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Biomedical subjects

Pamela K Keel

Publications and source records attributed to Pamela K Keel.

At least 19 recordsLinked to original sources
PubMed2005

Point prevalence of bulimia nervosa in 1982, 1992, and 2002.

Background. Recent epidemiological data suggest a decline in bulimia nervosa (BN) incidence in primary care. We sought to examine BN point prevalence from 1982 to 2002 in a college population.Method. In 1982, 1992, and 2002, 800 women and 400 men were randomly sampled from a university for a study of health and eating patterns. Participation rates were 72% in women and 63% in men, resulting in n=2491 participants.Results. BN point prevalence decreased significantly in women over the period of observation. Eating Disorder Inventory Bulimia scores decreased across cohorts, and these decreases remained significant when male and female and Caucasian and non-Caucasian students were analyzed separately.Conclusion. These data support a decline in BN rates that cannot be attributed to changes in service utilization. Changing socio-cultural factors may explain a true decrease in BN incidence and prevalence.

Adult↗
PubMed2005

Does "excessive" or "compulsive" best describe exercise as a symptom of bulimia nervosa?

OBJECTIVE: The criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; Washington, DC: American Psychiatric Association) for bulimia nervosa include "excessive exercise" as an inappropriate compensatory behavior, suggesting that it is the quantity of the physical activity that is symptomatic, rather than its quality. The current study evaluated the hypothesis that psychological commitment to exercise (compulsive quality) will be more predictive of disordered eating attitudes and behaviors than the amount of time devoted to exercise (excessive quantity). METHOD: Female (n = 162) and male (n = 103) undergraduates completed the Eating Disorder Inventory (EDI) subscales, the Obligatory Exercise Questionnaire (OEQ), and questions to assess the duration and frequency of exercise. RESULTS: Using multivariate analysis, the OEQ score was a positive predictor of disordered eating attitudes and behaviors, and exercise time was a negative predictor. DISCUSSION: "Compulsive" may be a better description than "excessive" in characterizing exercise as a symptom of bulimia nervosa.

Adolescent↗
PubMed2005

Shared transmission of eating disorders and anxiety disorders.

OBJECTIVE: Eating disorders have high comorbidity with mood, anxiety, and substance use disorders. Using twins from the population-based Minnesota Twin Family Study (MTFS), we examined comorbidity and shared transmission between eating pathology and these disorders. METHOD: Female twins (N = 672), ages 16-18 years, completed structured clinical interviews assessing anorexia nervosa and bulimia nervosa (as described in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV; American Psychiatric Association, 1994]), as well as mood, anxiety, and substance use disorders (as described in the 3rd Rev. ed. of the Diagnostic and Statistical Manual of Mental Disorders [DSM-III-R]). Shared transmission was examined using a discordant monozygotic (MZ) twin design. RESULTS: Significant comorbidity was found between eating disorders and major depression, anxiety disorders, and nicotine dependence. Within MZ twin pairs discordant for eating disorders (n = 14), non-eating-disordered cotwins demonstrated increased risk for anxiety disorders compared with controls. Similarly, within MZ twin pairs discordant for anxiety disorders (n = 52), non-anxiety-disordered cotwins demonstrated increased risk for eating disorders compared with controls. DISCUSSION: Findings support shared transmission between eating disorders and anxiety disorders. However, the nature of this shared diathesis remains unknown.

Adolescent↗
PubMed2005

How do eating disorders and alcohol use disorder influence each other?

