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PubMed2005

Categorical versus dimensional models of eating disorders: an examination of the evidence.

OBJECTIVE: Eating disorders have been conceptualized as discrete syndromes or categories and as dimensions that differ in degree among individuals. Until recently, researchers have not directly addressed which of these models, categorical versus dimensional, is most valid. METHODS: The primary objective of this review was to examine the evidence related to the validity of dimensional versus categorical models of eating disorders. RESULTS: Findings from a series of taxometric studies have suggested that a conceptual representation of eating disorders may involve a latent taxon, related to binge eating (and possibly purging), and one or more dimensions. These studies found that binge eating was identified as a factor that does not occur on a continuum with anorexia nervosa, restricting subtype. Restricting subtype anorexia is continuous with normalcy, however. DISCUSSION: These findings should be viewed as preliminary evidence that may have implications for the etiology, assessment, prevention, and treatment of eating disorders.

Factor Analysis, Statistical↗

PubMed2005

Fluid Intake in patients with eating disorders.

OBJECTIVES: The current study examined the fluid intake of patients with eating disorders and factors that may influence the amount and type of fluid consumed. Subjects comprised 81 inpatients with eating disorders. METHODS: A 7-day semi-standardized, retrospective fluid history was taken by a dietitian when the subjects were admitted to an eating disorder unit. Total fluid consumed per day was measured, which included all energy-free, energy-containing, and caffeine-containing fluids (all in milliliters per kilogram). Age, body mass index (BMI), and eating disorder behaviors (purging, binge eating, and excessive exercise) were also evaluated. RESULTS: Fluid intakes ranged from 250 ml to >6 L per day, with an average of 2.7 L. Only 17% of patients had fluid intakes in the recommended range. The most commonly consumed beverage was water followed by diet cola, coffee, juice, and tea. The lower the BMI and the older the patient, the greater the fluid intake. CONCLUSIONS: Fluid intake is variable and should be part of the clinical assessment of the eating disorder patient.

Adolescent↗

PubMed2005

Core beliefs and the presence or absence of eating disorder symptoms and depressive symptoms in adolescent girls.

OBJECTIVE: Core beliefs specific to eating disorder and depressive symptoms were investigated in four groups of adolescent girls well matched on these symptoms. METHOD: A total of 272 girls were included and two measures of core beliefs were compared. The measures were the Young Schema Questionnaire (YSQ) and the Negative Self-Beliefs subscale of the Eating Disorder Belief Questionnaire (EDBQ). RESULTS: One-way analyses of variance found that both measures distinguished a "healthy" group and a group high on depressed symptoms, but not one high on eating disorder symptoms. Both measures also distinguished the unhealthy group from a high eating disorder symptom group, but only the EDBQ subscale distinguished this group from the group high on depressive symptoms. Discriminant function analysis indicated that both measures identified beliefs specific to depression but only the EDBQ subscale was able to identify beliefs specific to eating disorder symptoms. These beliefs were I'm stupid and I'm ugly. DISCUSSION: In an analogue population at least, the EDBQ negative self-beliefs subscale may be a more sensitive measure of eating disorder related core beliefs than the YSQ. The practical difficulties of replicating the current study in a clinical population are discussed, and a next step is proposed for future research on this topic.

Adolescent↗

PubMed2005

Influence of race, gender, and socioeconomic status on binge eating frequency in a population-based sample.

OBJECTIVE: This study investigates race and gender differences in the demographic and socioeconomic determinants of frequency of binge eating using a population-based sample. METHOD: An analysis of self-reported data on 573 women and 360 men (range, 18-97 years) from a cross-sectional, multistage area probability sample of individuals aged 18 years and older residing in the Detroit metropolitan area conducted in 1995. RESULTS: For women, the frequency of binge eating is negatively associated with age and family income, and positively associated with being married, depression, and time residing in polluted neighborhoods. For men, the frequency of binge eating is negatively associated with age. The frequency of binge eating was not affected by education, race, obesity, or current dieting. CONCLUSION: The frequency of binge eating is highest among adults younger than 40 years. It follows an income gradient for women, but not for men. After controls for individual disadvantage, there is no residual Black/White difference in binge eating.

