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PubMed2002

Eating disorders during adolescence and the risk for physical and mental disorders during early adulthood.

BACKGROUND: Data from a community-based longitudinal investigation were used to investigate whether adolescents with eating disorders are at an elevated risk for physical and mental disorders during early adulthood. METHODS: Psychosocial and psychiatric interviews were administered to a representative community sample of 717 adolescents and their mothers from 2 counties in the state of New York in 1983, 1985 to 1986, and 1991 to 1993. In 1983, the mean age of the youths was 13.8 years. RESULTS: Adolescents with eating disorders were at a substantially elevated risk for anxiety disorders, cardiovascular symptoms, chronic fatigue, chronic pain, depressive disorders, limitations in activities due to poor health, infectious diseases, insomnia, neurological symptoms, and suicide attempts during early adulthood after age, sex, socioeconomic status, co-occurring psychiatric disorders, adolescent health problems, body mass index, and worries about health during adulthood were controlled statistically. Problems with eating or weight during adolescence predicted poor health outcomes during adulthood, regardless of whether an eating disorder had been present. Only 22% of the adolescents with current eating disorders had received psychiatric treatment within the past year. CONCLUSION: Eating disorders during adolescence may be associated with an elevated risk for a broad range of physical and mental health problems during early adulthood.

Adolescent↗

PubMed1997

Codependency as a mediator between stressful events and eating disorders.

This study examined the role of codependency in the relationship between stressful events and the development of eating disorders. Ninety-five undergraduate women completed the Codependency Assessment, the Eating Disorder Inventory-2, the Differentiation of Self Scale, and an open-ended questionnaire asking about stressful experiences, including relationships with alcoholic family members. Results supported the hypothesis that women who reported experience with an alcoholic significant other or a chronic stressful situation exhibited higher levels of eating disordered behavior. However, a family history of parental alcohol abuse alone did not result in differences in eating disorder symptoms. Further, women who exhibited more characteristics of codependency (e.g., caretaking, needs for control) also evidenced more eating disorder symptoms. The findings suggest a developmental sequence, whereby codependency mediates the relationship between excessive stress and the development of an eating disorder.

Adolescent↗

PubMed2000

Personality differences between eating-disordered women and a nonclinical comparison sample: a discriminant classification analysis.

The present study evaluated the extent to which eating-disordered and nonclinical comparison samples could be differentiated on self-reported personality measures of autonomy and sociotropy and a projective measure of dependency. Sixty-two women meeting diagnostic criteria for eating disorder and a nonpsychiatric comparison group of 62 women completed the autonomy and sociotropy subscales of the Personal Style Inventory-II and the Rorschach Oral Dependency Scale (ROD). A discriminant classification analysis indicated 85.5% of eating-disordered subjects and 88.7% of control subjects were identified accurately from their scores on autonomy, sociotropy. and ROD. Results suggest that the experience of eating disorders is associated with a mixed clinical presentation characterized by issues related to sociotropy-dependency, and especially, achievement-related vulnerabilities. Potentially fruitful areas for future study include assessing the utility of autonomy and sociotropy as predictors of eating disturbances in prospective research and evaluating their utility in predicting treatment prognosis among patients with eating disorders.

Adolescent↗

PubMed1997

Childhood sexual abuse and precursors of binge eating in an adolescent female population.

OBJECTIVE: We examined the cross-sectional association between childhood sexual abuse (CSA) and self-reported binge eating in an adolescent female population. METHODS: Study subjects were recruited from clinics specializing in the treatment of CSA, and control subjects were from high schools in the same cities. Height and weight were measured and subjects completed four questionnaires pertaining to binge eating, depression, locus of control, and self-esteem. RESULTS: Study subjects showed significantly higher depression, external locus of control, and binge eating, and significantly lower self-esteem and weight satisfaction scores than did control subjects. After adjusting for all covariables simultaneously, CSA was not an independent correlate of binge eating score. The strongest correlates of binge eating score in the multivariable analysis were depression, body mass index (BMI), and weight satisfaction. CONCLUSIONS: Psychological factors such as depression or weight satisfaction were more influential than is sexual abuse per se in the relationship between CSA and eating disorders.

Adolescent↗

PubMed1997

Self-esteem, eating problems, and psychological well-being in a cohort of schoolgirls aged 15-16: a questionnaire and interview study.