OBJECTIVE: Although eating disorders and alcohol use disorder (AUD) are known to co-occur, the influence of one on the other has not been studied. METHOD: In a prospective study, women diagnosed with either anorexia nervosa (AN; n = 136) or bulimia nervosa (BN; n = 110) were interviewed and assessed for Research Diagnostic Criteria (RDC) AUD every 6-12 months over 8.6 years. RESULTS: Over one fourth of the sample (n = 66 [27%]) reported a lifetime history of AUD. Ten percent of the study subjects (n = 24) developed AUD over the course of the study. AUD did not influence recovery from either eating disorder. Poor psychosocial functioning and history of substance use predicted prospective onset of an episode of AUD for both diagnostic groups. Unique predictors for AUD for women with AN were depression, overconcern with body image, and vomiting. Recovery from AUD was predicted by group therapy and hospitalization (women with AN) and individual therapy and exercise (women with BN). CONCLUSION: The influence of eating disorders on AUD appears to be greater than the reverse. A substantial number of patients who initially present with an eating disorder develop alcohol problems over the course of time, suggesting that the risk is an ongoing one that should be monitored by clinicians.

Adult↗
PubMed2005

Purging disorder: an ominous variant of bulimia nervosa?

OBJECTIVE: The current study evaluates the clinical significance and distinctiveness of purging disorder (PD), an eating disorder characterized by recurrent purging in the absence of objective binge episodes (OBE) among normal-weight individuals. METHOD: Women with PD (n = 37), bulimia nervosa (BN; n = 39), or no eating disorder (n = 35) completed clinical assessments. Women with PD (n = 23) and BN (n = 25) completed 6-month follow-up assessments. RESULTS: Compared with controls, both eating-disordered groups reported significantly higher eating, Axis I, and Axis II pathology. Compared with BN, PD was associated with significantly lower eating concerns, disinhibition, and hunger. At 6-month follow-up, rates of remission did not differ significantly between PD and BN, and crossover between disorders was rare. CONCLUSION: PD appears to be a clinically significant and potentially distinctive eating disorder.

Adolescent↗
PubMed2005

Disordered eating attitudes and behaviors in ballet students: examination of environmental and individual risk factors.

OBJECTIVE: The current study compared the prevalence of disordered eating attitudes and behaviors among adolescent ballet dancers at national, regional, and local schools. METHOD: Female ballet students (N = 239; mean age = 15.0 +/- 1.5 years) from five geographically disparate summer programs completed the Eating Dis-order Inventory (EDI) and answered questions regarding eating disorder symptoms. RESULTS: Students from both national and local schools reported significantly higher EDI total, Drive for Thinness, and Perfectionism scores compared with regional students. In contrast, national students reported significantly greater dieting scores and lifetime histories of self-induced vomiting compared with regional and local students. CONCLUSION: Eating pathology among adolescent ballet dancers may be a function of both genetic and environmental risk. Dancers who exhibit high levels of perfectionism and, perhaps consequently, place themselves in highly competitive environments, may exhibit a significantly increased risk for disordered eating in comparison to dancers who are less perfectionistic and/or place themselves in less competitive environments.

Adolescent↗
PubMed2004

Application of a latent class analysis to empirically define eating disorder phenotypes.

CONTEXT: Diagnostic criteria for eating disorders influence how we recognize, research, and treat eating disorders, and empirically valid phenotypes are required for revealing their genetic bases. OBJECTIVE: To empirically define eating disorder phenotypes. DESIGN: Data regarding eating disorder symptoms and features from 1179 individuals with clinically significant eating disorders were submitted to a latent class analysis. The resulting latent classes were compared on non-eating disorder variables in a series of validation analyses. SETTING: Multinational, collaborative study with cases ascertained through diverse clinical settings (inpatient, outpatient, and community). PARTICIPANTS: Members of affected relative pairs recruited for participation in genetic studies of eating disorders in which probands met DSM-IV-TR criteria for anorexia nervosa (AN) or bulimia nervosa and had at least 1 biological relative with a clinically significant eating disorder. Main Outcome Measure Number and clinical characterization of latent classes. RESULTS: A 4-class solution provided the best fit. Latent class 1 (LC1) resembled restricting AN; LC2, AN and bulimia nervosa with the use of multiple methods of purging; LC3, restricting AN without obsessive-compulsive features; and LC4, bulimia nervosa with self-induced vomiting as the sole form of purging. Biological relatives were significantly likely to belong to the same latent class. Across validation analyses, LC2 demonstrated the highest levels of psychological disturbance, and LC3 demonstrated the lowest. CONCLUSIONS: The presence of obsessive-compulsive features differentiates among individuals with restricting AN. Similarly, the combination of low weight and multiple methods of purging distinguishes among individuals with binge eating and purging behaviors. These results support some of the distinctions drawn within the DSM-IV-TR among eating disorder subtypes, while introducing new features to define phenotypes.

