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PubMed2006

Reward and punishment sensitivity in dysfunctional eating and hazardous drinking women: associations with family risk.

Biologically based personality traits such as reward and punishment sensitivity, and family factors, such as maternal dysfunctional eating and parental alcohol abuse, have been linked to hazardous drinking and disordered eating. However, specific relationships between personality and family factors in the development of these disorders are still unclear. A total of 443 women completed measures of reward and punishment sensitivity, family environment, maternal eating and parental drinking. Reward sensitivity was directly associated with both dysfunctional eating and drinking. Punishment sensitivity was associated with dysfunctional eating but not hazardous drinking. Punishment sensitivity mediated a chaotic family environment and daughters' dysfunctional eating. It is suggested that reward and punishment sensitivity are key traits to examine when investigating vulnerability to risky behaviour. Future research into disordered eating is likely to be advanced by an active search for mediators and moderators of family risk.

Adolescent↗

PubMed2006

The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.

BACKGROUND: Little population-based data exist on the prevalence or correlates of eating disorders. METHODS: Prevalence and correlates of eating disorders from the National Comorbidity Replication, a nationally representative face-to-face household survey (n = 9282), conducted in 2001-2003, were assessed using the WHO Composite International Diagnostic Interview. RESULTS: Lifetime prevalence estimates of DSM-IV anorexia nervosa, bulimia nervosa, and binge eating disorder are .9%, 1.5%, and 3.5% among women, and .3% .5%, and 2.0% among men. Survival analysis based on retrospective age-of-onset reports suggests that risk of bulimia nervosa and binge eating disorder increased with successive birth cohorts. All 3 disorders are significantly comorbid with many other DSM-IV disorders. Lifetime anorexia nervosa is significantly associated with low current weight (body-mass index <18.5), whereas lifetime binge eating disorder is associated with current severe obesity (body-mass index > or =40). Although most respondents with 12-month bulimia nervosa and binge eating disorder report some role impairment (data unavailable for anorexia nervosa since no respondents met criteria for 12-month prevalence), only a minority of cases ever sought treatment. CONCLUSIONS: Eating disorders, although relatively uncommon, represent a public health concern because they are frequently associated with other psychopathology and role impairment, and are frequently under-treated.

Adolescent↗

PubMed2004

Similarities and differences between women and men on eating disorder risk factors and symptom measures.

Researchers studying eating disorders in men often use eating disorder risk and symptom measures that have been validated only on women. Using a sample of 215 college women and 214 college men, we report on the validity of doing so with a set of measures chosen to reflect a wide range of risk factors and symptoms. The Bulimia Test-revised (BULIT-R), the restraint scale (RS), the three-factor eating questionnaire (TFEQ), the Eating Expectancy Inventory, and the eating attitudes test (EAT) all had the same factor structures for both genders, and tests of invariance showed that factor loadings, factor variances, and intercorrelations among factors were equivalent across gender. A modified Structured Clinical Interview for DSM-IV anorexic symptoms questionnaire did not perform adequately for either gender. Men produced slightly less reliable scores on virtually all measures, with the result that Pearson-based estimates of correlations among the measures were slightly lower for men. Men had lower scores on symptom and risk measures, but not on other eating measures.

Adult↗

PubMed2005

Comparison of child interview and parent reports of children's eating disordered behaviors.

Self-report questionnaires of child eating behavior have demonstrated poor agreement with child interview methods and parent report. However, no study has investigated the relationship between child interview and parent report. Therefore, we compared results from a diagnostic interview, the Eating Disorder Examination adapted for Children (ChEDE) to those from a questionnaire, the Adolescent Version of the Questionnaire on Eating and Weight Patterns-parent version (QEWP-P), in a nontreatment sample of overweight and normal weight children. Both instruments were administered to 88 overweight (BMI >or= 85th percentile) and 79 normal weight (BMI<85th percentile) children, age 10.2 +/- 1.7 years, recruited from the community. The ChEDE and QEWP-P were not concordant in terms of the type of eating episodes that occurred in the past month. Using the ChEDE as the criterion method, the QEWP-P had reasonably high specificity, but low sensitivity for the presence of binge episodes (sensitivity 50%, specificity 83%) or objective overeating (sensitivity 30%, specificity 79%) during the past month. ChEDE subscales were, however, significantly related to items assessing eating-related distress on the QEWP-P. While parent report of child eating behaviors may provide some general information regarding eating psychopathology in young nontreatment-seeking children, they do not accurately reflect the results of a structured interview.