Adolescent↗

PubMed2006

An update on the definition of "excessive exercise" in eating disorders research.

OBJECTIVE: The current study informed the definition of "excessive exercise" by examining relations between exercise behavior, eating-disordered behavior, and quality of life (QOL) in a community sample of women. METHOD: Self-report measures of frequency of exercise, obligatory exercise and motivation for exercise, and of eating disorder psychopathology and QOL, were completed by 3,472 women aged 18-42 years who engaged in regular exercise. RESULTS: The extent to which exercise is intended to influence weight or shape and the degree to which guilt is experienced when exercise is postponed were the exercise variables most strongly associated with elevated levels of eating disorder psychopathology and reduced QOL. Subgroups of participants who reported exercising solely for weight and shape reasons (n = 322 [9.3%]), intense guilt after postponement of exercise (n = 136 [3.9%]), or both (n = 116 [3.3%]), had markedly elevated levels of eating disorder psychopathology. There was no association between excessive exercise and reduced QOL after the effects of eating disorder psychopathology were statistically controlled. CONCLUSION: The findings suggest that exercise is excessive when its postponement is accompanied by intense guilt or when it is undertaken solely to influence weight or shape. Operational definitions of excessive exercise might usefully include reference to these terms. The findings may also be of benefit in informing the content of prevention programs, which address dysfunctional exercise behavior. Excessive exercise is unlikely to be associated with impairment in psychosocial functioning in the absence of eating disorder psychopathology. It may, however, be a useful indicator of such psychopathology.

Activities of Daily Living↗

PubMed2006

A longitudinal study investigating disordered eating during the transition to motherhood among Chinese women in Hong Kong.

OBJECTIVE: The current longitudinal study explored the prevalence and psychosocial factors of disordered eating among new Chinese mothers in Hong Kong. METHOD: Self-report questionnaires on bulimic symptoms and pregnancy-related factors were collected at both prenatal and postnatal periods from 131 Chinese women. RESULTS: Participants reported significantly more severe disordered eating in the postnatal than in the prenatal period, with percentages being 19.08% and 8.4%, respectively, using the Eating Disorder Inventory-2. Results revealed that prenatal disordered eating, weak maternal-fetal attachment, a low level of instrumental spousal support during pregnancy, postnatal depressive symptoms, and a poor mother-infant relationship were significantly related to disordered eating at 6 months postchildbirth. CONCLUSION: Findings suggested that the transition to motherhood is a period of stress that may either precipitate or exacerbate disordered eating.

Adaptation, Psychological↗

PubMed2006

Binge eating and purging in a multi-ethnic community sample.

OBJECTIVE: The purpose of the present study is to document the frequency of three eating disorder-related behaviors (binge eating; self-induced vomiting; and use of laxatives, diuretics, and diet pills) among a multi-ethnic community sample. METHOD: A questionnaire was administered to 1225 Hispanic, Asian, black, and white women and men. Participants responded to items (based on DSM-IV diagnostic criteria for eating disorders) about binge eating and purging behavior. RESULTS: Binge eating and purging were more common among women than among men in Hispanic, black, and white subsamples (frequency rates were similar among Asian men and women). Ethnic differences were found in frequency of purging among women (ethnicity was not associated with behavior rates among men). Fewer Asian than Hispanic, black, and white women induced vomiting and used laxatives, diuretics, and diet pills as weight control methods. CONCLUSION: The fact that frequency rates differed as a function of participant sex and ethnicity underscores the importance of considering both of these group variables when examining disordered eating and weight control behaviors.

Adult↗

PubMed2002

Influence of environmental temperatures during gestation and at birth on eating characteristics in adolescence: a replication and extension study.