Adolescent↗
PubMed2004

Bulimia symptoms and other risk behaviors during pregnancy in women with bulimia nervosa.

OBJECTIVE: The current study examined the change in bulimic symptoms as well as alcohol, drug, and tobacco use during pregnancy in subjects with bulimia nervosa. METHOD: A self-report questionnaire was used to collect retrospective data on eating disorder symptoms and substance use during pregnancy from 129 participants in a long-term study of bulimia nervosa. Follow-up data were collected for a total of 322 pregnancies occurring over a 10-15-year period. RESULTS: Overall, subjects reported that body dissatisfaction worsened, but binge eating and purging improved during pregnancy. However, the number of women completely abstinent from bulimic symptoms did not change significantly with pregnancy. Body esteem often worsened with pregnancy, particularly for women with active bulimia symptoms. Self-reported alcohol use significantly declined with pregnancy. DISCUSSION: In general, bulimia nervosa symptoms decreased during pregnancy, although the number of women completely abstinent did not change significantly.

Adult↗
PubMed2004

Personality characteristics of women before and after recovery from an eating disorder.

BACKGROUND: Previous studies of personality characteristics in women with eating disorders primarily have focused on women who are acutely ill. This study compares personality characteristics among women who are ill with eating disorders, recovered from eating disorders, and those without eating or other Axis I disorder pathology. METHOD: Female participants were assessed for personality characteristics using the Temperament and Character Inventory (TCI): 122 with anorexia nervosa (AN; 77 ill, 45 recovered), 279 with bulimia nervosa (BN; 194 ill, 85 recovered), 267 with lifetime histories of both anorexia and bulimia nervosa (AN + BN; 194 ill, 73 recovered), 63 with eating disorder not otherwise specified (EDNOS; 31 ill, 32 recovered), and 507 without eating or Axis I disorder pathology. RESULTS: Women ill with all types of eating disorders exhibited several TCI score differences from control women, particularly in the areas of novelty-seeking, harm avoidance, self-directedness, and cooperativeness. Interestingly, women recovered from eating disorders reported higher levels of harm avoidance and lower self-directedness and cooperativeness scores than did normal control women. CONCLUSIONS: Women with eating disorders in both the ill and recovered state show higher levels of harm avoidance and lower self-directedness and cooperativeness scores than normal control women. Although findings suggest that disturbances may be trait-related and contribute to the disorders' pathogenesis, additional research with more representative community controls, rather than our pre-screened, normal controls, is needed to confirm these impressions.

Adult↗
PubMed2004

Alcohol use disorder comorbidity in eating disorders: a multicenter study.

BACKGROUND: Eating disorders and alcohol use disorders (AUDs) commonly co-occur, although the patterns of comorbidity differ by eating disorder subtype. Our aim was to explore the nature of the co-morbid relation between AUDs and eating disorders in a large and phenotypically well-characterized group of individuals. METHOD: We compared diagnostic and personality profiles of 97 women with lifetime anorexia nervosa only, 282 women with lifetime bulimia nervosa only, and 293 women with a lifetime history of both anorexia nervosa and bulimia nervosa or anorexia nervosa with binge eating (ANBN) (DSM-IV criteria). All individuals were participants in a multicenter study of the genetics of anorexia nervosa and bulimia nervosa. We explored pattern of onset, Axis I and II comorbidity, and personality characteristics of individuals with and without AUDs by eating disorder subtype. Personality characteristics were assessed with the Multidimensional Perfectionism Scale, the Temperament and Character Inventory, and the Barratt Impulsivity Scale. RESULTS: Alcohol use disorders were significantly more prevalent in women with ANBN and bulimia nervosa than in women with anorexia nervosa (p =.0001). The majority of individuals reported primary onset of the eating disorder, with only one third reporting the onset of the AUD first. After eating disorder subtype was controlled for, AUDs were associated with the presence of major depressive disorder, a range of anxiety disorders, and cluster B personality disorder symptoms. In addition, individuals with AUDs presented with personality profiles marked by impulsivity and perfectionism. CONCLUSIONS: Individuals with eating disorders and AUDs exhibit phenotypic profiles characterized by both anxious, perfectionistic traits and impulsive, dramatic dispositions. These traits mirror the pattern of control and dyscontrol seen in individuals with this comorbid profile and suggest that anxiety modulation may be related to alcohol use in this group.

