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PubMed2003

Perspectives of eating disorders from the Charité Hospital in Berlin.

Eating disorders have attracted steadily expanding clinical and scientific attention since second half of the 19(th) century and, particularly, after the core descriptions of anorexia nervosa had been delivered by Gull and Lasègue. In this review, we attempt to illustrate perspectives on eating disorders that have emerged since then from the work at the Charité Hospital in Berlin. It is shown that the professional fate of care for eating disorders has been tied closely to the maturation of the specialty of child and adolescent psychiatry and psychotherapy in the 20(th) century. From the early beginnings of Theodor Ziehen (1862-1950) heading the Psychiatric and Neurological University Clinic of the Charité Hospital in Berlin and being devoted to child psychiatry and psychology, the issue of eating disorders has been pursued at the Charité throughout the vicissitudes of time. After a ward for children suffering from mental illnesses was instituted by Karl Bonhoeffer (1868-1948) in 1921, child and adolescent psychiatry and psychotherapy has constituted itself first in terms of a division and finally as a separate department at the Charité Hospital. Over the years, quite a remarkable body of work on eating disorders has accumulated in this institution. It is emphasised that the value of contributions inherited appears not just of historical interest. The past has addressed psychotherapeutic, anthropological, biological, psychometric, neuropsychological, and transcultural aspects which continue to yield insights into the nature of eating disorders. Tasks and prospects ahead are based upon this background, and some of these are outlined briefly.

Adolescent↗

PubMed2003

The outcome of adolescent eating disorders: findings from the Victorian Adolescent Health Cohort Study.

The study aimed to ascertain the outcome of adolescent onset eating disorders in a representative cohort of females. The design was a seven wave cohort study conducted over 6 years. 982 female participants from a total sample of 2032 secondary school students initially aged 14-15 years at 44 schools in the state of Victoria Australia. Branched questionnaires (BET) were used for assessing symptoms of eating disorder. A partial syndrome was defined where a subject met two DSM-IV criteria for either anorexia or bulimia nervosa. The revised Clinical Interview Schedule (CIS-R) was used for assessing depression and anxiety, and self-report frequency of use and retrospective diaries for substance use. The mean point prevalence of eating disorders in females between 15-18 years at the partial syndrome level was 2.4 % (1.8-31). At follow-up at the age of 20 years the point prevalence was 3 % (1.9-4.1). In all 8.8 % reported an eating disorder across the six year study period. Eleven percent of those with eating disorder in the teens had persisting disorder at follow-up. In contrast, close to 50 % had high levels of depression and anxiety, a finding that was particularly marked for those with the partial syndrome of bulimia nervosa during the teens. The bulimia group tended to report a higher level of heavy alcohol use at follow-up. Eating disorders at the partial syndrome level are common in young women but most teenage syndromes are brief and self-limiting. The findings are consistent with the partial syndrome of bulimia nervosa being viewed as a variant of affective disorder with different associated behaviours at particular developmental points.

Adolescent↗

PubMed2003

Shall the anthropometry of physique cast new light on the diagnoses and treatment of eating disorders?

Body weight is crucial to eating disorders. Beyond gender, age, and height it is determined by anthropometric features of physique, i. e. somatotypes. We investigated their impact on the anthropometric and metabolic assessment of nutritional status, psychometrics, and other clinical aspects of eating disorders. In 133 eating disordered girls (ICD-10 & DSM-IV criteria) of well-recorded catamneses, various somatometric measures (n = 133), serum leptin (n = 30), plasma tryptophan (n = 108), and psychometric scales (n = 119; EDI-64 & EAT-40) were examined, preferably on repeated occasions of their treatment and in comparison to 41 healthy controls. Somatotyping was performed by gender- and age-specific quintiles of Strömgren's Metrik Index (MI) derived from 6995 volunteers constituting the anthropometric reference.Somatotypes represent a significant factor for assessing nutritional status. Exhibiting higher EDI-64 bulimia ratings at admission, more prevalent self-induced vomiting and purgative substance abuse as well as prolonged refractory illnesses with more previous inpatient treatment trials but later admissions, heavier somatotypes were significantly underrepresented in our total clinical sample but more prevalent among bulimic eating disorders (p < 0.05). Neglecting the anthropometry of physique biases against the detection and treatment of eating disorders in heavier somatotypes at weights below general average. Henceforth, this shall be avoided by somatotyping according to frame indices.