Past research has shown a season of birth effect in clinical subjects with eating disorders. Studies also indicate a similar effect of environmental temperatures in non-clinical subjects, as well as effects of environmental temperatures during the three trimesters of gestation. These two studies aimed to replicate and extend those findings. The participants were adolescents (ages 15-19 years) who attended public schools in a mid-Atlantic US city. They completed the relevant scales of the Eating Disorder Inventory (N=578) and the Three Factor Eating Questionnaire (N=191). Correlational analyses were employed to study the relationship of environmental temperatures during pregnancy (the three trimesters of intrauterine development and at birth) with eating characteristics. The results of the previous studies were broadly replicated in Study 1, but Study 2 revealed a difference in the pattern of associations according to the measure used. This contrast indicates that the way in which one conceptualizes eating pathology is of critical importance in understanding the long-term impact upon eating patterns of environmental temperature during the intrauterine period. Possible theoretical bases for these findings are discussed.

Adolescent↗

PubMed2002

The influence of definitions on the prevalence of eating problems in an adolescent population.

OBJECTIVE: The definitions of eating problems vary widely as they integrate cognitive, behavioural and physiological components to different degrees. The aim of this study was to show how much these differences affect the prevalence of eating problems in an adolescent population. METHOD: All of the 9131 adolescents in a Norwegian county participated in a health study, 8042 (88.1%) of whom gave valid responses to a questionnaire covering various aspects of eating problems, and had their weight and height measured. RESULTS: The prevalence of eating problems ranged from 0.3 to 47.0% depending on the definitions used. The various definitions also gave different gender ratios, although the prevalences increased with age in females only. CONCLUSIONS: The various definitions of eating problems had a low degree of correlation and led to quite variable prevalences. All of them showed that the prevalence of eating problems was higher in females, but their prevalence in males was also considerable.

Adolescent↗

PubMed2003

Assessment of two self-reporting questionnaires for eating disorders in women.

OBJECTIVE: The goals of this study were to evaluate how well the Eating Disorder Inventory (EDI) predicted specific eating disorders as identified by the Survey of Eating Disorders (SED), and to identify the most predictive EDI scales. An additional goal was to evaluate the EDI as a screening instrument for eating disorders among a large non-clinical group of women. METHOD: The community-based study sample consisted of 1245 Norwegian women between age 18 and 50 years (mean 23). Subjects filled out the EDI and the SED. RESULTS: The strongest predictors of SED-defined eating disorders were the EDI scales bulimia (BN) and drive of thinness (DT) and body mass index (BMI). When we classified women with an EDI sum score of 40 or higher as having an eating disorder (ED), the sensitivity was 38% and the specificity was 90%, compared to the SED diagnosis of ED. DISCUSSION: Our findings suggest modest agreement between the EDI and the SED, and modest sensitivity and specificity of the EDI. While these instruments, perhaps with some modification, may be adequate for use in selected research applications, they should probably be supplemented with additional information in a clinical or treatment setting.

Adolescent↗

PubMed2003

Acculturation and eating disorder symptomatology in Black men and women.

OBJECTIVE: We assessed the prevalence of eating disorder symptoms in Black South African men and also explored their possible links with acculturation. METHOD: The Eating Disorders Inventory (EDI) and the South African Acculturation Scale (SAAS) were administered to a sample of undergraduate students consisting of 50 Black women, 50 Black men and 50 White men. RESULTS: The Black men had significantly higher scores than the White men on the psychological subscales of the EDI and higher than cut-off scores on perfectionism, interpersonal distrust and maturity fears subscales. There were marginal racial differences in the average acculturation scores, whereas gender appeared to have a variable effect on acculturation attitudes. Specific acculturation strategies were found to be differentially associated with the EDI subscales. The association between acculturation and eating disorder symptoms in Black men was significantly higher than that in White men. DISCUSSION: Our results indicate that there is a higher prevalence of eating disorder pathology in Black men than in White men. This lends support to the possible association between acculturation and eating disorders, and challenges the assumption that non-Western individuals--and Black men in particular--are protected from body image disturbances and disordered eating patterns.