Age of Onset↗
PubMed2003

Predictors of mortality in eating disorders.

BACKGROUND: Anorexia nervosa, but not bulimia nervosa, has one of the highest mortality rates among psychiatric disorders. However, potential predictors of mortality, such as comorbid psychiatric illnesses, remain unclear. We sought to determine mortality ratios and predictors of fatal outcome in women diagnosed as having anorexia or bulimia nervosa. METHODS: Women (N = 246) diagnosed as having either DSM-IV anorexia nervosa (n = 136) or bulimia nervosa (n = 110) between January 1, 1987, and December 31, 1991, participated in a prospective longitudinal study. Vital status was determined by ongoing contact and a National Death Index search as of December 1998 (overall ascertainment, 99.8%) and telephone contact as of October 2000 (ascertainment, 95.0%). RESULTS: Eleven women died. Standardized mortality ratios were elevated for all causes of mortality (11.6; 95% confidence interval, 5.5-21.3) and suicide (56.9; 95% confidence interval, 15.3-145.7) in anorexia nervosa but not for death (1.3; 95% confidence interval, 0.0-7.2) in bulimia nervosa. Predictors of mortality in anorexia nervosa included severity of alcohol use disorder during follow-up (P<.001). Hospitalization for an affective disorder before baseline assessment seemed to protect women from a fatal outcome (P<.001). CONCLUSIONS: Physicians treating patients with anorexia nervosa should carefully assess patterns of alcohol use during the course of care because one third of women who had alcoholism and died had no history of alcohol use disorder at intake.

Alcoholism↗
PubMed2003

Gender differences in implicit weight identity.

OBJECTIVE: This study examined gender differences in explicit and implicit attitudes toward overweight and explicit and implicit weight identity. METHOD: Normal weight women (n=22) and men (n=20) and overweight women (n=20) and men (n=21) completed the Implicit Association Test and portions of the Eating Disorders Questionnaire. RESULTS: Although explicit and implicit anti-fat attitudes were ubiquitous, gender differences emerged for weight identity. Both men and women provided accurate explicit appraisals of their weight status. However, men implicitly identified themselves as light regardless of actual weight status. Women's implicit weight identity was associated with their actual weight status, explicit weight appraisal, and implicit self-esteem. DISCUSSION: These findings may provide additional insight into why men are underrepresented among those seeking weight loss and why women are at increased risk for developing eating disorders.

Adult↗
PubMed2003

The influence of puberty and ethnicity on awareness and internalization of the thin ideal.

OBJECTIVE: This study examined the effects of puberty and ethnicity on awareness and internalization of the thin ideal. METHOD: Fourth and fifth-grade girls (N = 67) and their parents (N = 67) completed questionnaires assessing demographic variables, eating pathology, pubertal development, and awareness and internalization of the thin ideal. RESULTS: Girls in pre/early puberty did not differ significantly from girls in mid/late puberty on awareness of the thin ideal; however, more developed girls had significantly greater internalization of the thin ideal. Caucasian and non-Caucasian girls also did not differ on awareness of the thin ideal, but non-Caucasian girls reported greater internalization. No significant interactions between race and puberty existed on the dependent variables. DISCUSSION: Factors specifically related to puberty seem to be key to girls' development of disordered eating attitudes. The effect of puberty on increased internalization of the thin ideal cannot be explained by increased age or awareness of the thin ideal.

