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Biomedical subjects

C M Bulik

Publications and source records attributed to C M Bulik.

At least 55 records · Page 3Linked to original sources
PubMed1998

Heritability of binge-eating and broadly defined bulimia nervosa.

BACKGROUND: Using diagnostic information obtained at two different times, we incorporated error of measurement into structural equation twin models to evaluate the contribution of additive genetic, common environmental, and individual-specific environmental factors to the liability to binge-eating and broadly defined bulimia nervosa (BN). We also evaluated the validity of the equal environment assumption (EEA) with reference to these two phenotypes. METHODS: We interviewed 1897 female twins (including both members of 854 twin pairs) from a population-based register about their lifetime history of binge-eating and of broadly defined BN twice, approximately 5 years apart. RESULTS: The reliabilities of a lifetime history of binge-eating (kappa = .34) and of broadly defined BN (kappa = .28) were low. Based on single interviews, the heritability of binge-eating was estimated to be 50% and broad BN 60%, with the remaining variance attributable to individual-specific environment. Common environmental influences had no effect on liability to either trait. By combining information from two interview waves and thereby incorporating error of measurement into a structural equation model, the estimated heritability of the latent vulnerability to binge-eating (82%) and broadly defined BN (83%) increased substantially. Although there were no violations of the EEA detected for binge-eating, cosocialization influenced twin concordance for broadly defined BN. CONCLUSIONS: Lifetime histories of binge-eating and broadly defined BN appear to be highly heritable conditions of low reliability.

Adolescent↗
PubMed1998

A controlled family study of anorexia nervosa and bulimia nervosa: psychiatric disorders in first-degree relatives and effects of proband comorbidity.

BACKGROUND: We used contemporary family-epidemiological methods to examine patterns of comorbidity and familial aggregation of psychiatric disorders for anorexia and bulimia nervosa. METHODS: Direct interviews and blind best-estimate diagnostic procedures were used with diagnostically "pure" groups of probands with eating disorders and a matched control group. Lifetime prevalence rates of eating disorders, mood disorders, substance use disorders, anxiety disorders, and selected personality disorders were determined in female probands with restricting anorexia nervosa (n=26) or bulimia nervosa (n=47), control women (n=44), and first-degree biological relatives (n=460). RESULTS: Relatives of anorexic and bulimic probands had increased risk of clinically subthreshold forms of an eating disorder, major depressive disorder, and obsessive-compulsive disorder. Familial aggregation of major depressive disorder and obsessive-compulsive disorder was independent of that of anorexia nervosa and bulimia nervosa. These relatives also had increased risk of other anxiety disorders, but the mode of familial transmission was not clear-cut. The risk of substance dependence was elevated among relatives of bulimic probands compared with relatives of anorexic probands, and familial aggregation was independent of that of bulimia nervosa. The risk of obsessive-compulsive personality disorder was elevated only among relatives of anorexic probands, and there was evidence that these 2 disorders may have shared familial risk factors. CONCLUSIONS: There may be a common familial vulnerability for anorexia nervosa and bulimia nervosa. Major depressive disorder, obsessive-compulsive disorder, and substance dependence are not likely to share a common cause with eating disorders. However, obsessional personality traits may be a specific familial risk factor for anorexia nervosa.

Adolescent↗
PubMed1998

Food cravers: characteristics of those who binge.

OBJECTIVE: Food cravings are a frequently described antecedent to binge eating, yet not all of those who report food cravings also binge eat. The present study sought to determine the factors that distinguish cravers who binge versus those whose cravings are satisfied by a relatively "normal" amount of food. METHOD: A food craving questionnaire, a psychiatric diagnostic interview containing questions on binge eating, and a self-report booklet were completed by a group of cravers recruited by advertisement and a group of cravers from a randomly selected sample. RESULTS: In both groups, the cravers who binged were differentiated from those who did not binge by higher measures of body mass index (BMI), more frequent diagnoses of bulimia nervosa, a higher level of dietary restraint, and a by a temperament characterized by low self-directedness. In the recruited cravers, those who binged were also more likely to have had an episode of major depression, social phobia, to be cognitively controlled and harm avoidant. A comparison of recruited cravers with randomly selected cravers and control women suggests that greater rates of psychopathology and eating-related disturbances and lower levels of parental care may be found in recruited samples. DISCUSSION: In addition to elucidating factors associated with binge eating in cravers, this study highlights important differences between recruited and random samples.