Adult↗

PubMed2004

Predictors of body image dissatisfaction and disturbed eating attitudes and behaviors in African American and Hispanic girls.

Disturbed eating attitudes and behaviors are widespread among girls in the United States. Because obesity is one of the leading risk factors for eating disorder development, African American and Hispanic girls may be at heightened risk due to their greater prevalence and degree of overweight. The present study examined the associations among disturbed eating attitudes and behaviors, body image dissatisfaction, weight classification, fears of negative evaluation, and coping skills among 139 African American and Hispanic girls in Grades 4 and 5 from a low-income urban area. African American girls had significantly lower body image dissatisfaction than Hispanic girls. Significant predictors of body image dissatisfaction included fear of negative evaluation and weight classification. Fear of negative evaluation was also a significant predictor of disturbed eating attitudes and behaviors. Overall, 10.1% of the African American girls and 12.7% of the Hispanic girls qualified for a diagnosis of a probable eating disorder. Girls with eating disorders had greater fears of negative evaluation and engaged in more cognitive avoidance. Both groups are at risk of eating disorder development.

Adaptation, Psychological↗

PubMed2005

Gender differences regarding psychopathological, family and social characteristics in adolescents with abnormal eating behavior.

OBJECTIVE: (1) To identify gender differences regarding psychopathological, family and social characteristics in adolescents with abnormal eating behavior; (2) to study risk factors for this abnormal eating in boys and girls. METHOD: Adolescents participating in this community-based longitudinal study completed, at the age of 13 (t(1)) and 15 years (t(2)), a semi-structured interview and the validated Spanish versions of several self-reported questionnaires measuring eating and general psychopathology. A control group of 150 pupils and 159 adolescents with abnormal eating behavior were selected. RESULTS: Girls with abnormal eating showed significantly more psychiatric morbidity and boys more social difficulties. Body dissatisfaction and psychiatric morbidity predicted abnormal eating at t(2) only in girls. DISCUSSION: The findings contribute to the debate on gender differences in abnormal eating behavior etiology.

Adolescent↗

PubMed2005

The comparative utility of statistically derived eating disorder clusters and DSM-IV diagnoses: relationship to symptomatology and psychiatric comorbidity at intake and follow-up.

INTRODUCTION: The classification of eating disorders has been a matter of considerable debate. The present paper extends previous work and aimed to compare the utility of statistically derived clusters of eating disorders and conventional diagnoses. METHODS: Adult female eating disorder patients who had previously been classified on the basis of cluster analysis of key diagnostic variables were examined on measures of eating disorder symptomatology and psychiatric comorbidity at intake (N=601) and subsequent follow-up after 6 and 36 months (N=349, N=322, respectively). RESULTS: Compared to DSM-IV diagnoses, clusters demonstrated greater utility in terms of more distinct between-group differences and higher effect sizes in relation to a wide range of variables. The greater utility of clusters was in important respects due to the reallocation of EDNOS patients to more relevant alternative categories and to a greater emphasis on psychological and behavioural features of eating disorders. CONCLUSIONS: In order to achieve a better classification of eating disorders, it will be important to place increased emphasis on common psychological features. There is a need to move away from increased use of subtypes and toward a definition of eating disorder per se.

Adult↗

PubMed2006

Early childhood sleep and eating problems as predictors of adolescent and adult mood and anxiety disorders.