Anthropometry↗

PubMed2003

The offspring of mothers with eating disorders.

There is good evidence that children of parents with psychiatric disorders are at increased risk of disturbances in their development. There is considerable research on disorders such as depression and alcohol abuse, but research on the children of parents with eating disorders has only recently emerged. This paper reviews evidence in a number of domains, including genetic factors; pregnancy; the perinatal and postpartum period; followed by infancy, and the early years, focusing on feeding and mealtimes, general parenting functions and growth. Psychopathology in the children, parental attitudes to children's weight and shape, and adolescence are then considered. While numerous case reports and series have been published, there are very few systematic controlled studies, and virtually no reports of the influence of fathers with eating disorders or the male partners of mothers with eating disorders. The available evidence suggests that children of mothers with eating disorders are themselves at increased risk of disturbance in a variety of domains. This risk depends on a range of factors, and it should be noted that difficulties in the offspring of mothers with an eating disorder are far from invariable. Finally, based on current evidence, five types of mechanisms by which eating disturbance in parents can influence child development are summarised.

Adolescent↗

PubMed1998

Personality characteristics predict outcome of eating disorders in adolescents: a 4-year prospective study.

Results of studies on predictive factors in eating disorders have not been very clear until now. Attention has focused primarily on the predictive value of eating behaviour, duration of illness, comorbidity, and population characteristics for groups with mixed eating disorders, but lately several studies have concentrated on the influence of psychological and personality characteristics. In this 4-year prospective follow-up study of 49 eating-disordered adolescent patients, the predictive value of psychological factors and personality characteristics for the course of eating disorders is determined and discussed. The prognostic power of psychological variables measured by means of the Eating Disorder Inventory and the Dutch Personality Questionnaire is found to be stronger than that of behavioral factors and population characteristics and is different for anorectic and bulimic patients. For restricting anorectics, strong maturity fears predict poor outcome after four years, while for bulimic anorectics a longer duration of illness is related to poor prognosis. For patients with bulimic characteristics low self-esteem at admission is predictive of poor outcome.

Adolescent↗

PubMed2007

Are there gender-specific pathways from early adolescence psychological distress symptoms toward the development of substance use and abnormal eating behavior?

The aim of the present longitudinal community study was to test whether psychological distress at 13 years of age predicted reported substance use problems in boys and abnormal eating behavior in girls 2 years later. The sample consisted of 500 male and 576 female students. The use of substances was evaluated using a semi-structured interview, psychological distress with the General Health Questionnaire (GHQ) and eating psychopathology with the Eating Attitudes Test (EAT-40), and the Bulimic Investigatory Test Edinburgh (BITE). Controlling the effect of initial substance use problems, psychological distress predicted later reported substance use problems in males. Girls with an initial score above the cut-off point on the GHQ were two times more likely to be at risk of having an eating disorder 2 years later. Therefore, psychological distress might take different developmental pathways in males and females, leading toward eating problems in the latter versus substance use in the former.

Adolescent↗

PubMed2004

The rise of eating disorders in Japan: issues of culture and limitations of the model of "westernization".