Adolescent↗
PubMed1998

Elevated total cholesterol in bulimia nervosa.

OBJECTIVE: It has been suggested that total serum cholesterol concentrations are elevated in bulimia nervosa. The objectives of this study were to compare cholesterol concentrations in women with bulimia nervosa with those of depressed women and population norms and to determine the dietary correlates of elevated cholesterol concentrations. METHODS: 126 women with bulimia nervosa and 57 women with major depression participating in clinical trials were studied. Total serum cholesterol concentrations were available for all participants. Prospective 2-week dietary intake analysis was examined for 49 of the bulimic women. RESULTS: Bulimic women had markedly higher total cholesterol concentrations than depressed women and in comparison to consensus recommendations and population norms. This finding remained highly statistically significant after taking into account an array of potential physical and psychopathological covariates. Dietary analysis suggested that increased total cholesterol concentrations were related to cholesterol and fat intake during binge eating, but not during normal eating. DISCUSSION: Bulimic women have higher total cholesterol concentrations that are related to excess cholesterol and fat intake during binge eating.

Adolescent↗
PubMed1998

Personality and dimensions of dietary restraint.

OBJECTIVE: Given that dietary restraint and associated dietary behavior may predispose individuals to frank eating disorders, and that differences in personality profiles have been observed across subtypes of eating disorders, we sought to address whether aspects of restrained eating (cognitive restraint, disinhibition, and susceptibility to hunger) could be distinguished using the Temperament and Character Inventory (TCI). METHOD: One hundred and one women aged 18-45 selected at random from the community completed the Diagnostic Interview for Genetic Studies (DIGS), the TCI, and the Three Factor Eating Questionnaire (TFEQ). RESULTS: Novelty seeking (NS) was significantly positively correlated with disinhibition. Self-directedness (SD) was negatively correlated with the total TFEQ score, disinhibition, and susceptibility to hunger. Self-transcendence (ST) correlated positively with total TFEQ score and cognitive restraint. DISCUSSION: These findings suggest that individuals with character traits denoting low SD and high ST may be particularly reactive and susceptible to societal messages pertaining to the ideology of slenderness.

Adolescent↗
PubMed1998

The epidemiology and classification of bulimia nervosa.

BACKGROUND: We sought to determine whether there was empirical support for the diagnostic thresholds of DSM-IV bulimia nervosa (BN) and whether an empirically derived typology resembled the diagnostic categories of DSM-IV. METHODS: Detailed information about bulimic behaviours were assessed via personal interview in a population-based sample of 1897 Caucasian female twins. We assessed the lifetime prevalence of the component bulimic behaviours and DSM-IV and DSM-III-R BN. Latent class analysis of nine separate bulimic symptoms was used to develop an empirical typology of bulimic behaviour. RESULTS: Although the lifetime prevalences of bingeing (23.6%) and vomiting (4.8%) were relatively common, DSM-IV BN was distinctly uncommon (0.5%). The criterion that specified the frequency and duration of bingeing and vomiting was an important limiting condition. Analysis of alternative thresholds found little support for the DSM-IV thresholds requiring an average of twice per week for 3 months. Latent class analysis yielded an interpretable four class solution that had little overlap with the DSM-IV typology. CONCLUSIONS: As in other studies of unselected samples of women, the lifetime presence of bulimic behaviours are relatively high. Our results suggest that the DSM-IV approach to categorizing bulimic behaviour inadequately captures the spectrum of lifetime bulimic behaviours in the general population.

Adult↗
PubMed1998

The role of exposure with response prevention in the cognitive-behavioural therapy for bulimia nervosa.