BACKGROUND: Recent studies have suggested that eating and sleep problems during early childhood may pose as risk factors for mood and anxiety disorders in later life. We aim to study the associations between early childhood sleep and eating problems, specifically high motor activity during sleep and irregularities in sleep/eating schedules, and lifetime history of mood and anxiety disorders. METHODS: We followed up 164 offspring, who were at high and low risk for major depression by virtue of their parental history (at least one parent had Major Depressive Disorder). Target sleep and eating problems were measured using Dimensions of Temperament Survey (DOTS). The offspring were blindly assessed at 3 times over 20 years using a structured diagnostic interview. RESULT: Irregularities in sleeping and eating schedules in childhood (low rhythmicity) was associated with adolescent-onset major depression and anxiety disorder, as well as childhood-onset anxiety disorder. High motor activity level during sleep was associated with both childhood-onset and adolescent-onset dysthymic disorder. Neither childhood sleep nor eating irregularities were associated with adult onset psychopathology. LIMITATIONS: Retrospective reports of childhood sleep and eating patterns were derived from parent-reports. Reported problems may overlap with clinical diagnoses. CONCLUSION: Clinicians should be alerted to parental reports of children's sleep and eating problems suggesting low rhythmicity, as well as high motor activity levels during sleep. These early behaviors may be predictive of subsequent mood and anxiety disorders in childhood and adolescence.

Adolescent↗

PubMed2004

Unhealthy weight management behavior among adolescent girls with type 1 diabetes mellitus: the role of familial eating patterns and weight-related concerns.

PURPOSE: To explore familial eating patterns and weight-related concerns among families of adolescent girls with type 1 diabetes mellitus (DM) and to examine associations with disordered eating behaviors among the girls. METHODS: Interviews were conducted with 30 adolescent girls (ages 13-20 years), who had DM for at least 1 year, and separately with their parents. Eighty-four percent of the girls were Caucasian, 13% were African-American, and 3% were Hispanic. The sample included 15 girls who reported (on a questionnaire) engaging in disordered eating behaviors (DE) and a matched comparison group of girls who reported no disordered eating (Non-DE). The semi-structured interview questions focused on adolescent and parent perceptions of the impact of DM on family roles, relationships, and routines, as well as who does what in managing the DM. A content analysis of the interviews identified themes regarding family meal patterns and weight-related issues. RESULTS: Although variation was found, more than one-half (57%) of the families were classified as having a high level of meal structure (e.g., frequent family meals). Families with DE girls were more likely to be classified as having a low level of meal structure (e.g., infrequent family meals) than families with Non-DE girls. Weight concerns were common; nearly half (48%) of all families were classified as having a high level of weight-related concerns (e.g., at least one member having a high desire to lose weight). The prevalence of families with a parent engaging in behaviors to lose weight and/or making negative comments about eating or weight was higher in families of DE girls than Non-DE girls. The combination of low family meal structure and high familial weight concerns was much more prevalent in families with DE girls (58%) than in families of non-DE girls (7%). CONCLUSIONS: Interactions around food and weight appear common in many families of adolescent girls with DM. Whereas frequent family meals may help to defend against disordered eating in youth with DM, family weight concerns and behaviors appear to be risk factors for disordered eating.

Adolescent↗

PubMed2006

Disordered eating among a multi-racial/ethnic sample of female high-school athletes.

