Pain thresholds in obese binge-eating disorder subjects.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
J E Mitchell
Publications and source records attributed to J E Mitchell.
Alexithymia, obesity, and binge eating disorder.
Eighty-three obese subjects with binge eating disorder (BED) were compared with 99 obese subjects not meeting criteria for BED on the Toronto Alexithymia Scale (TAS). Overall, the subjects in our sample were not significantly alexithymic, the mean global TAS score being 62.8 (SD = 10.2) which is comparable with the values found in non-patient control samples. Furthermore, the mean TAS scores did not differ between obese subjects with and without BED. However, we found a slightly higher prevalence of alexithymia (TAS total score 74 and above) in BED subjects compared with non-BED subjects (24.1% and 11.1%, respectively). A series of stepwise multiple regression analyses were run, exhibiting a significant relationship between the TAS and educational level and the Eating Disorder Inventory (EDI) subscales Interpersonal Distrust and Ineffectiveness. Age, body mass index, measures of depression, and eating pathology did not predict TAS scores.
Adult↗
Refeeding, metabolic rate, and weight gain in anorexia nervosa: a review.
Patients with anorexia nervosa require refeeding to restore normal body weight. A variety of studies have examined the role of metabolic rate in the refeeding of anorectic patients. Several measurement techniques have been used to divide metabolic rate into its components: basal metabolic rate, resting energy expenditure, activity-induced thermogenesis, and dietary-induced thermogenesis. In anorexia nervosa patients several consistent findings are present. First, the number of kilocalories required for weight gain or weight maintenance increases as weight increases. Second, over 50% of the body mass gained in anorectic individuals represents fat tissue. Finally, both a history of bulimic symptoms and a higher premorbid body weight may lead to lower calorie requirements. These findings suggest the need for gradual increase in calories provided throughout treatment; resting energy expenditures may aid the determination of caloric requirements
Adipose Tissue↗
Onset of binge eating, dieting, obesity, and mood disorders among subjects seeking treatment for binge eating disorder.
Binge eating disorder (BED) identified in adulthood is often clinically associated with obesity and a lifetime history of affective disorders. Several authors have suggested that dieting may predispose individuals to binge eating which then may lead to obesity. However, few BED studies have examined the chronology of the onset of binge eating, dieting, obesity, and mood disorders. This study evaluated retrospective reports from 30 women participating in a BED treatment study. Although the majority of subjects in this adult sample were obese, initiation of binge eating behavior usually occurred during adolescence at a time when most subjects reported being of normal weight. Obesity developed several years after the age of onset of meeting BED criteria. Onset of binge eating usually predated that of dieting or major depressive disorder in the majority of subjects. The results support the importance of early intervention for binge eating.
Adolescent↗
An age-matched comparison of subjects with binge eating disorder and bulimia nervosa.
The purpose of this study was to compare data from a group of obese subjects with binge eating disorder (BED) with data from a group of normal weight bulimia nervosa (BN) subjects. Subjects were compared using the Eating Disorder Questionnaire (EDQ), the Eating Disorder Inventory (EDI), the Personality Disorders Questionnaire for DSM-III-R (PDQ-R), the Hamilton Anxiety and Depression Rating Scales, and the Beck Depression Inventory. A group of 35 age-matched subjects were selected retrospectively from treatment study subjects. The EDQ findings indicated that members of the BN group desired a lower body mass index, were more afraid of becoming fat, and more uncomfortable with their binge eating behavior than the BED group members. The BED subjects had a younger age of onset of binge eating behavior (14.3) than the BN subjects (19.8), even though both groups started dieting at a similar age (BED = 15.0, BN = 16.2). The EDI results showed BN subjects had more eating and weight-related pathology, with significantly higher scores on five of the eight subscales. On the PDQ-R more BN subjects endorsed Axis II impairment (BN = 69%, BED = 40%). While demonstrating greater eating pathology in the BN group, this study also found significant pathology and distress in BED subjects.
Adolescent↗
Identification of cues associated with compulsive, bulimic, and hair-pulling symptoms.
Subjects with obsessive compulsive disorder, bulimia nervosa, or trichotillomania selected cues which elicited or worsened their symptoms from a 339 item list. Principal components analysis suggested a four-component solution. Each disorder was significantly associated with one of these components. Diagnostic assignment based on component scores yielded 85% correct classification. The diagnostic groups did not differ on a negative feeling state component. The results indicate that both disorder-specific and generic components exist. This approach has potential for defining clinical subtypes, studying the interaction of feeling states and environmental cues in evoking symptoms, and designing treatment strategies.
