Biomedical subjects

S R Sunday

Publications and source records attributed to S R Sunday.

At least 19 recordsLinked to original sources

PubMed2001

Changing patterns of hospitalization in eating disorder patients.

OBJECTIVE: This study investigated the changing patterns of hospitalization of eating disorder patients over the past 15 years. METHOD: The records of 1,185 eating disorder patients between 1984 and 1998 were examined on several variables. RESULTS: Over the 15 years, the number of first admissions increased from 20 to 182. There was a concomitant decrease in length of stay from 149.5 days in 1984 to 23.7 days in 1998. Readmissions increased markedly from 0% during the first year to 27% of total admissions in 1998. The discharge weight of anorectic patients significantly decreased from a body mass index (BMI) of 19.3 in 1984 to 17.7 in 1998. These changes were particularly salient in the past 3 years, concurrent with a dramatic rise in managed care cases. CONCLUSIONS: Over the past 15 years, eating disorder hospital treatment has metamorphozed from long-term treatment of a disorder to stabilization of acute episodes. For some patients, this change has been deleterious and not cost effective.

Adolescent↗

PubMed2001

Neurocognitive evidence favors "top down" over "bottom up" mechanisms in the pathogenesis of body size distortions in anorexia nervosa.

Perceptually-based disturbances in body image, or body size distortions, have been posited to occur in anorexia nervosa (AN). Perception does not result from a simple flow of sensory information from periphery to cortex ("bottom-up" processing), but involves the selection of inputs most likely to be relevant in light of an individual's experience and expectations ("top-down" processing). Most investigations of body size distortion in AN have used procedures likely to engage top-down processing, raising the possibility that attitudinal disturbances may play a role. To our knowledge, there have been no studies that assess the presence, in AN, of neurocognitive deficits associated with neurologically based disturbances in body schema. Such deficits, if found, could provide evidence of body image distortion unlikely to result from top-down processing. We tested 20 inpatients with AN on measures of proprioception, finger identification, right/left orientation, general cognition and eating disorders symptomatology, both before and after treatment. Matched normal controls were tested on the same measures over the same time intervals. Significant differences between the two groups occurred only prior to treatment, and only on those measures which involved executive, in addition to more body-schema-specific functions. This suggests that patients with AN do not have enduring deficits in the domain of body-schema, but may have subtle cognitive dysfunction, in the acute state, which is not specific to, but can interact with processing of body-schema-related information. This, in turn, suggests that their body image distortion may not be secondary to bottom-up perceptual disturbances.

Adolescent↗

PubMed2000

Comparison of the yale-brown-cornell eating disorders scale in recovered eating disorder patients, restrained dieters, and nondieting controls.

OBJECTIVE: Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) scores were assessed in recovered eating disorder patients, restrained dieters, and unrestrained nondieters. METHOD: YBC-EDS interviews were conducted with 53 recovered eating disorder patients who had no symptoms within at least 6 months, 29 restrained dieters, and 36 unrestrained controls. RESULTS: Unrestrained control subjects had no typical eating-disordered preoccupations or rituals. The majority (62%) of restrained dieters did have current eating-disordered preoccupations but only 5 had current eating-disordered rituals. Most recovered eating disorder subjects had no current eating-disordered preoccupations (66%) and 76% had no current eating-disordered rituals. Unrestrained eating controls had significantly lower Preoccupation, Total, and Motivation to Change scores on the YBC-EDS than the other groups and significantly lower Ritual scores than the recovered eating disorder group. There were no significant differences between the restrained dieters and the recovered eating disorder group. DISCUSSION: Recovered eating disorder patients who no longer meet any of the DSM-IV criteria for an eating disorder are similar in severity of eating concern to normal weight restrained eating dieters. Both of these groups have more eating and weight concerns as compared with the unrestrained eating, nondieting controls. The YBC-EDS effectively distinguishes the healthy eating controls from restrained eating dieters and recovered eating disorder patients.

Adult↗

PubMed2000

Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior.