PURPOSE: To determine the prevalence of disordered eating (DE) attitudes and behaviors in a multi-racial/ethnic sample of female high-school athletes. METHODS: The Eating Disorders Examination Questionnaire (EDE-Q) was administered to 453 suburban female high-school athletes (277 Caucasian, 103 Latina, and 73 African American; aged 15.7 +/- 1.2 years) during their competitive season. RESULTS: The prevalence of DE in the total sample was 19.6%; among the three ethnic groups, prevalence estimates were 19.2%, 18.4%, and 23.3% for African Americans, Caucasians, and Latinas, respectively. The prevalence estimates of binge eating (12.6%) and vomiting (7.8%) were significantly higher in Latinas as compared to African Americans (5.5%, 1.4%) and Caucasians (5.4%, 2.2%; chi2 p < .05). The prevalence of diuretic and laxative use was low among all athletes (< 3%), with no differences by ethnicity (p > .05). After adjusting for body mass index (BMI) and sport, analysis of covariance (ANCOVA) with Bonferroni post-hoc pair-wise comparisons indicated that Caucasian and Latina athletes scored higher than African Americans on all EDE-Q subscales except eating restraint, which was higher only in Caucasians compared to African Americans (p = .001-.046). CONCLUSIONS: Caucasian and Latina female high-school athletes may be at greater risk for eating disorders than their African American peers. Furthermore, Latina athletes may be particularly at risk for binge-eating disorder. Culturally-sensitive behavioral interventions targeted specifically for high-school athletes are needed to reduce the risk of eating disorders and associated long-term health consequences in this population.

Adolescent↗

PubMed2005

Disturbed eating attitudes, coping styles, and subjective quality of life in adolescents with Type 1 diabetes.

OBJECTIVES: To evaluate coping styles and quality of life in youth with Type 1 diabetes with and without eating disorders and to identify relationships between these variables in each group. METHODS: Adolescents were evaluated for eating disorders with a two-stage diagnostic procedure. Adolescents with and without eating disorders then provided data on coping styles and on subjective well-being. RESULTS: Adolescents with Type 1 diabetes and disordered eating behavior reported more often blaming themselves and resorting to wishful thinking and poorer physical and psychosocial quality of life than do adolescents with Type 1 diabetes without disordered eating behavior. Specific coping strategies were also positively linked with quality of life and metabolic control. CONCLUSIONS: Eating disorders and disordered eating behavior in adolescents with Type 1 diabetes seem to be associated with certain negative and avoidant coping strategies and with impeded physical and bio-psychosocial well-being.

Adaptation, Psychological↗

PubMed2004

The NMDA receptor antagonist MK-801 alters lipoprivic eating elicited by 2-mercaptoacetate.

Eating behavior is controlled, at least in part, by levels of circulating metabolic fuels such as glucose and free fatty acids, and drugs that interfere with the availability of these fuels can elicit eating. One such drug is 2-mercaptoacetate (2MA), an inhibitor of fatty acid oxidation. Evidence also suggests that NMDA receptors may mediate some aspects of normal eating and satiety. The present study was conducted in order to determine whether NMDA receptors may play a role in feeding elicited by 2MA. Rats received intraperitoneal injections of either saline, 2MA, the non-competitive NMDA receptor antagonist MK-801 or a combined injection of 2MA and MK-801, and subsequent intake of a fat-enriched, mash diet was measured at 1, 2, 3 and 4 h post-injection. Results showed that cumulative food intake was significantly increased by 2MA alone, as compared to saline controls, with most of the 2MA-elicited eating occurring during the first hour post-injection. While MK-801 alone did not alter food intake, it did have a biphasic effect on feeding elicited by 2MA. MK-801 initially suppressed and later enhanced eating elicited by 2MA. Although it is unclear whether MK-801 is acting centrally, peripherally or both to alter 2MA-induced eating, these results implicate NMDA receptors and the neurotransmitter glutamate in the regulation of lipid-associated eating and satiety.

Animals↗

PubMed1998

Nutritional status of female athletes with subclinical eating disorders.

