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PubMed1984

[Interactional treatment of eating behavior disorders].

The Eating Disorders Center (EDC), is a clinical-research project of the Mental Research Institute (MRI) centered in the study and treatment of Anorexia Nervosa (Self Starvation), Bulimia (binge-eating and purging) and weight/diet obsessions/compulsions. This paper presents: a) A brief description of the Center, both in its research and clinical aspects. The clinical program is centered in the application of the MRI's brief interactional approach to the treatment of eating disorders. The research project is being developed. b) A definition of terms, taken from the Statistical Manual of Mental Disorders (DSM III) and how these eating disorders have shown an increase in recent years. c) A brief discussion of theories of etiology and maintenance in the field of eating disorders. This point includes the perspective on eating disorders of several theoretical models, and how we believe that it is the societal model the one that can account for the recent increase of eating disorders.

Adolescent↗

PubMed1982

Treatment of behavior-related eating problems in retarded students: a review of the literature.

A taxonomy of feeding problems is proposed based on the two dimensions of cause (behavior-, neuromotor-, or physical-related) and problem area (drinking, eating, self-feeding, social, or self-injurious). Studies representative of each area were identified and one area, behavior-related eating problems, was selected for indepth review. Examples of children with problems in this area were described and a rationale for intervention was presented based on nutrition and health and normalization. Nine variables in treatment approaches were identified and compared. Integration of four of the variables was described as a viable approach to treating behavior-related eating problems in mentally retarded persons. Personnel involved with the development of mentally retarded students at the severe and profound levels are often concerned with eating and feeding problems. Such problems are extensive within those populations and may be life-threatening. In addition, caregivers often expect that reduction of these problems will also reduce the amount of care such students require. Problems include self-feeding, normal eating (i.e., chewing and swallowing patterns) and appropriate social behavior at mealtime. While bountiful information exists concerning many aspects of feeding and eating, information on some aspects of critical importance is scattered. A taxonomy of feeding and eating problems is presented in this review to show the relationship of available information.

Adolescent↗

PubMed1994

Risk and trigger factors for the development of eating disorders in female elite athletes.

This study examined risk factors and triggers for eating disorders in female athletes. Subjects included were all of the elite female athletes in Norway (N = 603), ages 12-35 yr, representing six groups of sports: technical, endurance, aesthetic, weight dependent, ball games, and power sports. The Eating Disorder Inventory was used to classify individuals at risk for eating disorders. Of the 117 athletes defined at risk, 103 were administered a structured clinical interview for eating disorders. A comparison group was also interviewed, consisting of 30 athletes chosen at random from a pool not at risk and matched to the at-risk subjects on age, community of residence, and sport. Ninety-two of the at-risk athletes met criteria for anorexia nervosa, bulimia nervosa, or anorexia athletica. The prevalence of eating disorders was higher in sports emphasizing leanness or a specific weight than in sports where these are less important. Compared with controls, eating disordered athletes began both sports-specific training and dieting earlier, and felt that puberty occurred too early for optimal performance. Trigger factors associated with the onset of eating disorders were prolonged periods of dieting, frequent weight fluctuations, a sudden increase in training volume, and traumatic events such as injury or loss of a coach.

Adolescent↗

PubMed1995

Frequency of eating occasions and weight change in the NHANES I Epidemiologic Follow-up Study.

OBJECTIVE: To examine the association of frequency of eating occasions with prospective, and retrospective weight change. DESIGN: Data from the NHANES I (1971-75) Epidemiologic Follow-up Study (NHEFS, 1982-84) (n = 7147) was used. Weight change was defined as the difference between the weight measured at follow-up in 1982-84 and the weight measured at baseline in 1971-75. Baseline frequency of eating occasions was estimated by summation of actual times at which food was reported consumed in a 24-h dietary recall. Follow-up frequency of eating was estimated from subject responses at follow-up to number of meals and snacks consumed daily. RESULTS: Men and women reported (mean +/- s.e.) baseline frequency of 5.3 +/- 0.06 and 4.9 +/- 0.03 eating occasions, respectively. Frequency of eating occasions at follow-up was 3.6 +/- 0.02 occasions in both men and women. Baseline body mass index and frequency of eating were inversely related in multivariate regression analyses in both men and women (P < 0.02). Regression analyses adjusted for multiple covariates showed no association between weight change and frequency of eating at baseline or follow-up. CONCLUSION: Baseline frequency and subsequent weight change or follow-up frequency and preceding weight change were unrelated in the NHEFS cohort.