BACKGROUND: One hundred and thirty-five women with bulimia nervosa participated in a randomized clinical trial designed to determine whether the addition of exposure with response prevention to a core of cognitive-behavioural therapy (CBT) leads to greater clinical improvement and lower risk of relapse. We present results from the end of treatment and 6- and 12-month follow-up. METHODS: Participants received eight sessions of CBT and were then randomized to either exposure to pre-binge cues (B-ERP), exposure to pre-purge cues (P-ERP), or a relaxation training control condition (RELAX). RESULTS: CBT produced significant clinical change. At the end of the behavioural treatments, there were no significant differences across the three groups on abstinence (66% in B-ERP, 45% in P-ERP and 47% in RELAX), or frequency of bingeing and purging. B-ERP, but not P-ERP, significantly reduced anxiety on the cue reactivity assessment, food restriction, body dissatisfaction and depression. These differences were not maintained at 6-month follow-up. At 12-months, B-ERP was independently associated with lower food restriction and better global functioning. CONCLUSIONS: CBT is a highly effective treatment for bulimia nervosa. B-ERP was modestly superior to P-ERP at post-treatment; however, the advantage did not remain throughout the follow-up interval. ERP for bulimia nervosa is an expensive and logistically complicated treatment that does not appear to offer any significant additive benefits that are proportional to the amount of effort required to implement the treatment.

Adolescent↗
PubMed1998

Outcome of anorexia nervosa: a case-control study.

OBJECTIVE: Although there have been many studies of the outcome of anorexia nervosa, methodological weaknesses limit their interpretation. The authors used a case-control design to try to improve knowledge about the outcome of anorexia nervosa. METHOD: All new female patients referred to an eating disorders service between Jan. 1, 1981, and Dec. 31, 1984, who had probable or definite anorexia nervosa were eligible for inclusion. Of these women, 86.4% (N = 70) were located and agreed to participate. The comparison group (N = 98) was a random community sample. All subjects were interviewed with a structured diagnostic instrument. RESULTS: A minority of the patients (10%) continued to meet the criteria for anorexia nervosa a mean of 12 years after initial referral. Even among those who no longer met these criteria, relatively low body weight and cognitive features characteristic of anorexia nervosa (perfectionism and cognitive restraint) persisted. The rates of lifetime comorbid major depression, alcohol dependence, and a number of anxiety disorders were very high. CONCLUSIONS: In the managed care/brief treatment era, therapeutic approaches with an excessive focus on weight gain that neglect the detection and treatment of associated psychological features and comorbidity may be inappropriate. Anorexia nervosa is a serious psychiatric disorder with substantial morbidity.

Adolescent↗
PubMed1998

Genetic epidemiology of binging and vomiting.

BACKGROUND: Bulimia nervosa is typically defined as the combination of the behaviours of binging and vomiting. We sought to clarify the relationship of these behaviours from a genetic epidemiological perspective. METHOD: Using data on the lifetime history of binging and vomiting from a personally interviewed population-based sample of female twins (n = 1897), we applied bivariate twin modelling to estimate the sources of variation for these traits. RESULTS: The association between having ever binged (23.6%) and having ever induced vomiting (4.8%) was very strong (odds ratio = 8.78, P << 0.0001). The best-fitting model indicated that lifetime binging and vomiting were both heritable (46% and 72%) and influenced by individual-specific environmental factors (54% and 28%). The overlap between the genetic (ra = 0.74) and individual-specific environmental factors (re = 0.48) for the two traits was substantial. No violations of the equal environmental assumption were evident. CONCLUSIONS: Including binging and vomiting under the rubric of bulimia nervosa appears to be appropriate. Our data are consistent with the identification of binging and vomiting as complex traits resulting from the interplay of multiple genes and individual-specific environmental influences. In contrast to 'environmentalist' theories, our results suggest that genetic influences may be of particular relevance to the aetiology of binging and vomiting.

Adult↗
PubMed1997

The nutrient intake of women with bulimia nervosa.