OBJECTIVE: To assess the energy and nutritional status of female athletes with subclinical eating disorders and compare them with that of control subjects and standard norms. DESIGN: Group classification (subclinical eating disorder or control) was based on responses to a health and diet history questionnaire, a battery of self-report eating disorder questionnaires, and an in-depth interview. Energy and nutrient intakes and energy expenditure were determined by means of 7-day weighed food records and 7-day activity logs. Micronutrient status was assessed for iron, zinc, magnesium, vitamin B-12, and folate. SUBJECTS: Twenty-four female athletes with subclinical eating disorders and 24 female control athletes. STATISTICAL ANALYSES: Descriptive statistics were used to analyze demographic data. One-way analysis of variance was used to determine group differences in energy and nutrient intakes, energy balance, and blood values. RESULTS: Groups were similar in age, height, weight, fat-free mass, and body mass index. Mean energy intake was lower in the group with subclinical eating disorders (1,989 kcal/day) than in the control group (2,300 kcal/day; P=.004), whereas mean energy expenditures were similar (2,405 and 2,293 kcal/day, respectively). The group with subclinical eating disorders had significantly (P<.05) lower mean protein and fat intakes compared with the control group; mean micronutrient intakes were not significantly different. Mean status measures for iron, zinc, magnesium, vitamin B-12, and folate were within the normal ranges for both groups and no differences were noted between the groups. A similar number of athletes within each group used vitamin/mineral supplements < or = 4 times per week. CONCLUSION: Although female athletes with subclinical eating disorders had dietary intakes of energy, protein, carbohydrate, and certain micronutrients that were below recommended levels, micronutrient status appeared relatively unaffected, probably due to their use of supplements.

Adult↗

PubMed2001

Towards effective treatment of eating disorders: nothing is as practical as a good theory.

There is much room for improvement in the treatment of eating disorders, anorexia nervosa in particular. It is argued that for more effective treatment a radical change in thinking and doing is needed. First, the wide-spread multicausal model of eating disorders must be abandoned and replaced by (a) fundamental strategic research into the most parsimonious explanation of eating disorders and (b) interventions solely directed on the specific maintaining mechanisms. Second, evidence-based working is needed in mental health care. In daily practice, two of three psychotherapists do not treat their eating disordered patients with the best treatment available, i.e. cognitive behaviour therapy. The Dutch Ministry of Health, Welfare and Sport tried to improve the care for eating disorder patients by the nomination of several specialist hospital units. These units are, however, not selected for their treatment quality or the use of evidence-based treatment protocols. It is argued that this ministerial operation will not increase the supply of effective treatment. The Minister obviously should have done two other things to improve the amount and quality of treatment supply for eating disorders: First, she better could invest in a broad array of workshops, training and supervision programs in cognitive behaviour therapy for all psychotherapists working with eating disorders. Second, since nothing is so practical as a good theory, the facilitation of research into parsimonious models of the relevant mechanisms as well as the experimental tests of interventions on these mechanisms would have been a promising move to effective treatment.

Cognitive Behavioral Therapy↗

PubMed2004

Subtyping female adolescent psychiatric inpatients with features of eating disorders along dietary restraint and negative affect dimensions.

Cluster-analytic studies of eating disorders in adult patients have yielded two subtypes (pure dietary and mixed dietary-negative affect). This study aimed to replicate the subtyping in female adolescent psychiatric inpatients with features of eating disorders. Cluster analyses of 137 patients with eating-disordered features revealed a dietary-negative affect subtype (43%) and a pure dietary subtype (57%). The dietary-negative affect subtype was characterized by greater likelihood of binge eating, greater eating-related psychopathology, and greater body image dissatisfaction. The two subtypes did not differ significantly in scores reflective of clinical syndromes (other than the significantly higher depressive affect in the negative affect subtype), but the dietary-negative affect subtype was characterized by greater personality disturbance and higher reported concerns in clinical areas, including suicidality and childhood abuse. The cluster analysis produced different results from an alternative approach to subtyping by vomiting. These findings provide further support for the reliability and validity of this subtyping scheme for eating pathology. Clinically, the findings suggest that the combination of dieting and negative affect signals a more disturbed variant of eating-disorder related psychopathology in female adolescent psychiatric inpatients.

Adolescent↗

PubMed2000

Parental representation in eating disorder patients with suicide.