Acculturation↗

PubMed2003

Maladaptive eating attitudes of elite and amateur Turkish dancers: are they at risk?

The aims of this study were to investigate whether Turkish dancers are at risk of eating disorders, and to identify any gender and elite vs. amateur differences. The study involved 100 participants (64 females and 36 males) divided into three groups: 6lite dancers, amateur dancers and controls. The elite dancers were the members of the State Conservatoire; the amateur dancers were university students attending university dance clubs; the control group consisted of university students who were not members of dance clubs. All of the participants completed the Eating Attitude Test and a questionnaire about eating habits. Both the elite and amateur dancers had more pathological eating attitudes than the controls. Females had more problematic eating attitudes than males. Both elite and amateur female Turkish dancers may be at risk for disordered eating. The implications for prevention are discussed.

Adult↗

PubMed2004

Short-term follow-up of adults with long standing anorexia nervosa or non-specified eating disorder after inpatient treatment.

OBJECTIVE: There are few follow-up studies on outcome for patients with long standing anorexia nervosa (AN) or non-specified eating disorder with several comorbid psychiatric disorders. Inpatient treatment is one option for these patients. The aim of this prospective study was to report one-year follow-up for a consecutive sample of these patients after an inpatient treatment program. METHOD: All 24 patients with a mean age of 28 years and mean duration of an eating disorder of 11 years were treated in a 23-week inpatient group treatment program for AN. Patients were assessed using Eating Disorder Examination interview (EDE), Eating Disorder Inventory (EDI) and Symptom Check List (SCL-90-R) at pre-treatment, post-treatment and at one year after start of treatment. At the follow-up 24 patients were personally interviewed. On admission 12 (50%) had AN, 8 (33%) non-specified eating disorder (EDNOS) and 4 (17%) bulimia nervosa (BN). All had previously suffered from AN and were clinically evaluated to have mostly anorectic psychopathology. RESULTS: Ten (42%) patients had improved at follow-up and 14 (58%) had a poor outcome. There was a moderate but significant improvement on the EDE, EDI and GSI from pre-treatment to follow-up. The improvement occurred during inpatient treatment, and no significant differences from post-treatment to follow-up were found. Patients with low weight on admission showed a significant mean weight increase of about 4 kg at the follow-up. CONCLUSIONS: At one-year follow-up there was a moderate reduction of eating disorder symptoms and general psychiatric symptoms for patients with long standing anorexic symptoms. The improvement occurred during inpatient treatment. Inpatient treatment may be a treatment option in long-time rehabilitation for some of these patients.

Adolescent↗

PubMed2004

Internal consistency, convergent validity and reliability of a brief questionnaire on disordered eating (DEQ).

Clinical interviews are considered the gold standard for the evaluation of the specific psychopathology associated with eating disorders. However, there are situations in which brief but valid and reliable self-report questionnaires can be helpful. For this reason, we have developed a new questionnaire, called the DEQ (Disordered Eating Questionnaire), brief enough to be used in epidemiological screenings, that evaluates the frequency and intensity of disordered eating attitudes and behaviours within a time frame of three months and addresses face valid questions to the general population. The aim of this study was to evaluate the dimensionality, reliability and convergent validity of this questionnaire. The DEQ was filled in by Italian secondary school girls and boys, together with the Contour Drawing Rating Scale (CDRS) and with the Eating Attitudes Test (EAT-26). The results showed a single component that explain a portion of variance of around 36%. The reliability of the scale is highly satisfactory. The scale is also valid, since scores on the DEQ scale are significantly and highly correlated with body dissatisfaction, measured by the CDRS, with body mass inex (BMI) and with all the subscales of the EAT-26. As expected, there were gender differences, given that DEQ scores were higher in females than in males.

Adolescent↗

PubMed2004

Affective temperament in the eating disorders.

