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PubMed2000

Parents' restrictive feeding practices are associated with young girls' negative self-evaluation of eating.

OBJECTIVE: This study was conducted to determine whether parents' restriction of young girls' access to palatable foods promotes the consumption of those foods while evoking negative self-evaluation. DESIGN: Girls' intake of 10 snack foods was measured immediately following a standard lunch, in a setting with free access to palatable snack foods. Girls' self-evaluation about their eating was assessed following the free access snack session. In addition, reports of parental restriction were obtained from mothers, fathers, and girls. PARTICIPANTS: Participants were 197 girls aged 4.6 to 6.4 years and their parents. STATISTICAL ANALYSIS: Structural equation modeling was used to test models describing relationships between parents' restriction and girls' eating. RESULTS: Following the standard lunch, girls' snack food intake during the 10-minute free access session ranged from 0 to 436 kcal, with a mean of 123 +/- 7 kcal. Approximately half of the girls reported negative self-evaluation about eating 1 or more of the 10 foods provided. The revised path model indicated that parents' restriction predicted both girls' snack food intake and girls' negative self-evaluation of eating. Girls' negative self-evaluation of eating was not associated with the amount of food that they consumed when not hungry, but was linked to their perceptions of being restricted from those foods. APPLICATIONS/CONCLUSIONS: These findings indicate that restricting young girls' access to palatable foods may promote the intake of restricted foods and may also generate negative feelings about eating restricted foods.

Child↗
PubMed2003

Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment.

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.

Bulimia↗
PubMed2003

Decreased levels of serum brain-derived neurotrophic factor in female patients with eating disorders.

BACKGROUND: Several lines of evidence suggest that brain-derived neurotrophic factor (BDNF) plays a role in the regulation of eating behavior. Because of its role in eating behavior, which is especially relevant to eating disorders, BDNF is an attractive candidate for investigation of potential biological markers of eating disorders such as bulimia nervosa (BN) and anorexia nervosa (AN). METHODS: We enrolled 18 female patients with BN, 12 female patients with AN, and 21 age-matched female normal control subjects in this study. Eating-related psychopathology and depressive symptoms were evaluated using the Bulimic Investigatory Test, Edinburgh (BITE) and the Hamilton Depression Rating Scale (HDRS). Serum BDNF levels were measured by a sandwich enzyme-linked immunosorbent assay. RESULTS: Serum levels of BDNF in the patients with AN or BN were significantly (p<.0001) decreased compared with those of normal control subjects, and serum BDNF levels in the patients with AN were significantly (p=.027) lower than those in patients with BN. A significant positive correlation (r=.378, p=.006) between serum BDNF levels and body mass index in all of the subjects was detected. Furthermore, there was a significant positive correlation (r=.435, p=.015) between the BITE symptom scale score and HDRS in these patients. CONCLUSIONS: The present study suggests that BDNF may play a role in the pathophysiology of eating disorders.

Adolescent↗
PubMedDate not supplied

Disordered eating, weight dissatisfaction and dieting in relation to unwanted childhood sexual experiences in a community sample.

A study was conducted to examine the relationships among eating pathology, weight dissatisfaction and dieting, and unwanted sexual experiences in childhood. An unselected community sample of 201 young and 268 middle-aged women were administered questionnaires assessing eating behaviors and attitudes, and past and current sexual abuse. Results showed differential relationships among these factors for the two age cohorts: for young women, past sexual abuse predicted weight dissatisfaction, but not dieting or disordered eating behaviors, whereas for middle-aged women, past abuse was predictive of disordered eating, but not dieting or weight dissatisfaction. Current physical or sexual abuse was also found to be predictive of disordered eating for the young women. These findings underscore the complexity of the relationships among unwanted sexual experiences and eating and weight pathology, and suggest that the timing of sexual abuse, and the age of the woman, are important mediating factors.

Adolescent↗
PubMedDate not supplied

Seasonal mood patterns in eating disorders.