OBJECTIVE: We examined parental, personality, and symptomatological characteristics in relation to suicide attempts among eating disorder patients. METHODS: Fifty-one eating disorder inpatients, divided into two groups according to lifetime suicide attempts, and 107 non-psychiatric subjects were compared on the following variables: Parental Bonding Instrument (PBI), Global Clinical Score (GCS), Eating Disorder Inventory-91 (EDI-91), Eating Attitudes Test-26 (EAT), clinical and personality characteristics, and family backgrounds. RESULTS: Suicidal patients reported significantly higher overprotection by both parents than non-suicidal patients and non-psychiatric subjects. Suicidal patients had a more prevalent history of child abuse, affective instability, unstable self-image, avoidance of abandonment, maladaptive perfectionism, personality disorder, and mood disorder. There were no differences in symptomatological factors or the severity of the eating disorders. CONCLUSION: The results suggest that high overprotection is associated with suicidal behaviour in eating disorder patients. The association between overprotective parenting and personality characteristics, and methods of suicide prevention are discussed briefly.

Adolescent↗

PubMed2002

Eating disorders in young women with type 1 diabetes mellitus.

Research findings from the past decade regarding the association of type 1 diabetes mellitus and eating disorders are critically reviewed in this paper. Although there has been much debate regarding the specificity of this association, a recent large multisite case-controlled study demonstrated that the prevalence rates of both full syndrome and subthreshold eating disorders among adolescent and young adult women with diabetes are twice as high as in their nondiabetic peers. Further, a 4-year follow-up study showed that disordered eating behavior in young women with diabetes often persists and is associated with a threefold increase in the risk of diabetic retinopathy. These eating disturbances tend to be associated with impaired family functioning and with poor diabetes management. Health care professionals should maintain a high index of suspicion for the presence of an eating disturbance among young women with diabetes, particularly among those with persistently poor metabolic control and/or weight and shape concerns. Screening for such disturbances should begin during the prepubertal period among girls with diabetes. A brief psychoeducational intervention leads to a reduction in disturbed eating attitudes and behavior but is not sufficient to improve metabolic control. More intensive treatment approaches, which should include a family-based component, may be needed to improve metabolic control. The evaluation of these and other treatment approaches is indicated in view of the serious short- and long-term health risks associated with eating disorders in young women with diabetes.

Adolescent↗

PubMed2004

Application of Prochaska's transtheoretical model of change to patients with eating disorders.

OBJECTIVE: Although eating disorders cause severe somatic and psychological sequelae, a majority of affected patients are not motivated for treatment. The aim of this study was to assess stages of change in patients with eating disorders and to analyze their correlations with clinical characteristics and treatment processes using Prochaska's transtheoretical model of change. METHODS: A consecutive sample (N=88) including outpatients suffering from anorexia (n=29), bulimia (n=32), and eating disorders not otherwise specified (n=27) was recruited from an eating disorders clinic with a low-threshold access. The patients' readiness to change their eating behavior was assessed by a self-rating scale (URICA), and a score for each participant on each subscale (precontemplation, contemplation, action) was derived from the scale. Patients were introduced to a set of eight treatment processes over the course of four treatment sessions. During the four sessions, therapists rated whether or not patients appeared to be using each of the treatment processes. RESULTS: While diagnostic subtype, age, illness duration, and previous treatments were not associated with motivational stages, self-referral was positively correlated to treatment motivation. Emotional involvement, specific behavioral change processes, and beginning a continuing treatment were correlated with more advanced stages of change. CONCLUSION: This study supports the notion of the stages of change as an independent dimension that is relevant for the treatment of eating disorders. The lack of impact of previous, presumably nonspecific treatments on the stages of change underlines the importance to assess and to improve specifically patients' motivation. Therapeutic work towards the mobilisation of emotions with regard to their eating problem as a means to improve readiness to change should be examined in future studies.

Adult↗