Adult↗

PubMed1996

Two year maintenance of weight loss after a VLCD and behavioural therapy for obesity: correlation to the scores of questionnaires measuring eating behaviour.

OBJECTIVE: To investigate changes in weight, Three Factor Eating Questionnaire and Binge eating scores during a two-year period from the start of a VLCD (Nutrilett) and behavioural modification therapy for obesity. DESIGN: Prospective study of a 17-weeks weight loss programme with one- and two-year follow-up visits. SUBJECTS: 62 healthy, overweight subjects without previous eating disorders. The mean (+/- SD) age 41 +/- 8 years and BMI 36.4 +/- 2.6 kg/m2. MAIN OUTCOME MEASURES: Weight loss, Binge eating scale, Bulimic Investigatory Test and Three Factor Eating Questionnaire before and after therapy and at 1 and 2 year control visits. RESULTS: The mean weight loss (+/- SD) at the end of the treatment was 14.9 +/- 4.6 kg (n = 59) and at the two-year control 5.8 +/- 7.6 kg (n = 57). After two years 20 (32%) patients had a weight loss of more than 10% (good result), 24 patients a weight loss of 0-10% of their initial weight (partial result) and 13 patients weighed more than before therapy (poor result). The mean binge eating, disinhibition and hunger scores decreased in all patients by the end of the therapy. At the end of two years these improvements in the scores were maintained in patients with a good result but the scores returned to the pretreatment levels in the patients with partial or poor result. The mean restraint scores increased in all patients after treatment and were maintained in those with a good or partial result. CONCLUSIONS: VLCD combined with behaviour modification is a useful mode of therapy for obesity with low drop-out rate and majority (71%) of patients below pretreatment weight at the two-year control. One third of the patients succeeded to maintain positive changes in the scores measuring eating behaviour which was associated with sustained weight loss.

Adult↗

PubMed1997

Assessing the specific psychopathology of binge eating disorder patients: interview or self-report?

Research addressing the assessment of binge eating and associated eating disorder psychopathology has steadily increased in recent years. Few studies have examined the relationship between the various assessment methods. This study compared an investigator-based interview, the Eating Disorder Examination (EDE), with a self-report version of that interview, the EDE-Q. Fifty-two individuals (six men and 46 women) with binge eating disorder (BED) completed both instruments. Modest-to-good agreement and significant correlations (P < 0.0001) were found between the two methods on all four subscales assessing specific eating disorder psychopathology (i.e., Restraint, Eating Concern, Weight Concern, and Shape Concern subscales). However, higher levels of disturbance were consistently reported on the EDE-Q than the EDE interview. The two methods were not significantly or reliably related to one another when assessing binge eating. This may be due in part to the difficulty inherent in identifying binges in subjects with BED. Examination of individual item scores suggest that it might be possible to improve the performance of the EDE-Q by clarifying the definitions of certain complex features, although this should not be at the expense of compromising the practical utility of its self-report format.

Adolescent↗

PubMed1996

Familial eating concerns and psychopathological traits: causal implications of transgenerational effects.

OBJECTIVE: This study extends an earlier investigation on the link between familial traits and eating disorders (EDs), and examines the extent to which selected eating attitudes and psychopathological traits are (a) familial in nature and (b) specific to anorexia- and bulimia-spectrum disorders. METHODS: We measured various ED-relevant dimensions (eating and body image attitudes) and psychopathological traits (e.g., affective instability, narcissism, compulsivity, restricted expression) in the mothers, fathers, and sisters of probands displaying an ED (n = 88), another psychiatric disturbance (n = 42), or neither disturbance (n = 59). Total sample, including relatives, was 553. RESULTS: A principal components analysis (PCA), used to reduce variables and to characterize main sources of variation, yielded three interpretable factors: eating concerns and symptoms (grouping all eating-related dimensions), dramatic-erratic traits (grouping affective instability, narcissism, and conceptually related dimensions), and obsessive-compulsive traits (grouping compulsivity and restricted expression). Correlations among subjects' factor scores (derived from the PCA) showed two types of transgenerational effects: correspondences between daughters' and parents' psychopathological traits, and between daughters' and mothers' eating concerns. Despite these, relatives of ED probands were not discriminable on any factor score from relatives of controls. DISCUSSION: These results imply that transgenerational effects exist on eating attitudes and psychopathological traits, but do not uniquely identify families in which clinical ED syndromes occur.