OBJECTIVE: The purpose of this study was to examine the role of perfectionism as a phenotypic trait in anorexia nervosa and its relevance across clinical subtypes of this illness. METHOD: The Multidimensional Perfectionism Scale and the perfectionism subscale of the Eating Disorder Inventory were administered to 322 women with a history of anorexia nervosa who were participating in an international, multicenter genetic study of anorexia nervosa. All participants were additionally interviewed with the Yale-Brown Obsessive Compulsive Scale and the Yale-Brown-Cornell Eating Disorder Scale. Mean differences on dependent measures among women with anorexia nervosa and comparison subjects were examined by using generalized estimating equations. RESULTS: Persons who had had anorexia nervosa had significantly higher total scores on the Multidimensional Perfectionism Scale than did the healthy comparison subjects. In addition, scores of the anorexia subjects on the Eating Disorder Inventory-2 perfectionism subscale exceeded Eating Disorder Inventory-2 normative data. For the anorexia nervosa participants, the total score on the Multidimensional Perfectionism Scale and the Eating Disorder Inventory-2 perfectionism subscale score were highly correlated. Total score on the Multidimensional Perfectionism Scale was also significantly related to the total score and the motivation-for-change subscale score of the Yale-Brown-Cornell Eating Disorder Scale. CONCLUSIONS: These data show that perfectionism is a robust, discriminating characteristic of anorexia nervosa. Perfectionism is likely to be one of a cluster of phenotypic trait variables associated with a genetic diathesis for anorexia nervosa.

Adolescent↗

PubMed1999

More males seek treatment for eating disorders.

OBJECTIVE: This study compares males and females with DSM-IV-defined eating disorders who were admitted to the inpatient eating disorders service at The New York Hospital, Cornell between 1984 and 1987. METHODS: During this period, 51 males and 693 females presented for their first admission. Demographic information, questionnaires, and SCID interviews were used to compare the male and female samples. RESULTS: Males were significantly more likely than females to have a later onset of their eating disorder (20.56 vs. 17.15 years), and to be involved in an occupation or sport in which weight control influences performance. There were no significant gender differences in other characteristics or comorbid diagnoses. Males constituted an increasing percentage of total admissions between 1984 and 1997 (r = .692, p = .009). DISCUSSION: The similarities of core eating disorder psychopathology and comorbid illness in male and female patients encourage the continued use of similar detection and treatment strategies with both groups.

Adolescent↗

PubMed1998

The relationship between alexithymia, depression, and axis II psychopathology in eating disorder inpatients.

OBJECTIVE: The major purpose of this study was to examine alexithymia in relationship to depression and Axis II psychopathology in eating disorder patients. METHOD: Fifty-three female inpatients representing three DSM-IV eating disorder diagnostic groups and 14 control subjects completed the Toronto Alexithymia Scale (TAS), the Eating Disorder Inventory-2, and the Beck Depression Inventory within the first week of their hospital admission and shortly before discharge. Structured Clinical Interviews for DSM-III-R (SCID) I and II were also conducted. Multiple regression analyses were used to determine the contribution of mood, diagnostic, and personality variables in predicting the alexithymia score. RESULTS AND DISCUSSION: After controlling for depression, only the TAS factor, "difficulty expressing feelings," remained significantly different between groups, with the anorexia nervosa-restrictors (AN-R) having significantly higher scores than controls and bulimia nervosa patients. This factor appears to be a relatively stable personality characteristic in AN-R. The level of depression and the presence of avoidant personality disorder were the most predictable variables for the alexithymia total score.

Adult↗

PubMed1998

Smoking and body image concerns in adolescent girls.