OBJECTIVE: This study aimed to investigate the extent of eating problems and their association with self-esteem in girls aged 15-16. METHOD: Six hundred and nine schoolgirls aged 15-16 completed a questionnaire examining eating behavior, self-esteem, and general psychological well-being. A subsample of 31 girls was subsequently interviewed in terms of eating behavior and self-esteem. RESULTS: The questionnaire findings revealed that 56% of girls felt too fat and had used some form of weight control strategy. In addition, 32% scored above the Hospital Anxiety and Depression Scale (HADS) threshold for anxiety and 43% reached the Rosenberg Self-Esteem Scale criterion for low self-esteem. Interviews confirmed that those showing abnormal eating behavior in the questionnaires did indeed show greater eating pathology as well as lower self-esteem. Interviews also revealed that those with high levels of eating concern showed greater levels of global self-dissatisfaction and higher dissatisfaction with their physical appearance and family relationships. DISCUSSION: The results suggest that preventative interventions targeted at girls with low self-esteem may be appropriate.

Achievement↗

PubMed1997

The prevalence and correlates of binge eating in a British community sample of women with a history of obesity.

OBJECTIVE: To estimate the frequency of binge eating and binge eating disorder and their correlates in a sample of women with a history of obesity. METHOD: A group of women who had been found in a previous community study to have a body mass index > or = 30 were studied using self-report measures (n = 74) and interview (n = 62). RESULTS: One subject met criteria for binge eating disorder, while 24% reported binging. Subjects who reported binging were significantly more likely to have a past history of depressive illness. DISCUSSION: Prevalence of binge eating, binge eating disorder, and psychopathology was broadly in keeping with that found in North America. In addition, there were nonsignificant trends towards a positive family history of obesity, of childhood obesity, of early onset of dieting, of excessive concern about weight and shape, and a recent history of weight reduction. Further study is required to elucidate the causes of binge eating in the obese.

Adult↗

PubMed1997

Stress, coping, and disturbed eating attitudes in teenage girls.

OBJECTIVE: This study explored the relationship between stressors and disturbed eating attitudes among adolescent females, assessing the moderating role of coping and the mediating influence of poor self-esteem. METHOD: Two hundred eighty-six teenage girls were recruited from local schools, and completed standardized measures of stressors, coping, self-esteem, perfectionism, and disturbed eating attitudes. Regression analyses were used to test for moderating and mediating effects. RESULTS: Stressors and emotion-focused coping were found to be associated with low self-esteem, which in turn was strongly associated with disturbed eating attitudes. Stressors were also directly related to disturbed eating attitudes. DISCUSSION: The findings provide partial support for existing models of the etiology and maintenance of eating psychopathology, but have wider implications for our understanding of the eating disorders and their treatment.

Adaptation, Psychological↗

PubMed1998

Eye movement desensitization and reprocessing in eating disorders: caution against premature acceptance.

OBJECTIVE: Eye movement desensitization and reprocessing (EMDR) has been claimed effective in the treatment of a wide variety of psychiatric disorders, including eating disorders. An informal survey suggests that EMDR is now widely offered to patients with eating disorders. Before accepting a new therapy such as EMDR, one must determine that its benefits outweigh its adverse effects. This paper reviews the literature in an attempt to assess the benefits and risks of the use of EMDR in the treatment of eating disorders. METHOD: We reviewed the literature on the use of EMDR to treat eating disorders and other conditions. RESULTS: Looking at the question of its benefits, we were unable to find any methodologically sound studies that have shown efficacy for EMDR in eating disorders, or, indeed, any psychiatric disorder. We were also unable to find a sound theoretical basis for expecting EMDR to be effective. In addition, EMDR may have adverse effects. First, EMDR is sometimes used in conjunction with efforts to "recover" memories of traumatic events. But "recovered memory" therapy may carry a risk of inducing potentially harmful false memories. Second, use of EMDR may prevent or delay other therapies of established efficacy for eating disorders, such as cognitive behavioral therapy and antidepressants. DISCUSSION: In light of the findings of our review, the risk/benefit ratio of EMDR does not as yet encourage its widespread acceptance.

Desensitization, Psychologic↗

PubMed1998

Binge eating in bariatric surgery patients.

OBJECTIVE: Eating behavior, attitudes toward eating and body weight and shape, and depression were assessed in a sample of 64 morbidly obese gastric bypass surgery candidates. METHOD: The Beck Depression Inventory (BDI), the Three-Factor Eating Questionnaire (TFEQ), and the Eating Disorder Examination (EDE) were administered at the first preoperative visit. RESULTS: Twenty-five subjects (39%) reported at least one binge episode per week on average over the 3 months prior to seeking treatment. Binge eaters had significantly higher TFEQ Disinhibition and Hunger scores than nonbinge eaters. Binge eaters also differed from nonbinge eaters in terms of attitudes toward eating, shape, and weight. DISCUSSION: A significant number of gastric bypass surgery candidates report binge eating. The findings are consistent with other studies showing binge eaters to be a distinctive subgroup of the obese.