Adolescent↗

PubMed1996

Substance use among women with eating disorders.

OBJECTIVE: The results of past research suggest that bulimics are more likely than anorexics to engage in substance use, and that binge eating and/or purging may be an indicator of increased likelihood of substance use. We further investigated substance use among women with eating disorders. METHOD: We compared women with anorexia nervosa (n = 134) to women with bulimia nervosa (n = 320) with regard to history of substance use and investigated potential relationships between eating disorder symptom presentation and substance use. RESULTS: Even after controlling for age and eating disorder symptom severity, women with bulimia nervosa were more likely than those with anorexia nervosa to have used alcohol, amphetamines, barbituates, marijuana, tranquilizers, and cocaine. Independent of diagnostic category, severity of caloric restriction was predictive of amphetamine use, severity of binge eating was predictive of tranquilizer use, and severity of purging was predictive of alcohol, cocaine, and cigarette use. DISCUSSION: Results are discussed in relation to the results of past research and with an emphasis on the importance of considering eating disorder symptom presentation in addition to formal eating disorder diagnosis.

Adult↗

PubMed1998

Light therapy in the clinical management of an eating-disordered adolescent with winter exacerbation.

A 17-year-old female followed for atypical eating disorder characterized by restriction was noted to worsen medically during winter months in each of 2 consecutive years. A trial of bright light therapy was initiated during the second admission. Within days of light treatment, the patient showed signs of clinical improvement in mood and eating. Within 1 month of light treatment, the patient's depression ratings decreased from a Beck Depression Inventory (BDI) score of 37 (severe) to 17 (mild/moderate). In addition, her eating improved moderately as revealed both by a slight decrease in Eating Attitudes Test (EAT) score (78 to 64) and by significant improvements in dietary intake and medical status. The present report suggests that light therapy may be a useful adjunct in the clinical management of eating-disordered youth who present with seasonal patterns of exacerbation. Controlled studies of light treatment in younger eating disorder populations are warranted.

Adolescent↗

PubMed2000

Negative affect moderates the relation between dieting and binge eating.

OBJECTIVE: Although laboratory experiments suggest that negative affect inductions potentiate the relation between dieting and disinhibited eating, little research has tested whether this finding generalizes to binge eating in the natural environment. Thus, we assessed whether negative affect moderated the relation between dieting and binge eating in a passive-observational study. METHOD: This aim was addressed with longitudinal data from a community sample of adolescents (N = 631). RESULTS: For females, dieting and negative affect predicted binge eating in cross-sectional and prospective analyses, but negative affect potentiated the relation between dieting and binge eating only in the cross-sectional analyses. Similar, but attenuated results were found for males. DISCUSSION: Findings converge with those from laboratory studies in suggesting that negative affect moderates the relation between dieting and binge eating, but also imply that dieting and negative affect constitute independent risk factors for binge eating. The lack of prospective effects may suggest that the interactive relations have a short time lag or are difficult to detect prospectively.

Adolescent↗

PubMed1995

An age-matched comparison of subjects with binge eating disorder and bulimia nervosa.

The purpose of this study was to compare data from a group of obese subjects with binge eating disorder (BED) with data from a group of normal weight bulimia nervosa (BN) subjects. Subjects were compared using the Eating Disorder Questionnaire (EDQ), the Eating Disorder Inventory (EDI), the Personality Disorders Questionnaire for DSM-III-R (PDQ-R), the Hamilton Anxiety and Depression Rating Scales, and the Beck Depression Inventory. A group of 35 age-matched subjects were selected retrospectively from treatment study subjects. The EDQ findings indicated that members of the BN group desired a lower body mass index, were more afraid of becoming fat, and more uncomfortable with their binge eating behavior than the BED group members. The BED subjects had a younger age of onset of binge eating behavior (14.3) than the BN subjects (19.8), even though both groups started dieting at a similar age (BED = 15.0, BN = 16.2). The EDI results showed BN subjects had more eating and weight-related pathology, with significantly higher scores on five of the eight subscales. On the PDQ-R more BN subjects endorsed Axis II impairment (BN = 69%, BED = 40%). While demonstrating greater eating pathology in the BN group, this study also found significant pathology and distress in BED subjects.