OBJECTIVE: Use of cigarettes has increased dramatically among adolescent females. Because young women use smoking as a weight control strategy, increased drive for thinness and body dissatisfaction may be associated with smoking. This study examined the relationship between smoking and body image concerns among adolescent females with and without eating disorders. METHODS: Incidence of smoking and Eating Disorders Inventory (EDI) scores were compared among 411 nonclinical females and 82 eating disorder females with anorexia nervosa or bulimia nervosa aged 11 to 18. RESULTS: Of the three groups, anorectic-restrictors were the least likely and bulimics the most likely to smoke. After covarying age, both eating disorder and nonclinical smokers had significantly greater psychopathology on Drive for Thinness, Body Dissatisfaction, and Interoceptive Awareness than nonsmokers. DISCUSSION: Despite high levels of body image disturbance, anorectic-restrictors did not use smoking as a weight control strategy. Body image concerns were more prevalent in smokers than in nonsmokers.

Adolescent↗

PubMed1997

Eating behavior and eating disorders: the interface between clinical research and clinical practice.

Cognitive-behavioral therapy (CBT) has been shown to be a highly effective form of treatment for patients with bulimia nervosa and anorexia nervosa. Issues of satiety disturbances, food restriction, and food choice are central to this form of therapy; however, ingestive behavior research that directly addresses these issues in eating disorder patients has often been overlooked by clinicians. These areas of research are reviewed and the implications of the findings for more effective CBT therapy with anorexics and bulimics are discussed.

Cognitive Behavioral Therapy↗

PubMed1996

Micro- and macroanalyses of patterns within a meal in anorexia and bulimia nervosa.

Hospitalized women with anorexia nervosa and/or bulimia nervosa and dietarily restrained and unrestrained, clinically normal women were provided with a multi-item breakfast meal. Eating patterns and hunger and satiety ratings were assessed. Subjects were offered three foods which varied in fat and carbohydrate contents. Anorectic-restrictors differed most from the control subjects: they had a longer meal duration, a slower overall rate of eating, more frequent pauses during the meal, and more short bouts of eating. They also displayed abnormal ratings of hunger and satiety: they were generally less hungry, had less urge to eat, and were more full than controls of bulimics. Both anorectic and bulimic patients showed more variability in total energy intake than did the controls. Patients usually displayed one of two patterns - either severe restriction or overeating. Abnormal hunger and satiety patterns indicating confusion typified the responses of bulimics; additionally, they showed more urge to eat in the post-meal period than did the controls. A higher proportion of fat in the initial part of the breakfast was related to a larger meal size for the bulimics. It is suggested that these techniques may be useful in evaluating the outcome of treatment for eating disorder patients.

Anorexia Nervosa↗

PubMed1995

The Yale-Brown-Cornell Eating Disorder Scale: a new scale to assess eating disorder symptomatology.

Anorectic and bulimic patients (n = 100) were interviewed using the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS). All patients reported preoccupations and rituals related to their eating disorder ranging from mild to severe symptomatology, with mean scores in the moderate range. The preoccupations were more severe than the rituals; however, the rituals were still time-consuming, distressing, and interfered with functioning. Both preoccupations and rituals were largely ego syntonic. The YBC-EDS is an easy to administer interview which characterizes and quantifies preoccupations and rituals associated with eating disorders. It is useful both for research and clinical purposes.

Adaptation, Psychological↗

PubMed1995

Anorexia nervosa and bulimia nervosa in adolescence: effects of age and menstrual status on psychological variables.

OBJECTIVE: To compare, in adolescents and adults with anorexia nervosa and bulimia nervosa, eating disorder symptomatology and comorbid affective and anxiety states. METHOD: Two hundred fifty consecutive, female inpatients on an eating disorders unit were studied. They were given the Beck Depression Inventory; the Depression, Obsessive-Compulsive, Anxiety, and Phobic Anxiety scales from the Symptom Checklist 90; and the Eating Disorder Inventory. Patients were divided into categories based on age, diagnosis, and menstrual status. RESULTS: Onset of anorexia nervosa before age 14 and primary amenorrhea were associated with the greatest maturity fears during acute illness. For patients with restricting anorexia, adolescents aged 17 through 19 years had the highest drive for thinness compared to adolescents aged 13 through 16 years and adults. The lowest levels of depression and anxiety were seen in patients younger than age 14 with restricting anorexia. CONCLUSION: Overall, few psychological differences between adults and adolescents with eating disorders were found, with the exceptions of the youngest restricting anorectic patients at the time of treatment and both restricting and bulimic-anorectic patients who had a very early onset of their illness. Younger patients with acute anorexia nervosa may not require pharmacotherapy for anxiety and depression and may benefit from a focus on maturity fears in psychotherapy.