OBJECTIVE: The objective of this study was to evaluate the meal patterns and nutrient intake of women with bulimia nervosa (BN), and to compare them to clinical variables and recommended dietary allowances (RDA). METHOD: The nutrient intake of 50 women with BN was analyzed from 14 day dietary records. The data were compared to the median intakes of a random sample of women and to the RDA. Clinical variables for the women with BN were also available. RESULTS: Compared to nonbinge episodes per day, binge eating was significantly higher in energy from sucrose, fat, saturated fatty acids (SFA), monounsaturated fatty acids (MUFA) and lower in protein. Compared to the population median, binge eating was significantly lower in percent energy from protein, and higher in percent carbohydrate (CHO), sucrose, SFA, and MUFA, while nonbinge eating was significantly lower in percent energy from fat, SFA, and MUFA. Total intakes were significantly higher in energy and percent energy sucrose compared to the population. Despite significantly lower nonbinge energy intake, calcium, vitamins A and C, iron, and folate were not significantly different to the population median. However, one half or more of the subjects had less than two-thirds the RDA for nonbinge calcium, iron, zinc and for total intake one fourth remained less than two-thirds the RDA for iron and zinc. CONCLUSION: Nonbinge eating was characterized by low energy intake and by low intake of iron, calcium, and zinc. Binge eating, characterized by high sucrose and SFA content, overcompensated for these low energy intakes. Where treatment reduces or eliminates binge eating, it should also encourage consumption of regular meals and in particular, consumption of foods rich in zinc and iron.

Adolescent↗
PubMed1997

The effect of a reduced energy diet and meal patterns on smoking and coffee drinking in women.

OBJECTIVE: We examined the effect of three feeding conditions on cigarette smoking and coffee drinking in four healthy women. We hypothesized that food deprivation and changes in meal patterns would increase rates of smoking and coffee drinking based on extensive animal literature documenting this effect. METHOD: The conditions were: normal three meals per day containing usual energy intake, one meal per day (dinner time) containing 50% of usual energy intake, and three meals per day containing 50% of usual energy intake. Each condition lasted 3 days. RESULTS: Neither reduction of energy intake nor alteration in the pattern of meals had any observable effect on number of cigarettes smoked, number of cups of coffee consumed, expired air carbon monoxide levels, or urges to smoke or drink coffee. DISCUSSION: This study adds to the growing body of literature suggesting that the food deprivation effect observed in animals does not apply readily to humans. Reasons for the absence of this effect are discussed.

Adult↗
PubMed1997

Initial manifestations of disordered eating behavior: dieting versus binging.

OBJECTIVE: We examined the onset of binge eating and dieting in 108 women with bulimia nervosa to determine whether (1) dieting always preceded binge eating; (2) dieting always preceded the onset of bulimia nervosa; and (3) individuals who manifested early initial binge eating differed from those whose earliest manifestation of disordered eating behavior was dieting in terms of lifetime psychopathology and temperament. METHOD: One hundred eight women were assessed at entry to a randomized clinical trial of cognitive-behavioral therapy for bulimia nervosa using structured diagnostic methodology. Retrospective recall of the onset of disordered eating behavior was used to categorize individuals as initial binge eaters or initial dieters. We then compared lifetime psychopathology and temperament across the two groups. RESULTS: Seventeen percent of women reported early binge eating prior to any dieting behavior. The mean age of onset of binging in this group was approximately 10 years. Neither the clinical picture of bulimia nervosa nor lifetime psychopathology differed between initial binge eaters and initial dieters. Individuals with early binge eating endorsed higher novelty seeking and lower harm avoidance. CONCLUSION: In a minority of women with bulimia nervosa, binge eating precedes dieting. These women display markedly higher novelty seeking and lower harm avoidance. Possible links between the dopamine system, novelty seeking, and appetitive behavior are discussed.

Adolescent↗
PubMed1997

Psychiatric disorders in women with bulimia nervosa and their first-degree relatives: effects of comorbid substance dependence.

OBJECTIVE: Women with bulimia nervosa (BN) and comorbid substance dependence often display impulsive behaviors. We assessed Axis I and II psychiatric diagnoses in their first-degree relatives in order to understand the etiological factors that may contribute to this subtype of BN. METHOD: We used contemporary family-epidemiological methodology to compare the lifetime prevalence of psychiatric disorders among 47 women with BN and 44 non-eating-disordered community control women, and their first-degree relatives (177 and 190, respectively). BN probands were stratified by the presence (n = 20) or absence (n = 27) of a lifetime history of alcohol and/or drug dependence. RESULTS: Social phobia, conduct disorder, and clusters B and C personality disorders were significantly more prevalent among BN probands with substance dependence than among BN probands without substance dependence or control women probands. Substance use disorders, social phobia, panic disorder, and cluster B personality disorders were significantly more prevalent among the relatives of BN probands with substance dependence than the relatives of the other two groups. DISCUSSION: Women with BN and substance dependence have problems with social anxiety, antisocial behavior, and a variety of personality disturbances, and come from families where there are problems with substance use disorders, anxiety, impulsivity, and affective instability. These data raise the possibility that a familial vulnerability for impulsivity and affective instability may contribute to the development of substance dependence in a subgroup of women with BN.