Adolescent↗

PubMed2002

Social anxiety as a barrier to treatment for eating disorders.

BACKGROUND: The goal of this pilot investigation is to determine the relationship between social anxiety and treatment-seeking behavior for eating disorders in an outpatient psychiatric clinic. METHOD: Twenty-eight patients seeking treatment for anorexia or bulimia at an outpatient eating disorders clinic completed a battery of self-report measures on eating pathology, attachment style and functioning, and social anxiety at initial intake appointment. Levels of eating pathology and social anxiety at consult were compared with service utilization records on entry into treatment. RESULTS: Individuals who did not engage in treatment had significantly higher levels of social anxiety (F = 8.29, df = 1, p < .05) compared with those who did engage in treatment. There were no differences in demographic characteristics, diagnoses, or level of eating pathology at intake. CONCLUSIONS: Social anxiety may act as a barrier to effective help-seeking and utilization of mental health treatment among individuals with eating disorders. Replication of these findings in a larger sample and more in-depth study of the mechanism of the observed association between use of services and social anxiety may be useful in planning more effective outreach in the community to underserved populations in need of treatment for eating disorders.

Adult↗

PubMed2002

Medical and psychiatric morbidity in obese women with and without binge eating.

OBJECTIVE: To determine the prevalence of obesity and binge eating in a population-based sample of female twins and to examine whether the presence of binge eating was associated with a greater risk for medical and psychiatric disorders in obese women. METHOD: A population-based study of twins who were born between 1934 and 1971 and both members responded to a mailed questionnaire (individual response rate was conservatively estimated to be 64%). Data for the present study are from the first and third interview waves. In Wave 1 (1987-1989), we assessed 92% of the eligible individuals (N = 2,163), 90% face-to-face and the remainder by telephone. We assessed lifetime history of psychiatric disorders, major medical disorders, health limitations, health satisfaction, and an array of personality and attitudinal measures. RESULTS: Obese women with binge eating reported greater health dissatisfaction and higher rates of major medical disorders than obese women without binge eating. Binge eating was also associated with higher lifetime prevalence of major depression, panic disorder, phobias, and alcohol dependence. Obese women with binge eating scored higher on neuroticism and symptom scales measuring depression, anxiety/phobia, and neurovegetative symptoms (i.e., insomnia, agitation, retardation, and obsessive-compulsive traits). DISCUSSION: The presence of binge eating in obese women is a marker for greater medical and psychiatric morbidity.

Adult↗

PubMed2002

Eating and body image disturbances in adolescent psychiatric inpatients: gender and ethnicity patterns.

OBJECTIVE: To examine gender and ethnicity patterns in eating and body image disturbances in adolescents hospitalized in a psychiatric facility. METHOD: Participants comprised 715 inpatients who completed the Millon Adolescent Clinical Inventory. Gender (317 males, 398 females), ethnicity (553 Caucasians, 77 Latinõ Americans, 85 African Americans), and Gender x Ethnicity interactions in the features of eating disorders and body image disturbance were explored in the study group. RESULTS: Eating-related disturbances at diagnostic threshold were infrequent but participants' reported rates of specific features and symptoms were not. Overall, a significantly higher proportion of females than males reported features of eating and body image disturbances. The three ethnic groups differed significantly in their reports of body image disturbances but not in their endorsement of features of eating disorders. Post-hoc comparisons revealed that a significantly higher proportion of Caucasian participants reported body image concerns than did African American and Latinõ American participants who did not differ significantly from one another. Significant Gender x Ethnicity interactions were observed, with Caucasian females endorsing higher rates of features of eating disorders and body image disturbances than African American and Latinõ American females. DISCUSSION: In adolescent psychiatric inpatients, although Caucasian females report the highest rates of the features of eating and body image disturbances, such concerns are not uncommon in males and in minorities.

Adolescent↗

PubMed2002

An evaluation of the relationship between mood and binge eating in the natural environment using ecological momentary assessment.