Adolescent↗

PubMed1994

Psychiatric comorbidity in patients with eating disorders.

The Structured Clinical Interview for DSM-III-R (SCID and SCID II) was administered to 105 eating disorder in-patients in order to examine rates of comorbid psychiatric disorders and the chronological sequence in which these disorders developed. Eighty-six patients, 81.9% of the sample, had Axis I diagnoses in addition to their eating disorder. Depression, anxiety and substance dependence were the most common comorbid diagnoses. Anorexic restrictors were significantly more likely than bulimics (all subtypes) to develop their eating disorder before other Axis I comorbid conditions. Personality disorders were common among the subjects; 69% met criteria for at least one personality disorder diagnosis. Of the 72 patients with personality disorders, 93% also had Axis I comorbidity. Patients with at least one personality disorder were significantly more likely to have an affective disorder or substance dependence than those with no personality disorder.

Adolescent↗

PubMed1992

Relationship of perceived macronutrient and caloric content to affective cognitions about food in eating-disordered, restrained, and unrestrained subjects.

Cognitive sets concerning food were examined in eating-disorder patients and in restrained and unrestrained control subjects. Subjects rated 38 common foods for preference, presence or absence of guilt and danger, preferred monthly frequency, and caloric, fat, and carbohydrate content. Cognitive ratings were examined based upon the individual's perceived amounts of calories and macronutrients. Hedonic ratings of foods perceived as high in fat or calories were different in patients with current or past anorexia and did not change with treatment. The fat-calorie aversions seen in these patients, therefore, appear to be stable trait characteristics of the disorder. Guilt and danger were perceived as separate constructs by unrestrained and restrained control subjects but not by patients. Perceived high amounts of calories or fat triggered stronger feelings of guilt and danger for restrained control subjects and patients (especially bulimic patients) as compared with unrestrained control subjects. The patients' expressions of guilt and danger improved with treatment.

Affect↗

PubMed1991

Temporal patterns of hunger and fullness ratings and related cognitions in anorexia and bulimia.

Hunger and fullness during an experimental liquid meal were evaluated by ratings in 84 eating-disordered patients, including three diagnostic subgroups, and in 19 controls who were normal in weight and eating healthily. Anorectic-restrictors had lower hunger ratings and higher fullness ratings than controls. The same tendency was present in anorectic-bulimics. These ratings were relatively unaffected by treatment. Anorectic-restrictors had longer meals than the anorectic-bulimics and normal-weight bulimics. The anorectic-restrictors also tended to eat more slowly than did the bulimic patients. These groups did not, however, differ in amount consumed. At the end of the experimental meal, the anorectic-bulimics were more preoccupied with thoughts of food and anorectic-restrictors had a lower urge to eat, as compared with the controls. Hunger and fullness ratings were negatively correlated for all diagnostic groups; however, these correlations were less pronounced for the eating disorder groups. The eating-disordered patients had predominantly "abnormal" patterns of hunger and fullness curves, indicating a confusion of these concepts.

Adult↗

PubMed1991

Serotonergic responsivity in eating disorders.

Evidence suggests that serotonin may play a role in the pathogenesis of eating disorders. In this ongoing study, serotonin-mediated physiological responses and whole-blood serotonin content are measured in young women with an eating disorder during the active phase of the illness and at the conclusion of inpatient treatment. The responsivity of central nervous system (CNS) serotonergic pathways is assessed by neuroendocrine challenge with a 60-mg oral dose of dl-fenfluramine, an indirect serotonin agonist, whereas the responsivity of the platelet serotonin2 (5-HT2) receptor complex is evaluated by measurement of the magnitude of serotonin-amplified platelet aggregation. Compared with normal controls, eating-disorder patients have exhibited a trend toward reduced prolactin responses to fenfluramine challenge at both the initial and followup assessments. Patients also have exhibited a substantially wider range of serotonin-amplified platelet aggregation responses than have controls; normal-weight bulimic patients have had significantly greater responses than both anorexic restrictors and normal subjects. These preliminary results suggest potential alterations in serotonin-mediated responses in eating-disorder patients that may vary with the diagnostic subgroup.

