265 female participants to complete the Eating Attitude Test (EAT) and Eating Disorder Inventory (EDI). We found a linear increase in psychological disturbances from normalcy to the milder forms of disordered eating, but a sharp and non-linear increase among the women with more severe signs of eating disorders. The results indicate that neither linearity nor non-linearity alone sufficiently describes the relationship between predisposing factors and eating disorder symptomatology.

Adolescent↗

Risk factors for eating disorders in adolescents. A Spanish community-based longitudinal study.

OBJECTIVE: The aim of this study was to identify psychopathological, social and family variables that, measured at the age of 13, might predict the development of eating disorders 2 years later, using a standardized interview and controlling the effect of initially abnormal eating behavior. METHOD: At age 13 and 15, 1076 adolescents completed questionnaires for the screening of psychiatric morbidity, abnormal eating attitudes and family dysfunction. Probable cases of eating disorders [159] and 150 controls were assessed with standardized interviews (SCAN). RESULTS: Controlling the effect of previous eating psychopathology, pathological body dissatisfaction, measured with the Body Shape Questionnaire (BSQ), and a negative perception of parental attitudes were predictors of eating disorders 2 years later. Self-esteem was a protective factor for body dissatisfaction. CONCLUSIONS: Preventive actions should focus on self-esteem as a protective factor for body dissatisfaction, a strong predictor for eating disorders. The significance of family perception should be explored more in detail in future research.

Adolescent↗

Noise-induced eating in rats facilitated by prior tail pinch experience.

In order to integrate the results of procedures that induce excessive nonregulatory eating, it is necessary to develop new procedures that elicit eating in satiated animals. To that end, the present study examined the effects of 90-dB white noise on eating in satiated rats. Twenty-four rats, including sixteen with prior tail pinch-induced eating experience, were presented with mash in baseline and noise conditions. Whereas white noise induced eating in tail pinch-experienced rats, noise did not do so in naive subjects. It was concluded that experience with eating in response to arousal increased the likelihood that an animal would respond to a different kind of arousal by eating.

Animals↗

Acquired pseudo eating disorder. An imitation or fabrication of anorexia nervosa.

Acquired pseudo eating disorder is a condition characterized by the development or fabrication of symptoms corresponding to an eating disorder in a patient hospitalized for an unrelated medical illness, who has previously been exposed to a patient(s) with anorexia nervosa. Two adolescent patients developed an eating disorder during medical hospitalization. Both acquired the condition while hospitalized for another reason (myelomeningocele and multiple sclerosis, respectively). The potential psychodynamics suggested the selection of an "eating disorder," amenable to control, over the reality of a threatening illness that was experienced as being out of control. Thus, the new and dramatic symptoms appeared to serve as a defense against a pervasive underlying depression. The patient's loudly proclaimed "eating disorder" seemed to originate from the imitation of anorexia nervosa patients. Recognition of this hospital-acquired pseudo eating disorder and appropriate counseling resulted in rapid resolution of the symptoms. It is possible to identify a pseudo eating disorder developing during a hospitalization and differentiate it from "true" anorexia nervosa.

Adolescent↗

The topography of binge eating.

The present study investigated the topography of binge eating by comparing characteristics of eating episodes recorded by individuals who engage in binge eating (n = 29) with those who do not (n = 27), and characteristics of binge and non-binge episodes recorded by individuals who binge eat. For 2 weeks, subjects continuously recorded the type and quantity of food eaten during each eating episode, time and place of consumption, number of persons present, mood while eating, and whether the food eaten was part of a meal or snack. Results indicated binge eaters experienced negative moods during a significantly greater proportion of their eating episodes than non-binge eaters. Within the group of binge eaters, negative moods were experienced during a significantly greater proportion of binge episodes than non-binge episodes. Furthermore, binge episodes occurred significantly more often than non-binge episodes from 6:00 to 12:00 p.m. and significantly less often at appropriate places. Clinical implications of these findings are discussed.

Emotions↗

Binge eating and dietary restraint in obese patients.

The present study was conducted to determine the prevalence and severity of binge eating among 432 women seeking behavioral treatment for obesity and to assess the relationship between binge eating and dietary restraint. Subjects completed standardized self-report questionnaires which assessed the severity of binge eating and habitual dietary restraint. Binge eating was extremely prevalent, with 46% of subjects reporting serious problems. Serious binge eating was more common in younger and heavier subjects. Further, binge eating severity was significantly related to overall dietary restraint. The current findings indicate that the treatments of binge eating may need to be considered in planning behavioral programs for the obese.

Adolescent↗