There has been an increasing body of research literature suggesting a seasonal pattern of mood fluctuations and eating behavior in bulimic patients. Fornari et al. [5] reported worsening of bulimic symptoms during winter. There is a logical connection between Seasonal Affective Disorder (SAD) and bulimia nervosa as both show increased appetite and carbohydrate craving and probably share a common neurobiologic abnormality such as serotonergic dysfunction. The aim of this study was to determine the prevalence of SAD in a sample of 259 consecutively evaluated outpatients admitted to an eating disorders clinic (254 women and 5 men). Eating disorder diagnosis was established on the basis of DSM-III-R criteria, and a modified version of the Seasonal Pattern Assessment Questionnaire was used to determine seasonality among patients. The sample was comprised of the following: 53.7% bulimics, 27.4% anorexics, 15.1% were classified as having an eating disorder not otherwise specified, and 3.9% had a diagnosis other than an eating disorder. The results indicated that 27.0% of the eating disorder patients met criteria for SAD. Of this group, 86 (71.4%) were bulimic, 35 (18.6%) were anorexic, and 20 (10.0%) were nonspecified. Details and additional findings are discussed.

Adult↗
PubMed2000

The relationship between eating disorders and substance use: moving beyond co-prevalence research.

The frequent comorbidity of eating disorders and substance use has been demonstrated consistently by research. Less is known about the basis of this relationship. A review of the literature indicates that the hypotheses proposed to clarify the etiological relationship between eating disorders and substance use have not been supported sufficiently or consistently by empirical evidence. General criticisms include: a lack of well developed models, a reliance on co-prevalence data, and a lack of integration of knowledge from eating disorder and substance use research. It is suggested that an understanding of the etiological relationship between eating disorders and substance use will be arrived at only after fundamental inquiries into the functional relationship between eating disorders symptomatology and substance use patterns have been conducted. A behavioral assessment approach is offered as a means of evaluating the functional relationship between eating disorder symptomatology and substance use.

Comorbidity↗
PubMed2004

[The auto-addictive hypothesis of pathological eating disorders].

The pathogenic role of self-addiction. Addiction to an endogenous chemical is a new paradigm termed 'self-addiction'. It may contribute to the development of certain habits, the pathological nature of which may set-in on the basis of this "self-addictive"dimension. Pathological eating habits could be inscribed in this perspective. Two extreme situations. In well-fed populations, the ingestion of food does not represent a limiting phase in the global feeding process. Its pathological management may, however, lead to two extreme situations: the absence of ingestion (anorexia) and excessive ingestion (bulimia). In favour of the self-addictive hypothesis. Eating disorders are associated with abnormal levels of endorphins and share clinical similarities with psychoactive drug abuse. The key role of endorphins has recently been demonstrated in animals with regard to certain aspects of normal, pathological and experimental eating habits (food restriction combined with stress, locomotor hyperactivity). The factors leading to pathological eating habits. Neurobiological bases for eating disorders and their durability have recently come to light in the recent implication of abnormalities in the recompense system in the onset of addiction. The endorphin self-addictive model in fact appears the most pertinent with regard to the clinical profile of eating habits and integrates the role of stress.

Behavior, Addictive↗
PubMed2002

Substance use in female adolescents with eating disorders.

To determine the prevalence of substance use in adolescents with eating disorders, compare the results with a data set of Ontario high school students, and explore why adolescents with eating disorders do, or do not, use various substances. From January 1999 to March 2000, 101 female adolescents who met the DSM-IV criteria for an eating disorder were followed up in a tertiary care pediatric treatment center. They were asked to participate in a cross-sectional study using a self-administered questionnaire assessing substance use and investigating reasons for use and nonuse; 95 agreed to participate and 77 completed the questionnaire (mean age, 15.2 years). The patients were divided into two groups: 63 with restrictive symptoms only, 17 with purging symptoms. The rates of drug use between subjects and their comparison groups were compared by z-scores, with the level of significance set at.05. During the preceding year, restrictors used significantly less tobacco, alcohol, and cannabis than grade- and sex-matched comparison populations, and purgers used these substances at rates similar to those of comparison subjects. Other drugs seen frequently in the purgers included hallucinogens, tranquilizers, stimulants, LSD, PCP, cocaine, and "ecstasy." Both groups used caffeine and laxatives, but few used diet pills. Restrictors said they did not use substances because they were bad for their health, tasted unpleasant, were contrary to their beliefs, and were too expensive. Purgers generally used substances to relax, relieve anger, avoid eating, and "get away" from problems. Female adolescents with eating disorders who have restrictive symptoms use substances less frequently than the general adolescent population but do not abstain from their use. Those with purging symptoms use substances with a similar frequency to that found in the general adolescent population. Because the sample size for the purging group was small, firm conclusions cannot be drawn from our analysis. Health care providers who treat adolescents with eating disorders are in a good position to identify those who use substances and may be at risk for substance abuse.