Adolescent↗

PubMed1990

Taste perceptions and hedonics in eating disorders.

Hedonic and intensity ratings of 20 dairy solutions, with varying levels of fat and sucrose, were obtained before and after treatment for anorectic-restrictors, anorectic-bulimics, normal-weight bulimics, and control subjects. There were no differences between diagnostic groups in ability to rate sweetness intensity; all subjects were able to correctly assess increasing sucrose concentration. During the pretreatment test, both bulimic groups showed elevated intensity ratings of lower fat solutions and solutions which contained no sugar as compared with the other two groups. These differences were not present after treatment. There were differences in hedonic ratings between the anorectic groups and the controls, which persisted even after treatment. Both groups of patients showed an aversion to high fat solutions; anorectic-restrictors also demonstrated an aversion to all solutions which contained no sugar. The stability of these hedonic profiles suggests that these responses may be trait characteristics of anorexia nervosa.

Adolescent↗

PubMed1987

Species differences in polysaccharide and sugar taste preferences.

This study compared the polysaccharide and sugar taste preferences of humans and four rodent species (laboratory rats, Rattus norvegicus; Golden Syrian hamsters, Mesocricetus auratus; Mongolian gerbils, Meriones unguiculatus; Egyptian spiny mice, Acomys cahirinus). In Experiment 1 human subjects rated the pleasantness, sweetness, and flavor intensity of polysaccharide (Polycose), sucrose, and maltose solutions at concentrations of 0.0125 M to 0.4 M, and 1% to 32% concentrations. At the higher molar concentrations Polycose was rated as less sweet and less pleasant than the sucrose and maltose solutions; there were no differences in the flavor intensity ratings. With the percent concentrations Polycose was rated as less sweet and less flavorable as the sucrose and maltose solutions; there were no reliable differences in the pleasantness ratings. In Experiment 2, the Polycose, sucrose, and maltose preferences of rats, hamsters, gerbils, and spiny mice were compared using 24 hr two-bottle tests (saccharide vs. water) at concentrations of 0.001 M, 0.005 M, 0.01 M, and 0.1 M. In general, the rats displayed stronger preferences for Polycose and maltose than did the other three species. In addition, the gerbils showed a stronger Polycose preference at the 0.1 M concentration than did the hamsters and spiny mice, and the spiny mice display a weaker preference for sucrose than did the other three species. Within species comparisons revealed that all four species displayed preferences for Polycose that were as strong or stronger than their preferences for sucrose and maltose. With only a few exceptions, male and female rodents did not differ in their saccharide preferences. Thus, while rats show the most robust Polycose preference of the four rodent species, all four species were attracted to the taste of polysaccharides. Humans, on the other hand, reported that Polycose solutions were unpleasant. The results suggest that rodents have taste receptors for starch-derived polysaccharides that humans lack.

Adult↗

PubMed1983

Palatability and meal patterns.

Investigations of palatability have often been confounded by nutritional, pharmacological or methodological problems. The present experiment examined the free-feeding meal patterns of two differentially preferred yet nutritionally equivalent diets. When the two diets were offered sequentially (Experiment 1), no differences were found in meal frequency, meal size, or meal duration. However, when the diets were offered simultaneously in Experiment 2, the preferred diet was consumed more frequently, in larger meals, and at a faster feeding rate than the less preferred diet. Further, the meal patterns in Experiment 2 of the preferred diet were identical with those found for both diets in Experiment 1. Therefore, the meal patterns of two diets with differing palatability depend upon the method of presentation with differences appearing when the diets are offered simultaneously but not when they are offered sequentially.

Animals↗