BACKGROUND: In this study, we investigate the affective temperamental characteristics in a sample of ED (eating disorder) patients. METHODS: 49 ED patients diagnosed by the SCID (Structured Clinical Interview for DSM-IV), were divided into two groups on the basis of the presence or absence of Binge Eating (restricting-anorexia nervosa [R-AN]= 16; Binge Eaters= 33). All patients were administered the TEMPS-I (Temperament Evaluation Memphis Pisa Semistructured - Interview), to assess affective temperament. A third group of controls (N= 1010), derived from a study with the TEMPS-I on normal subjects, was included for comparison. RESULTS: A full affective temperament was not found in patients of the restricting group. By contrast 24% of the binge eating group had a full affective temperament of one of three types. Comparing the three temperaments for the three groups, only cyclothymic temperament proved to be significant, with higher levels in the binge eating group (p<0.01). CONCLUSIONS: In this study, people with R-AN do not show a full affective temperament. However, people with binge eating, had depressive and hyperthymic temperament, and displayed higher level of cyclothymic temperament than the normal population. The findings of this study add to a growing literature on temperament in people with ED; particularly, they add to the view that may be various paths leading to R-AN, and these may differ from those of binge eating.

Adult↗

PubMed2004

Disordered eating attitudes and behaviours in the high-school students of a rural Canadian community.

BACKGROUND: Most surveys of disordered eating attitudes in teenagers target females in urban areas. To help plan the distribution of treatment resources for eating disorders in British Columbia we studied male and female students in all of the high schools of a rural community. METHODS: Three hundred and ninety-six of the 2,589 students attending the four high schools within the rural community completed the EAT-26 and a demographic questionnaire. RESULTS: Three hundred and eighty-one of the 396 students (96%) satisfactorily completed and returned the survey. Their ages ranged from 12 to 19 years with a mean of 15.2 years (SD=1.5 years). Fifty-nine percent of participants were female. On average, males wanted to be 6.2 kg (SD=1.2 kg) heavier and females wanted to be 2.8 kg (SD=6.5 kg) lighter and 8.3 percent of males and 17.3 percent of females scored twenty or above on the EAT-26. INTERPRETATION: The prevalence of disordered eating attitudes and behaviours in this rural setting was similar to that reported in urban communities in Canada. Disordered eating attitudes and behaviours were common in males. We conclude that there is need for treatment resources for males and that the need for treatment is as great in rural as urban communities.

Adolescent↗

PubMed1998

Analyzing the relation between self-esteem and eating disorders: differential effects of self-liking and self-competence.

Research in the past has demonstrated an association between low self-esteem and eating disorders. Recent research on self-esteem has shown, however, that self-esteem is composed of two distinct factors--self-liking and self-competence. The present study examined the relation between these two self-esteem factors and both eating disorders and eating disturbed cognitions. A total of 51 female participants from a high-risk population were clinically interviewed to identify the eating disorder and administered a series of questionnaires that included a measure of self-liking and self-competence. A strong relationship was found between self-liking and eating disorders, but no relationship was found between self-competence and eating disorders.

Adult↗

PubMed2006

Factors associated with abnormal eating attitudes among female college students in Japan.

OBJECTIVES: To determine the prevalence rates of abnormal eating attitudes and associated risk factors among female Japanese college students. SUBJECTS AND METHODS: The study population was 7812 female college students in Tokyo. They were asked to fill out the Japanese version of EAT-26 and lifestyle questionnaires. RESULTS: 5.1% of the subjects had a total EAT-26 score above the cutoff point (>20). Multiple regression analysis found the most important factors associated with abnormal eating attitudes were distorted body image, fewer sleeping hours, irregular meal habits, cigarette smoking and more exercise. DISCUSSION: The prevalence of abnormal eating attitudes among female college students in this study was lower than that of Japanese female high school students and lower than that reported for college students of both western and non-western countries. Our results suggest that body image dissatisfaction may be the most important factor associated with abnormal eating behavior.

Adolescent↗