As the first non-Western nation in contemporary history to become a major industrialized economic power, Japan is central to the debate on cultural relativism in psychiatric nosologies, and the study of eating disorders in Japan contributes to the complex discussion of the impact of culture and history on the experience, diagnosis and treatment of such disorders (R. Gordon 2001; Palmer 2001). Without question, the rise in eating disorders in Japan correlated with increasing industrialization, urbanization, and the fraying of traditional family forms following World War II. While the case of Japan confirms that the existence of eating disorders appears to be linked with these broader social transformations, it also points to the importance of specific cultural and historical factors in shaping the experience of eating disorders. In this article, we explore two particular dimensions of culture in contemporary Japan: (1) gender development and gender role expectations for females coming of age; and (2) beauty ideals and the role of weight and shape concerns in the etiology of eating disorders. Our analysis of these dimensions of culture, and the data accruing from empirical and qualitative research, reveal limitations to the model of "Westernization" and call for a more culturally sensitive search for meaning in both describing and explaining eating disorders in Japan today.

Adult↗

PubMed1994

Eating rates in normal and hypothalamic hyperphagic rats.

Two experiments were conducted to determine if hypothalamic hyperphagic rats eat at a faster than normal rate and if slowing the rate of eating would reduce their overeating. Experiment 1 used a 45 mg pellet eatometer to measure 24-h meal patterns and eating rates in control rats and rats made hyperphagic with medial hypothalamic (MH) knife cuts. The MH hyperphagic rats consumed larger and more frequent meals but ate at a slower rate than did control animals during both the dynamic and static phases of the syndrome. In Experiment 2, rats were given 30-min test meals with the same pellets presented in food cups (rather than one pellet at a time as with the eatometer). The MH rats consumed the pellets at the same rate as the controls, although their meals were twice as large. Experiment 1 also determined if slowing the rate of eating would reduce MH hyperphagia; eating rates were constrained by increasing the delay between successive pellet deliveries (normally < 1 s). An interpellet delay of 20 s reduced meal size and increased meal length and frequency but did not reliably reduce 24-h food intake in normal rats and dynamic or static phase MH rats. Interpellet delays of 40 or 60 s reduced daily food intake of static phase MH rats but only to control levels. These results indicate that MH hyperphagia is not associated with elevated feeding rates and is relatively unaffected by constraints on the rat's rate of eating.

Animals↗

PubMed1994

Gastric pressures in pigs during eating and drinking.

Pressures were measured with miniature transducers positioned within the gastric lumen of six young pigs, 20-40 kg, eating and drinking operantly. The pigs were free to move about, lie down, sleep, eat, and drink without disturbance. 1) At the end of 4-5-h fasts (with no drinking), mean pressure within the stomach was 12 cm H2O, then rose during 22-min eating bouts to 22 cm H2O. 2) At the end of 16-18-h periods of food and water deprivation, intragastric pressure was 9 cm H2O. When water was drunk, pressures rose only to 13 cm H2O, then fell. When food was then eaten, pressures rose during 29-min meals to 22 cm H2O. 3) During spontaneous eating and drinking, intermeal pressures were maintained at 22-25 cm H2O, fell by 4-5 cm H2O just as eating or drinking began, then rose slowly, but only to the preingestive pressure level by the end of the bout. These results indicate that during spontaneous eating and drinking, gastric distention per se plays a smaller direct role in causing satiety than it does during meals ingested after a period of food deprivation.

Afferent Pathways↗

PubMed1990

Does emotional eating interfere with success in attempts at weight control?

Questionnaire responses from a convenience sample were used to test for hypothesized relationships between changes over time in individuals' reported frequency of emotional eating and estimates of their success in attempts to reduce body weight over periods of at least 1 year. Respondents were 187 English adults, whose distribution of estimated Body Mass Indices (BMI) approximately that of the general population. Initial BMI was significantly (p less than 0.001) positively associated with reported frequency of emotional eating. Moreover, respondents indicating initially relatively high levels of emotional eating who reported a reduction in that level were found to lose significantly (p less than 0.01) more reported weight and to be significantly (p less than 0.05) more successful at approaching target weight over the period of the study than respondents who continued to report high levels of emotional eating. Similarly, respondents who reported an increase from initially relatively low levels of emotional eating, while not losing significantly less reported weight, were significantly (p less than 0.05) less successful at approaching target weight than those respondents who continued to report low levels of emotional eating.

