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OBJECTIVE: Diet pills (DP) and vomiting or laxative (VL) use as weight loss tactics are associated with substance use in older adolescent populations. This study examined the association of weight loss tactics and substance use among middle school students. METHODS: A Youth Risk Behavior Survey was administered to 6,957 middle school students in eastern North Carolina. Multiple logistic regression examined substance use as predictors of DP and VL use. RESULTS: DP and VL use was reported by 6.0% and 7.1% of students, respectively, with each reported more frequently by females and White students. Regression analysis demonstrated alcohol, cigarette, or marijuana use as predictors for individual race/gender groups whereas steroid use was a predictor for all race/gender groups. We found a clustering effect of alcohol and cigarette use with both DP and VL use. DISCUSSION: Substance use is associated with weight loss tactics as early as middle school. More research in the areas of clustering of behaviors and age at onset is needed.
OBJECTIVE: Various reports suggest that purging with laxatives is associated with greater behavioral impulsivity in bulimia nervosa (BN) patients. We investigated the extent to which laxative misuse corresponds to specific impulse-control problems. METHOD: Participants included bulimic women who misuse laxatives (BNL+; n = 12), bulimic women who do not misuse laxatives (BNL-; n = 33), and healthy normal eaters (NE; n = 26). Participants completed the Go/No-Go discrimination task (a well-validated computerized measure of response disinhibition), as well as self-report questionnaires of impulsivity, eating symptoms, and general psychopathology. RESULTS: Compared with the other groups, the BNL+ group made more commission errors on the Go/No-Go under cues for punishment, indicating they were more disinhibited when faced with possible negative outcomes. Compared with the BNL- group, the BNL+ group was also more likely to differ from the NE group on self-reported impulsivity. There were no differences between the two bulimic groups on eating symptoms and the three groups did not differ in terms of general psychopathology. DISCUSSION: Findings suggest that, controlling for eating symptoms and psychopathology, laxative misuse among BN patients is associated with difficulty inhibiting incorrect responses in the face of perceived threats.
OBJECTIVE: The purpose of the current study was to examine the association between laxative abuse and other symptoms and features among adult patients presenting with anorexia nervosa. METHOD: One hundred and seventeen patients with anorexia nervosa were studied. Laxative abusers and nonabusers were compared. RESULTS: Compared with nonabusers, laxative-abusing patients had higher ratings on the Ineffectiveness, Body Dissatisfaction, and Drive for Thinness subscales on the Eating Disorders Inventory (EDI), as well as more depressive and somatization symptoms. There was an association between laxative abuse and low self-esteem. DISCUSSION: Laxative abuse appears to be associated with especially severe psychopathology and low self-esteem among subjects with anorexia nervosa.
OBJECTIVE: Vomiting is a pernicious symptom of eating disorders. We explored the relation between the symptom of vomiting and features of eating disorder course and severity, personality traits, and Axis I and II comorbidity in individuals with purging-type eating disorders. METHOD: The sample included participants from the multisite, international Price Foundation Genetic Studies, who had an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified) and had data available for the frequency of purging behaviors (n = 1,048). Axis I disorders, personality disorders, trait anxiety, perfectionism, and temperament and character dimensions were included as possible correlates. RESULTS: The presence of vomiting was associated with less regular laxative use, lower self-directedness, organization, personal standards, and higher novelty seeking. CONCLUSION: Vomiting remains a prevalent and potentially destructive symptom of eating disorders, with significant dental and medical morbidity. Our findings suggest that certain clinical and personality variables distinguish individuals with purging-type eating disorders who vomit from those who do not, although there were no marked differences in Axis I or II comorbidity. Specifically targeting treatment to decrease duration of exposure to this dangerous symptom continues to be an important clinical objective.
OBJECTIVE: There is increasing knowledge regarding demographics, comorbid psychiatric disorders, and symptoms characteristic of males suffering from eating disorders. METHOD: The current case report describes the history, symptom progression, and successful treatment of an elderly bulimic male whose presentation was atypical. RESULTS: This case underscores the need to consider the presence of an eating disorder regardless of age and gender, when a patient complains of unexplained nausea, abdominal pain, or vomiting.
OBJECTIVE: The current study investigated the prevalence of laxative misuse among adult outpatients with eating disorders, distinguished demographic and psychobehavioral profiles of laxative misusers, identified specific predictors of laxative misuse, and explored whether prevalence rates and psychobehavioral profiles differ across eating disorder diagnoses. METHOD: Data were collected for 201 consecutive patients. Laxative misusers and nonmisusers were compared on demographic variables, measures of eating-related and weight-related behaviors and cognitions, and general psychopathology. RESULTS: Fifty-three (26.4%) patients had misused laxatives in the month before assessment. Laxative misusers scored significantly higher than nonmisusers on measures of anorexic behaviors and cognitions, restraint, and weight and shape concerns. They also displayed higher levels of depression and self-directed hostility. Laxative misuse was specifically predicted by anorexic behaviors and depression. Across diagnoses, proportions of misusers versus nonmisusers were similar. CONCLUSION: Laxative misuse remains prevalent among adult outpatients and is associated with increased severity of clinical presentation, regardless of the eating disorder diagnosis.
OBJECTIVE: To examine two assumptions implicit in the subtyping of eating disorders: (1) purging behaviors are interchangeable, and (2) a primary distinction exists between the presence vs. absence of any means of purging. METHOD: Data from a longitudinal study of health and eating patterns were used to compare women who reported self-induced vomiting, laxative abuse, or their combination. Further comparisons were made among women who used multiple purging methods (MP), a single purging method (SP), and randomly selected controls who never purged. RESULTS: Vomiting and laxative abuse were associated with similar levels of eating pathology whereas their combination was associated with greater eating pathology. MP women reported significantly greater eating pathology compared to SP women who reported significantly greater eating pathology compared to controls. Differences were maintained at 10-year follow-up. CONCLUSION: Purging behaviors may be interchangeable but the use of multiple purging methods is associated with greater severity over time.