Adult↗
PubMed1997

Food cravings in women with a history of anorexia nervosa.

OBJECTIVE: The objective of the present study was to determine the prevalence and characteristics of food cravings in women with a history of anorexia nervosa. METHOD: One hundred one control women selected at random and 64 women with a diagnosis of anorexia nervosa 10 to 14 years earlier (cases) completed the Diagnostic Interview for Genetic Studies, a food craving questionnaire, the Temperament and Character Inventory and the Three-Factor Eating Questionnaire. RESULTS: A similar proportion of cases and controls reported food cravings. A greater proportion of cases reported strong cravings with two or more features of intensity (p = .02). Cravings in the cases were more likely to be characterized by difficulty resisting the craved food (p = .0008), anxiety when the craved food was unavailable (p = .002), and a high frequency of occurrence (p = .001). The cases who craved were significantly more likely to have had lifetime BN (p = .02). CONCLUSION: A similar prevalence of food craving in cases as in controls suggests that successful control of food intake and/or denial of hunger overrides dietary restriction as a precondition for craving in anorexia nervosa. A dysfunction in the serotonergic system, the provision of intermittent reinforcement by binge episodes, and/or frustration due to unsuccessful attempts at dietary restraint may mediate the association of cravings with the presence of lifetime bulimia.

Adolescent↗
PubMed1997

Cognitions of restrained and unrestrained eaters under fasting and nonfasting conditions.

It has recently been suggested that the cognitions of unrestrained eaters and those of individuals with eating disorders are at opposing ends of a continuum, with restrained eaters occupying an intermediate position. The present study explored the everyday cognitions of 10 restrained and 10 unrestrained eaters under fasting and nonfasting conditions using a random thought-sampling technique. Analysis of the thought transcripts yielded a number of categories related to food, self, and others. The results revealed no differences between restrained and unrestrained eaters in terms of their relative percentages of thoughts about food and self. Differences were evident, however, in the nature of their cognitions. The results from this study suggest that the continuum hypothesis may hold only when it is the nature of cognitions, not their frequency, that is considered.

Adolescent↗
PubMed1997

Eating disorders and antecedent anxiety disorders: a controlled study.

We compared the prevalence and age of onset of adult and childhood anxiety disorders relative to the primary diagnosis in 68 women with anorexia nervosa (AN), 116 women with bulimia nervosa (BN), 56 women with major depression with no eating disorder (MD) and 98 randomly selected controls (RC) in order to determine whether antecedent anxiety disorders are plausible risk factors for AN and BN. Comorbid anxiety disorders were common in all three clinical groups (AN, 60%; BN, 57%; MD, 48%). In 90% of AN women, 94% of BN women and 71% of MD women, anxiety disorders preceded the current primary condition (P = 0.01), although panic disorder tended to develop after the onset of AN, BN or MD. In multivariate logistic regressions, the odds ratios (ORs) for overanxious disorder (OR = 13.4) and obsessive-compulsive disorder (OR = 11.8) were significantly elevated for AN. The ORs for overanxious disorder and social phobia were significantly elevated for BN (OROAD = 4.9; ORSP = 15.5) and MD (OROAD = 6.1; ORSP = 6.4). These data suggest that certain anxiety disorders are non-specific risk factors for later affective and eating disorders, and others may represent more specific antecedent risk factors.

Adolescent↗
PubMed1996

Salivary reactivity in women with bulimia nervosa across treatment.

We examined salivary reactivity to a high-risk binge food in women with bulimia before and after cognitive-behavioral treatment. Prior to treatment, there was no change in salivation after presentation of high-risk food cues. After treatment, salivation increased significantly (p = .002) over baseline after presentation of the same foods. Salivary reactivity was negatively correlated with systolic blood pressure, but was unrelated to heart rate, self-report anxiety, or depression. Changes in salivary reactivity may be meaningful clinical index worthy of further investigation in this population.

Adolescent↗