Adult↗

PubMed1998

Scope and significance of posttraumatic symptomatology among women hospitalized for an eating disorder.

OBJECTIVE: To examine posttraumatic symptomatology among women with eating disorders. METHOD: A sample of 294 women diagnosed as having anorexia nervosa (n = 121), bulimia nervosa (n = 103), or eating disorder-not otherwise specified (n = 70) completed a version of the posttraumatic stress disorder (PTSD) Symptom Scale along with instruments measuring specific eating disorder symptomatology and comorbid psychopathology. RESULTS: Of the total sample, 154 (52%) reported current symptomatology consistent with PTSD. However, severity of PTSD symptomatology was unrelated to either type or eating disorder or severity of either anorexic or bulimic symptomatology. Severity of PTSD symptoms was significantly associated with depression, anxiety, and dissociative experiences. DISCUSSION: The findings suggest that PTSD symptomatology is common and an important clinical variable among women with eating disorders, although apparently it is not directly related to the eating disorder per se.

Adolescent↗

PubMed1999

Sexual abuse in eating disorder subtypes and control women: the role of comorbid substance dependence in bulimia nervosa.

OBJECTIVE: The relationship between sexual abuse and eating disorders remains uncertain. Recent data have raised the possibility of differential rates of sexual abuse among subtypes of eating disorders. METHODS: We studied women with three subtypes of eating disorders: (1) 26 anorexia nervosa subjects (AN); (2) 20 bulimia nervosa subjects with comorbid substance dependence (BN + SDD); and (3) 27 bulimia nervosa subjects without substance dependence (BN - SDD). We compared women with these eating disorder subtypes to 44 control women (CW). Sexual abuse rates and diagnoses were assessed through direct structured interviews. RESULTS: We found an order effect for sexual abuse which was most common (65%) in BN + SDD subjects, followed by a rate of 37% in BN - SDD subjects and 23% in AN subjects. Subjects of all eating disorder subtypes had significantly higher rates of sexual abuse compared to a rate of 7% in CW subjects. DISCUSSION: Women with BN + SDD had the highest frequency and the most severe history of sexual abuse. However, the causal relationship between eating disorders and sexual abuse remains to be elucidated.

Adult↗

PubMed1999

Psychiatric comorbidity of eating disorders in men: a national study of hospitalized veterans.

OBJECTIVE: This study examined eating disorders and their psychiatric comorbidity in a national sample of hospitalized male veterans. METHOD: Review of discharge summaries for 466,590 male patients from Veterans Affairs medical centers for fiscal year 1996 resulted in the identification of 98 men with a current ICD-9-CM diagnosis of an eating disorder. For the comorbidity analyses, eating disorder cases were matched with controls drawn randomly from the pool of male patients without an eating disorder, using age and race as matching variables. RESULTS: There was a high rate of comorbid substance use and mood disorder for men with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). Men with AN were also at high risk for comorbid schizophrenia/psychotic disorder, men with BN were at risk for comorbid personality disorder, and men with EDNOS were at special risk for comorbid organic mental disorder and schizophrenia/psychotic disorder. DISCUSSION: For each eating disorder, there was a distinct pattern of psychiatric comorbidity that deserves further study.

Adult↗

PubMed1999

Evaluating direct and indirect measures for the functional assessment of binge eating.

OBJECTIVE: This study examined the usefulness of the Function of Binge Eating Scale and monitoring forms for a sample of subclinical binge eaters. METHOD: Participants included 23 college students who reported engaging in binge eating an average of two or more times per week. Participants completed the Function of Binge Eating Scale at the initial session, at 2 weeks, and at 4 weeks. Participants also monitored binge eating behavior and completed an Antecedent Checklist each time they engaged in binge eating. RESULTS: Participants responded similarly to direct and indirect measures of antecedents of binge eating although they tended to rate items on the indirect measures as more intense than on the direct measures. Boredom and dissatisfaction with body weight and shape were rated as the most intense proximate antecedents while anxiety and anger at others were reported as least intense. Irritability and depressed mood were the most frequently reported temporally remote antecedents. DISCUSSION: Implications and suggestions for future research are discussed.

Adult↗

PubMed2000

Female athletes and eating problems: a meta-analysis.