OBJECTIVE: Although many current theories of disordered eating focus on affective mechanisms, relatively little is known about the covariation of mood and eating in peoples' natural environments. This study examined the relationship between mood and binge eating behavior in the natural environment. METHOD: Twenty-seven college students with subclinical binge eating behavior self-monitored their mood on a handheld computer seven times daily for 2 weeks. RESULTS: On binge days, participants reported having significantly worse mood than on nonbinge days. When the trajectory of mood around the time of a binge was examined, no significant differences between prebinge and postbinge time were found when the entire binge day was examined. No mood differences were found between just prior to the binge (30-60 min prior to binge) compared with just after the binge (also within 30-60 min). A postbinge report indicated that reported mood immediately after a binge was worse than mood just prior to the binge. DISCUSSION: This study provides evidence that the affective experience of binge eating, when assessed in the natural environment, is negative. Furthermore, there was no evidence that binge eating was a response to an immediate or transient negative mood state or that binge eating provided relief from negative mood.

Bulimia↗

PubMed2003

Binge eating in obese children and adolescents.

OBJECTIVE: The first goal of the current study was to examine the extent to which a population of obese children and adolescents have developed binge eating problems. The second goal was to generate variables that would distinguish obese binge eaters from obese non-binge eaters. METHOD: A group of 126 children and adolescents seeking residential care because of their obesity was selected. A self-report version of the Eating Disorder Examination was administered. RESULTS: Binge eating episodes were reported by 36.5% of the obese youngsters. Six percent reported two or more episodes of binge eating a week. Obese binge eaters differed significantly from obese non-binge eaters in self-esteem and in a broad range of eating-related characteristics. Compared with obese non-binge eaters, the obese binge eaters were slightly younger. Obese binge eaters did not differ from obese non-binge eaters in degree of overweight or depression. DISCUSSION: Results suggest that binge eating is a prevalent problem among obese children and adolescents seeking help for their obesity. The marked difference between obese children with and without binge eating suggests the need for special treatment to focus on the problems of obese binge eaters.

Adolescent↗

PubMed2003

Genetic and environmental contributions to obesity and binge eating.

OBJECTIVE: Binge eating is present in a substantial proportion of obese individuals. A tendency toward obesity has been identified as a risk factor for eating disorders such as bulimia nervosa and binge eating disorder. The purpose of this article was to determine the extent of overlap between genetic and environmental factors that contribute to the liability to obesity and binge eating. RESEARCH METHOD: In a population-based sample of 2163 female twins, we conducted bivariate twin modeling to explore the relation between the genetic and environmental risk factors for obesity and binge eating. RESULTS: Bivariate twin modeling revealed substantial heritability for obesity (0.86: 95% CI, 0.77-0.94), moderate heritability for binge eating (0.49: 95% CI, 0.38-0.61), and a modest genetic correlation of +.34 (95% CI, 0.19-0.50) between the two traits. CONCLUSIONS: Both binge eating and obesity are heritable conditions, and there seems to be only modest overlap in the genetic risk factors that increase liability to each condition.

Adolescent↗

PubMed2003

The role of palatable food and hunger as trigger factors in an animal model of stress induced binge eating.

OBJECTIVE: Dieting and stress are etiological factors in eating disorders, and dieting strongly predicts stress-induced overeating in the nonclinical population. We developed an animal model of binge eating in sated rats that is evoked by stress, but only in rats with a history of caloric restriction and only if highly palatable food (HPF) is available after stress. This study investigated the effect of known binge triggers, a taste of HPF and of hunger, on this type of binge eating. METHOD: Female rats were cycled through the R/S protocol but this time were given just a taste of HPF with ad lib regular chow. After another R/S cycle, rats were stressed during restriction (while hungry) and were given HPF and chow. RESULTS: Although binge eating did not occur if only chow was available after stress, just a taste of HPF sufficed to increase chow intake to more than 160% (p < 0.001) of rats with a history of restriction only, stress-only, or neither. Hunger increased the proportion of chow consumed by both restricted groups, but stress magnified this hunger-induced overeating by increasing HPF intake to 137% of restriction-only rats (p < 0.001). DISCUSSION: These effects suggest that binge eating in this model is motivated by reward, not metabolic need, and parallels observations of binge triggers described in clinical binge-eating disorders. This strengthens the validity of using this animal model to target the physiology and treatment of eating disorders preceded by dieting and stress.

Animals↗