Adult↗

PubMed1990

Weight and eating concerns among pre- and young adolescent boys and girls.

The emergence of weight and eating concerns in pre- and young adolescents and the relations of these concerns to daily experience and psychologic adjustment were investigated. Four hundred eighty-one children from fifth to ninth grades completed a Weight and Eating Concerns Scale, a depression inventory, self-esteem and body image scales, and reported their daily experiences by the Experience Sampling Method. Girls tended to report more weight and eating concerns than boys. This discrepancy increased with age. In older girls (eighth and ninth graders) extreme weight and eating concerns were associated with other signs of emotional maladjustment. Girls who experience emotional distress may try to compensate for the strain by controlling body shape and in doing so, may place themselves at risk for developing an eating disorder. Boys currently appear to be protected from this difficulty. Our findings suggest that excessive weight and eating concerns in young adolescent girls signal psychologic maladjustment which may require attention.

Adolescent↗

PubMed1984

Eating epilepsy.

The clinical and EEG profiles of 13 cases of eating epilepsy are described. Temporal lobe epilepsy (TLE) formed the seizure type in 12 cases. In all but one case, the seizures were precipitated only by eating a heavy meal. In ten cases EEG showed interictal seizure discharges. EEG recordings were obtained from 12 patients during and after eating. In two patients clinical attacks (TLE) could be induced by eating in the laboratory. There was a good response to conventional anticonvulsants in only 3 cases. Alteration of eating habits helped in controlling reflex seizures in 2 cases. Various mechanisms of reflex precipitation of seizures by eating are discussed.

Adolescent↗

PubMed1986

Eating disordered behaviors: a comparison of male and female university students.

This study compared male and female students on measures characteristic of eating disordered behavior. Measures investigated were subscales of the Eating Disorders Inventory and of the Restrained Eating Scale. Results indicated that both males and females reported a fundamental pattern of eating disordered behavior. This pattern consisted of going on and off diets with an accompanying complaint of a lack of confidence in recognizing and identifying sensations of hunger and satiety. Females differed from males in that they reported more anorexic behavior and scored significantly higher on most measures of eating disordered behavior. Although the fundamental pattern of disordered eating leading to bulimia may be similar between the sexes, females appear to be at greater risk to the development of these behaviors.

Body Image↗

PubMedDate not supplied

Metabolic determinants of binge eating.

Binge-eating behavior is often thought to be the consequence of energy restriction and dietary restraint. However, evidence is accumulating that recurrent eating binges may be one behavioral mechanism in the expression of familial obesity, and may therefore precede the onset of dieting. The profile of patients with the DSM-IV binge-eating disorder resembles that of patients with familial obesity. There is further evidence for the involvement of the endogenous opiate peptide system. Binge-type foods are often rich in fat, sugar, or both. The opiate antagonist naloxone reduced the consumption of sweet high-fat foods in obese and lean female binge-eaters, though not in nonbinging controls. In contrast, obese as opposed to lean subjects were not differentially affected by naloxone. These data provide a psychobiological validation of the DSM-IV binge eating disorder and suggest that binge eating may be triggered by physiological events. As opposed to being the outcome of dieting, binge-eating episodes should be considered as its possible cause.

Adolescent↗

PubMed1992

Is chronic low self-esteem the cause of eating disorders?

Low self-esteem occurs commonly in patients with an eating disorder, a term which includes patients with both anorexia nervosa and bulimia nervosa. In this hypothesis it is proposed that chronic low self-esteem is a necessary prerequisite to the development of an eating disorder, and that chronic low self-esteem is the final common pathway through which the multiple aetiological factors involved in the causation of eating disorders act. Thus, eating disorders can best be viewed as a 'symptom' of chronic low self-esteem. This hypothesis is able to account for the recent increase in the incidence of eating disorders, and the increased incidence of depression in eating disordered patients. Suggestions for research to test this hypothesis are made.