Adolescent↗
PubMed2000

Eating behavior, depression, and self-esteem in high school students.

OBJECTIVE: In a representative sample of 4700 Slovene high school students, we examined their eating behavior and its correlations with some psychosocial and psychological characteristics with the aim of identifying the main risk factors for disordered eating. METHOD: Using a questionnaire which also included Zung's Self-rating Depression Scale and Rosenberg's Self-Esteem Scale, we compared girls (n = 2507) and boys (n = 2193) with regard to their satisfaction with their body weight, weight-reducing activities, and frequency of binge eating. We assessed their family relationships, abuse of alcohol and other psychoactive drugs, suicidal ideation, and suicidal tendences, as well as their level of depression and self-esteem. RESULTS: The results showed significant differences between girls and boys, between groups of those who were satisfied and those who were dissatisfied with their body weight, and also between groups which indulged in frequent binge eating and those which did not. CONCLUSION: Within a general population of adolescents, there is a substantial number of subjects with disordered eating behavior, some part of whom are at high risk for eating disorders.

Adolescent↗
PubMed2001

Social physique anxiety and eating attitudes in female athletic and non-athletic groups.

One purpose of the present study was to compare Social Physique Anxiety (SPA) scores among four different female groups (physique-salient (PS) athletes-aerobics competitors and divers, n = 63; weight-restricted athletes-rowers, n = 60; non-physique-salient (NPS) athletes--soccer, n = 75; and non-athlete students, n = 53). A second purpose of the study was to examine relations between SPA and disturbed eating attitudes among these four groups. Participants completed the Social Physique Anxiety Scale (SPAS; Hart, Leary, & Rejeski, 1989) and the Eating Attitude Test (EAT; Garner & Garfinkel, 1979). With respect to purpose one, an analysis of variance (ANOVA) with SPA (i.e., 9-item single factor model of the SPAS) as the dependent measure, failed to reach significance (F (3,184) = 1.61, p> .05). With respect to purpose two, significant relations were found between SPA and EAT scores for all four groups. Inferential comparison of the bivariate correlations (Fisher's Z transformations), however, showed no significant differences between groups. In addition, a moderated regression analysis was computed using EAT scores as the dependent measure. The variables were entered in the following order: SPA, followed by dummy vectors for each sport-type category, and then the interaction term between SPA and the dummy vectors. Results showed that there was no significant interaction effect. Thus, these analyses, taken together. suggest that the type of sport activity does not serve to moderate relations between SPA and disordered eating. Implications of the findings are discussed.

Adolescent↗
PubMed1996

Abnormal eating attitudes and behaviours in two ethnic groups from a female British urban population.

African-Caribbean (N = 136) and White British (N = 192) female family planning clinic attenders were administered the Bulimic Investigatory Test, Edinburgh (BITE) and the General Health Questionnaire (GHQ-28). A proportion of the participants were subsequently interviewed. The African-Caribbeans were found to have both significantly more disordered eating attitudes and a significantly higher level of abnormal eating behaviour than the White British. Although the African-Caribbean group had a significantly higher mean Body Mass Index this did not mediate the difference in levels of eating attitudes. When compared with the White British group more African-Caribbean women reported feelings of failure, guilt, abnormality and self-consciousness concerning their eating habits. The results indicate that eating problems may be highly prevalent in this ethnic minority population and suggest that there may be differences in the nature of eating disorder psychopathology between ethnic groups.

Black or African American↗
PubMed1990

An electrophysiological correlate of Eating Attitudes Test scores in female college students.