Adolescent↗
PubMed2003

Requiring remission of undue influence of weight and shape on self-evaluation in the definition of recovery for bulimia nervosa.

OBJECTIVE: The current study evaluated the concurrent validity of requiring remission of undue influence of weight and shape on self-evaluation (undue influence) in defining recovery from bulimia nervosa (BN). METHODS: Three groups completed the Beck Depression Inventory, the Mood and Anxiety Symptom Questionnaire, the Body Shape Questionnaire, and the Social Adjustment Scale: 31 women were fully recovered from BN (FR), 28 women had no behavioral symptoms of BN (partially recovered [PR]), and 59 matched non-eating-disordered controls (MC). RESULTS: The PR group had more pathologic scores on depression, anxiety, body dissatisfaction, and social adjustment compared with both the FR and MC groups, which did not differ from each other. DISCUSSION: These findings suggest that including remission of cognitive symptoms in a standardized definition of recovery may prove to be clinically useful in establishing reliable prognostic indicators. Future research should evaluate the role played by cognitive symptoms in triggering relapse.

Adolescent↗
PubMed2003

Influence of sexual orientation and age on disordered eating attitudes and behaviors in women.

OBJECTIVE: We evaluated the influence of age on the association between sexual orientation and disordered eating attitudes and behaviors in women. METHOD: Heterosexual (n=47) and homosexual (n=45) women recruited from the community completed self-report questionnaires including the Body Esteem Scale, the Eating Disorders Inventory-2, the Reasons for Exercise Inventory, and the Self Esteem Scale. RESULTS: A multivariate analysis of variance of eating disorder variables revealed a main effect for sexual orientation on drive for thinness and exercise to control weight and a main effect for age on body mass index (BMI) and body dissatisfaction, but it did not reveal a significant interaction between sexual orientation and age. DISCUSSION: Sexual orientation may influence certain types of disordered eating attitudes and behaviors in women such as endorsing an extreme ideal of thinness. However, homosexual and heterosexual women reported more similarities than differences.

Adult↗
PubMed2003

Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology.

The authors explore the extent to which eating disorders, specifically anorexia nervosa (AN) and bulimia nervosa (BN), represent culture-bound syndromes and discuss implications for conceptualizing the role genes play in their etiology. The examination is divided into 3 sections: a quantitative meta-analysis of changes in incidence rates since the formal recognition of AN and BN, a qualitative summary of historical evidence of eating disorders before their formal recognition, and an evaluation of the presence of these disorders in non-Western cultures. Findings suggest that BN is a culture-bound syndrome and AN is not. Thus, heritability estimates for BN may show greater variability cross-culturally than heritability estimates for AN, and the genetic bases of these disorders may be associated with differential pathoplasticity.

Culture↗
PubMed2002

Longitudinal comparison of anorexia nervosa subtypes.

OBJECTIVE: To compare patients with restricting anorexia nervosa (ANR) and binge/purge anorexia nervosa (ANBP) on measures of impulsivity, course, and outcome. METHODS: One hundred thirty-six treatment-seeking women with AN followed prospectively for 8-12 years were reclassified at intake as 51 ANRs and 85 ANBPs according to the DSM-IV subtyping classification. Lifetime Axis I and Axis II disorders were assessed using structured interviews; follow-up interviews were conducted at 6-12-month intervals to collect weekly data on eating disorder symptomatology. RESULTS: Women with ANR and ANBP did not differ on history of substance abuse, kleptomania, suicidality, or borderline personality diagnosis at intake, or on rates of recovery, relapse, or mortality. By 8 years of follow-up, 62% of women with ANR crossed over to ANBP prospectively and only 12% of women with AN never reported regular binge/purge behaviors. CONCLUSIONS: The findings on impulsivity, course, and outcome do not support the current subtyping system. The high crossover rate in our sample from ANR to ANBP suggests that ANR represents a phase in the course of AN rather than a distinct subtype.

Anorexia Nervosa↗