Anorexia Nervosa↗

PubMed1992

Atypical eating disorders.

Some patients with eating disorders have neither anorexia nervosa (A.N.) nor bulimia. Cases which do not rigorously meet the DSM-III-R criteria for anorexia nervosa or for bulimia are usually defined as "eating disorders N.O.S." Among them are patients with pathological characteristics very closely related to the above-mentioned categories. Others, however, although affected by an eating disorder, present a quite different clinical picture from either A.N. or bulimia. In a study of 80 eating disorder cases, only 45 met the strict definition of A.N. or bulimia. The other 35 were diagnosed as atypical eating disorders and are the focus of this presentation. 29 were classified as Eating Disorders N.O.S. and 6 as obesity. Co-morbidity, gender and age data, and clinical vignettes are presented.

Child↗

PubMed1993

Advanced pubertal development and eating disturbance in early adolescent girls.

This study assessed the hypothesis that early adolescent girls with advanced pubertal development would be at increased risk for eating disturbance compared with less-advanced peers. Sixth-grade girls differing in levels of pubertal development responded to the Eating Disorder Inventory (EDI); to questions about weight-related concerns and dieting; and to measures of body image and appearance satisfaction. Body mass index (BMI) was calculated from measured weights and heights, and used as a measure of body fatness. Also assessed were the relative contributions of physical variables (e.g., body fatness) and psychological variables (e.g., body image) to eating- and weight-related concerns. Results supported the hypothesis that more advanced pubertal development was associated with an elevated level of eating disturbance. Analyses suggested that although normal pubertal increases in fatness and weight initially might induce eating-related concerns, it is the psychological response to these changes, in the form of more negative body image, that ultimately becomes more important for promoting eating disturbance.

Age Factors↗

PubMed1994

Hypercarotenemia and transaminitis in female adolescents with eating disorders: a prospective, controlled study.

PURPOSE: Hypercarotenemia and transaminitis are reported as laboratory features of anorexia nervosa. However, the specificity and sensitivity of an elevation in serum carotene and transaminase are not known. Therefore, a prospective study was undertaken to determine the clinical utility of these serum markers. METHODS: Serum carotene was measured in 46 female adolescents between 13 years and 18 years of age (21 anorexia nervosa, 17 bulimia nervosa, 8 unclassified eating disorders). Findings were compared to levels of carotene in serum samples obtained from similarly aged females with either chronic inflammatory bowel disease (22 Crohn disease, 11 ulcerative colitis) or acute medical symptoms not associated with undernutrition or intestinal inflammation (N = 26), and 21 children of either sex with dyspeptic symptoms. RESULTS: Serum carotene was elevated in 6/46 (13.0%) females with eating disorders compared with only 2/80 (2.5%) children in the three comparison groups (p < 0.01). Hypercarotenemia was present in 4/21 girls with anorexia nervosa compared with 0/17 females with bulimia nervosa (p = 0.11). Transaminitis was present in 38.5% (AST) and 7.7% (ALT) of eating disorder patients. Liver enzyme abnormalities, however, did not correlate with hypercarotenemia. Transaminitis was also not specific for eating disorders since transaminitis was observed with comparable frequency in the three comparison groups. CONCLUSIONS: These findings confirm that hypercarotenemia is a laboratory feature in some subjects with eating disorders, in particular, anorexia nervosa. The low sensitivity (13.0%) does not provide justification for its use as a screening test. However, in complicated diagnostic settings a serum carotene determination could prove useful because the specificity (97.5%), positive predictive value (75.0%), and negative predictive value (66.1%) of an elevated carotene were high. These data also show that elevated carotene levels are not associated with hepatic abnormalities. Although transaminitis is reported as a laboratory feature of eating disorders, the prevalence of such abnormalities in this study was not higher than in age-matched comparison groups.

Adolescent↗