Adolescent↗
Life after medical practice. A retirement profile of Minnesota physicians.
This study investigates the current dynamics of physician retirement in Minnesota. A survey of all retired Minnesota physicians (878, with 65.7% response rate) revealed that 73% retired in their 60s, 22% at age 65. Good health was reported by 69% of the respondents, and fair health by 26%. Income was sufficient in most cases; 64% of respondents reported living comfortably, and only 14% said their incomes are barely adequate. The study also showed that retired physicians consider nonmedical activities much more important than medical activities; heading the list were visiting family (86%), reading (79%), and travel (63%). Finally, 35% of respondents found retirement to be better than they had expected, 54% found it about as expected, and only 9% felt retirement was not as good as expected. In retirement, Minnesota physicians are generally healthy, have sufficient funds to live comfortably, and generally spend their time doing nonmedical activities.
Age Factors↗
Electrocardiographic findings associated with very low calorie dieting.
OBJECTIVE: To determine the safety of very low calorie diets (VLCD) in regard to their effects on cardiac function. DESIGN: EKG changes were analyzed for 126 women on a VLCD of 3349 kJ/d (800 kcal/d). EKGs were done when the diet was begun, after 3 months of dieting, and at a 6 month follow up after being off the diet for 3 months. SETTING: Subjects were solicited through advertisements and charged $1,000 for participating after being screened for age, weight, and health status. MAIN OUTCOME MEASURES: EKG QTc intervals, PR interval, QRS interval, ST-T wave changes, and heart rate. RESULTS: Over one-fourth (27.0%) of subjects had normal EKGs at all three time points studied. Sinus bradycardia was the most common abnormality, observed in 60 subjects (47.6%) on at least one of the three EKGs. Fifty-eight (46%) patients had EKGs with ST-T wave abnormalities observed on at least one of the EKGs. Eight subjects (6.4%) had prolonged QTc (more than one standard deviation beyond the average for women) intervals on at least one EKG. None of these eight persons had significant untoward medical consequences. CONCLUSION: A VLCD diet of 3349 kJ/d (800 kcal/d) for up to 3 months is not associated with significant electrocardiographic abnormalities or clinical cardiac complications, provided the patients have low cardiovascular risk at baseline.
Adult↗
Pain thresholds are not elevated in trichotillomania.
Explore the source record for details and available documents.
Adult↗
Eating related and general psychopathology in obese females with binge eating disorder.
One hundred obese women with a mean age of 39.2 years, and a mean body mass index (BMI) of 35.9 kg/m2 were evaluated before entering a treatment study for weight reduction. According to the results of a structured interview, subjects were divided into four groups: (1) no overeating episodes, (2) episodic overeating episodes without the feeling of loss of control, (3) overeating plus the sense of loss of control (binge eating), and (4) full diagnostic criteria for binge eating disorder (BED). One-way analyses of variance (ANOVAs) revealed significant positive associations between binge eating and eating/weight-related characteristics such as a history of frequent weight fluctuations, the amount of time spent dieting, drive for thinness, and a tendency for disinhibition of eating. Furthermore, subjects exhibited more feelings of ineffectiveness, stronger perfectionistic attitudes, more impulsivity, less self-esteem, and less interoceptive awareness the more problems with binge eating they reported. The results support the idea that binge eaters might be a distinct subgroup among the obese population, and corroborate the utility of a diagnosis of BED in identifying the most disturbed obese subjects with regard to the variables tested.
Adult↗
Rational therapy of eating disorders.
Pharmacological treatments are one of several strategies used in the treatment of anorexia nervosa and bulimia nervosa. Many studies have found that antidepressants are effective in the treatment of bulimia nervosa and these drugs represent a mainstay of treatment for these patients. Over the past several years, selective serotonin reuptake inhibitors have become perhaps the most commonly used class of drugs. A variety of medications have been investigated for anorexia nervosa, but there is little consistent evidence that medications are effective. In both these illnesses it is important to diagnose and treat any comorbid conditions including mood and anxiety disorders; this may involve the administration of other medications, including anxiolytics such as benzodiazepines or buspirone or mood stabilising agents such as lithium, valproic acid (valproate sodium) or carbamazepine.
Anorexia Nervosa↗
Survival analysis of response to group psychotherapy in bulimia nervosa.