OBJECTIVE: The relationship between athletic participation and eating problems is examined using meta-analysis. Both the risk and protective elements of athletic participation are considered. METHOD: Data from 34 studies were used to examine the overall relationship between athletic participation and eating problems. Relationships for specific sports, elite athletes, and various age groups are also examined. RESULTS: Athletes appeared to be somewhat more at risk for eating problems than nonathletes. This was especially true of dancers. Significant effects did not emerge for gymnasts. Elite athletes, especially those in sports emphasizing thinness, were at risk. Nonelite athletes, especially in high school, had reduced risk of eating problems compared to controls. Body dissatisfaction was lower in athletes. CONCLUSION: There appear to be circumstances under which sports participation by women constitutes a risk factor for certain elements of eating problems. In other situations, athletic participation may be protective against eating problems.

Adolescent↗

PubMed2000

Relationship of weight and eating disorders in type 2 diabetic patients: a multicenter study.

OBJECTIVE: Previous work suggested that the degree of psychiatric symptomatology evidenced in overweight individuals was related to the severity of binge eating problems and not related to the severity of overweight. In a multicenter study, we investigated the relationship between weight and eating disorders (EDs) in a sample of type 2 diabetic patients. METHODS: Three hundred twenty-two patients with type 2 diabetes were stratified to various weight categories. Glycemic control, eating and body-related psychological problems, self-esteem, depressive, and general psychopathology of diaetic patients with and without an ED were compared. RESULTS: Eighty-one percent of all type 2 diabetic patients were overweight or obese. Prevalence rates of EDs ranged from 6.5% to 9.0%. Binge eating disorder was the most diagnosed ED. There was a strong relationship between body mass index (BMI) and eating disturbance-related variables and a weak or no relationship between BMI and depression or general psychopathologic variables. Patients with an ED showed a greater psychopathology compared to patients without an ED. The diagnosis of an ED did not seem to have a specific influence on glycemic control. CONCLUSIONS: Our results in a type 2 diabetic sample indicate that weight might have an impact on body and eating-related psychological distress in type 2 diabetic patients, but is of minor or no importance for depressive symptomatology, lower self-esteem, and general psychiatric symptomatology. Type 2 diabetic patients with an ED, however, suffer from considerable psychiatric symptomatology.

Analysis of Variance↗

PubMed1981

Personality variables related to compulsive eating in college women.

Investigated personality variables related to compulsive eating (episodic bouts of uncontrolled, excessive eating) in college women. Based on scores on the Compulsive Eating Scale, two groups were selected from a large sample of college women (mean age = 19) and classified high (N = 23) or low (N = 24) with regard to compulsive eating. Participants were administered the Sixteen Personality Factor Test, Social Desirability Scale. Locus of Control Scale, and Bem Sex Role Inventory. Results showed a number of significant differences between high and low groups. On the 16PF, high Ss showed higher inner tension, greater suspiciousness, and less emotional stability (ps less than .001). High Ss were more external in locus of control (p less than .02) and showed a greater need for approval (p less than .025). Sex role data showed a higher Masculine self-ideal (p less than .001) for the high group. There appear to be meaningful differences in personality variables that are related to compulsive eating. Results are discussed in terms of current theories of compulsive eating.

Adult↗

PubMed1993

Sexual abuse and eating disorders: a review.

Studies investigating a possible relationship between sexual abuse and eating disorders have reported highly discrepant results. Some variability can be accounted for by methodological issues including diagnostic criteria, study design, and assessment techniques. The heterogeneity of an eating disordered population, especially regarding the comorbidity of eating pathology and personality disorder, is also a factor. Overall results suggest that around 30% of eating disordered patients have been sexually abused in childhood, a figure that is relatively comparable to rates found in normal populations. For some patients there may be a direct link between sexual trauma and eating pathology, but in general sexual abuse is best considered a risk factor in a biopsychosocial etiological model of eating disorders. Complex associations between trauma, self-regulatory deficits, and psychopathology require further research.

Adolescent↗

PubMed1993

Disordered eating attitudes and behaviors, psychological adjustment, and ethnic identity: a comparison of black and white female college students.

The low prevalence of restrictive eating disorders among black women has been attributed primarily to cultural differences in the definition of beauty. Utilizing self-report measures, this study examined differences in the nature of disordered eating behaviors for black and for white female college students. Analyses of covariance and correlational tests revealed that white females demonstrated significantly greater disordered eating attitudes and behaviors than black females. Additionally, the data indicated that although disordered eating behaviors and attitudes are related to actual weight problems for black females, this is not the case for white females. Furthermore, this study is the first to provide evidence that restrictive eating disorders among black women are related to the degree to which they assimilate to mainstream culture. Finally disordered eating behaviors and attitudes were related to depression, anxiety, and low self-esteem in both groups.

Acculturation↗