OBJECTIVE: To test women's ability to recall their past binging and purging behaviors. DESIGN: Ten-year follow-up study of women who had participated in a cross-sectional survey during college. SUBJECTS: In 1982, a sample of freshman and senior women at a large university in the Boston area were questioned about their weight, dieting history, bulimic symptoms, and eating patterns, attitudes, and concerns. In 1992, all subjects who responded to the 1982 survey were followed up to assess changes in bulimic symptoms and ability to recall past behaviors. RESULTS: Among the 476 women who responded to both surveys, the percentage in 1992 who reported having ever binged and/or purged was less than the percentage in 1982, indicating that the recall of past behaviors was less than perfect. Denial in 1992 of ever having engaged in the behaviors ranged from 22% among the women who were self-inducing vomiting in 1982 to 64% among the women who had reported current fasting or strict dieting in 1982. Recall of past behaviors in 1992 was better among the women who had been current bingers or purgers in 1982. CONCLUSION: Our results demonstrate that ability to recall past binging and purging is only modest. Therefore to better understand the mental and physical health consequences of these behaviors this information should be collected prospectively.
This study examined cross-sectional gender and racial/ ethnic differences in bulimic behaviors among adolescents. Subjects were 704 male and 621 female students at a large urban public high school in the Northeast. Approximately 61% of the girls and 43% of the boys reported trying to lose weight or maintain their current weight; 2.0% of the students reported using laxatives or vomiting to control their weight. The use of these behaviors to control weight was only slightly more common among girls than boys (2.7% vs. 1.4%, p = 0.1). Although more black than white girls used laxatives or vomiting to control weight (odds ratio [OR] = 11.9, 95% confidence interval [CI] 1.5-95.3), there were no racial/ethnic differences in these behaviors among boys. However, Hispanic boys were twice as likely as white boys to binge eat at least monthly (OR = 2.0, 95% CI 1.1-3.6). Our results suggest that bulimic behaviors affect male and female adolescents from a variety of racial/ethnic backgrounds. In addition, in contrast to the large gender differences in the prevalence of dieting and binge eating, more modest differences were documented in the prevalence of using vomiting and laxatives to control weight.
The cellulose/pectin combination (C/P) investigated in this study is as efficacious as a psyllium seed product widely used as a bulk laxative. Because of its physical characteristics (whiteness, lack of flavor and odor, lack of gelling upon standing), it is easy to use as a component of baked foods, sauces, drinks, stews, and in other recipes. Given its fecal bulking equivalence to the popular psyllium-based products, C/P offers advantages to the patient who takes a bulking agent regularly because of the wide choice of methods of consumption, ensuring better compliance over long periods of time. This cellulose/pectin combination appears to be a viable alternative to the limited choice presently available to the bulk laxative user and could also be used as a plant fiber supplement whenever this is desirable.
Calcium polycarbophil is the calcium salt of polyacrylic acid crosslinked with divinyl glycol. It is chemically and physiologically inert. In dilute alkali it possesses marked hydrophilic capacity (60 to 100 times its weight), which is the basis for its therapeutic use. In daily dosages of 4 to 5 g in adults, it appears to be quite safe, is non-toxic, does not interfere with digestion or absorption, and does not cause gastrointestinal irritation. It appears to be effective in the treatment of both constipation and diarrhea due to functional or organic causes. Several days of continuous use are necessary before effectiveness becomes apparent. Clinical studies, of which there are relatively few, range from uncontrolled, unblinded evaluations of an almost anecdotal nature to well controlled, double-blind, crossover studies. Additional carefully controlled studies on dietary influences, exercise, and patient compliance would be helpful. Adverse effects, which are minimal, include epigastric fullness or heaviness, abdominal distention and bloating, and flatulence. As with all bulk-forming agents, calcium polycarbophil should not be used by persons who have stenotic lesions of the gastrointestinal tract.
The evaluation described in this article compared the Therevac SB "mini-enema" with bisacodyl suppositories in the bowel management programs of patients with spinal cord injury (SCI). Of particular interest were (a) determining whether the additional costs of Therevac SB could be justified and (b) identifying the degree of bowel program improvement possible. Fourteen SCI patients were selected from the SCI inpatient unit and the clinic of a Department of Veterans Affairs facility. All patients experienced a delay of at least 45 minutes between insertion of a suppository and the beginning of stool evacuation. Each patient used bisacodyl suppositories for five bowel programs, then Therevac SB for five programs, finally repeating the bisacodyl suppositories for five more programs. Each patient maintained a bowel program log. Ten patients completed the evaluation. Using a MANOVA, the authors found a significant difference between bisacodyl and Therevac SB mean evacuation times for this group. An analysis of direct and indirect costs related to bowel care with the two regimens is also presented.
An exploratory descriptive study was conducted to address the use of bowel medications 1 month after discharge from an inpatient rehabilitation center and the rationale for making changes from bowel medications prescribed at discharge. At discharge, 66% of the 114 participants took bowel medications, but 1 month later, 42% did. Stimulant laxatives accounted for nearly half the medications taken at each point. Most of the patients who made medication changes reduced the prescribed dose or altogether discontinued taking the prescribed medication. In response to open-ended questions about changes, participants gave reasons related to physiology and personal preference. Anticipating that many patients will change their bowel medications after discharge, practitioners need to consider patients' preferences and teach patients how to adjust their medications correctly.
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