A reanalysis of treatment response and relapse was performed using survival analysis in a 12-week clinical trial of cognitive behavioral group psychotherapy for the treatment of bulimia nervosa. One hundred forty-three (143) bulimic women with high incidence of binge eating, self-induced vomiting, and/or laxative abuse were randomly assigned to one of four possible treatment conditions that consisted of a combination of two factors: (1) emphasis on abstinence (high and low), and (2) treatment intensity (high and low). "Initial" and "maintained" response to treatment based on "total" and "near" abstinence criteria were determined using self-reported binge eating, vomiting, and laxative use data. Results suggest that an emphasis on abstinence appears important in achieving initial abstinence, whereas intensity of treatment may be important in maintaining abstinence.
Adolescent↗
A review of the controlled trials of pharmacotherapy and psychotherapy in the treatment of bulimia nervosa.
The treatment literature on bulimia nervosa includes several double-blind placebo controlled studies, the majority of which examine the use of antidepressants in bulimia nervosa. The psychotherapy literature has focused heavily on the use of cognitive behavioral therapy (CBT) in the treatment of this eating disorder. Some studies have compared CBT to other types of therapy or waiting list controls. The following review will examine the methodology and outcome of the pharmacotherapy and psychotherapy treatment studies of bulimia nervosa. The authors conclude that while the studies indicate treatment is somewhat effective, there remains uncertainty regarding the long-term effectiveness of most of the reported treatments.
Antidepressive Agents↗
Cognitive-behavioral group psychotherapy of bulimia nervosa: importance of logistical variables.
Although much of the psychotherapy for psychiatric disorders is conducted on a weekly basis, several researchers in the field of bulimia nervosa have utilized a more intensive approach as a means to strengthen treatment effects. A second issue concerns the amount of emphasis that should be placed on encouraging the interruption of bulimic symptoms early in treatment. In the current study we systematically studied these two issues. Subjects were randomly assigned to one of four forms of cognitive-behavioral group psychotherapy, the four cells differing on the variables of intensity and emphasis on abstinence. The results indicate that a high intensity approach, an early abstinence approach, or a combination of these two approaches are all significantly more effective in inducing remission in patients with bulimia nervosa compared with a weekly psychotherapy that uses the same manual-based cognitive-behavioral therapy approach.
Adolescent↗
Diagnosing binge eating disorder: level of agreement between self-report and expert-rating.
We assessed the correlation between a self-report questionnaire and an expert-rating including an initial interview and a longitudinal evaluation on the diagnosis of binge eating disorder (BED) in a sample of 100 obese women participating in a treatment program for weight reduction. The level of diagnostic agreement between patient-rating and expert-rating with regard to the presence or absence of BED was modest, with a kappa value of .57. According to Shrout, Spitzer, and Fleiss (Archives of General Psychiatry, 44, 172-177, 1987) this represents fair to good agreement beyond chance. The self-report instrument did not produce higher estimates of the frequency of BED in this selected sample of treatment seekers than the expert-rating, as observed in studies on the epidemiology of bulimia nervosa in community samples. The questionnaire identified 40 cases of BED, the expert-rating 43 cases. The results indicate that the disagreement between self-report and interview was mainly due to discordances in three of the diagnostic criteria of BED--namely loss of control, marked distress regarding binge eating, and the frequency requirement of two binge eating episodes per week for a 6-month period. Inconsistencies between subjects and clinicians with regard to the definition of an overeating episode and with regard to the behavioral indicators of loss of control did not lead to differences between self-report and observer-rating in the final diagnosis of BED.
Adult↗
Antidepressants vs. psychotherapy in the treatment of bulimia nervosa.
Studies of the effectiveness of psychotherapy and pharmacotherapy in the treatment of bulimia nervosa have been accumulating over the last decade. Only recently, however, have investigations been reported comparing the two modalities directly, assessing whether one might be more effective than the other, or whether a combination of the two approaches might be superior to either alone. This paper reviews the three combined treatment studies that have been published to date and discusses their implications for clinical practice and for future research.
Antidepressive Agents↗
Nociceptive, but not tactile, thresholds are elevated in bulimia nervosa.
Explore the source record for details and available documents.
Adult↗
Binge eating in the obese.
This review will first describe problems in the definition of the term binge eating, especially in the absence of purging (vomiting, laxative abuse). We highlight current approaches in the classification of obesity, and then provide an overview of the available literature on differences between obese binge eaters and obese non-binge eaters. Many studies indicate that binge eating is common among the female obese, with a frequency ranging from 23 to 46% among those seeking treatment for weight reduction. Despite differences in the definitions of binge eating and variability among the samples investigated, there is strong evidence that binge eaters represent a distinct subgroup among the obese. Binge eating obese exhibit significantly more eating and weight-related pathology, as well as more psychopathology compared to their non-binge eating obese counterparts.
Age Factors↗