Eating Attitudes Test (EAT) scores of forty female college students were compared to their electrodermal activity (EDA) responses when offered a plate of chocolate chip cookies. A significant positive correlation was detected between the EAT scores and the skin conductivity measures associated with the presentation of food. Women with the highest EAT scores also exhibited the greatest sympathetic nervous system responses to a plate of cookies. This finding supports the conclusion that the EAT is capable of identifying individuals who are preoccupied with food or anxious about eating.

Adolescent↗
PubMed1983

Screening for abnormal eating attitudes and psychiatric morbidity in an unselected population of 15-year-old schoolgirls.

The Eating Attitudes Test (EAT) and General Health Questionnaire (GHQ) have been validated in an unselected population of 15-year-old South London schoolgirls. Scores on the questionnaires were compared with the results of standard interview. The EAT was found to be an efficient screening instrument for abnormal eating attitudes and behaviour, whereas the GHQ was less satisfactory in its ability to screen for psychiatric morbidity in this age group than in adults. At the optimal cutting points, 6.9% of this population gave a positive response to the EAT and 19.3% gave a positive response to the GHQ. There was a statistically significant positive correlation between the two sets of scores. Compared with their peers, girls giving a positive response to the EAT also reported that they missed more meals during the day and that their weight was more unstable.

Adolescent↗
PubMed2005

The health service use and cost of eating disorders.

BACKGROUND: The economic burden and health service use of eating disorders have received little attention, although such data are necessary to estimate the implications of any changes in clinical practice for patient care and health care resource requirements. This systematic review reports the current international evidence on the resource use and cost of eating disorders. METHOD: Relevant literature (1980-2002) was identified from searches of electronic databases and expert contacts. RESULTS: Two cost-of-illness studies from the UK and Germany, one burden-of-disease study from Australia and 14 other publications with relevant data from the UK, USA, Austria, Denmark and The Netherlands could be identified. In the UK, the health care cost of anorexia nervosa was estimated to be 4.2 million UK pounds in 1990. In Germany, the health care cost was 65 million Euro for anorexia nervosa and 10 million Euro for bulimia nervosa during 1998. The Australian study reported the health care costs of eating disorders to be Aus $22 million for year 1993/1994. Other costing studies focused mostly on in-patient care reporting highly variable estimates. There is a dearth of research on non-health care costs. CONCLUSIONS: The limited available evidence reflects a general under-detection and under-treatment of eating disorders. Although both cost-of-illness studies may significantly underestimate the costs of eating disorders because of important omitted cost items, other evidence suggests that the economic burden is likely to be substantial. Comprehensive data on the resource use of patients with eating disorders are urgently needed for better estimations, and to be able to determine cost-effective treatment options.

Cost of Illness↗
PubMed2000

The association between childhood feeding problems and maternal eating disorder: a community study.

BACKGROUND: A possible association between childhood feeding problems and maternal eating disorder has been suggested by a clinic-based self-report questionnaire study. A community study was conducted, using standardized psychiatric interviews, to investigate the strength and specificity of this putative association. METHODS: Four-year-old children were screened using a self-report version of the Behaviour Screening Questionnaire, completed by mothers, and the Pre-School Behaviour Checklist, completed by teachers. Three groups of children were identified for follow-up: children with feeding problems (N = 42), children with a non-feeding form of disturbance (i.e. shyness, fearfulness or behavioural disturbance; N = 79), and a random sample of children with no disturbance (N = 29). The presence of feeding problems was confirmed by assessment of a filmed family meal, with ratings made blind to child group and maternal mental state. Maternal current and past affective disorder and current and past eating disorder were systematically assessed, blind to child status, using the Anxiety Disorders Interview Schedule and the Eating Disorder Examination respectively. RESULTS: Compared with the mothers of the two comparison groups of children, the mothers of the children with feeding problems had no raised rate of any affective disorder, either current or past, but they did have a markedly raised rate of both current and past DSM-IV eating disorder. The odds ratio of maternal eating disorder for the children with feeding problems was significantly raised at 11.1 (CI 1.4-91.8). CONCLUSION: There is a strong and specific association between childhood feeding problems and maternal eating disorder.

Adult↗
PubMed2000

Physical similarity and twin resemblance for eating attitudes and behaviors: a test of the equal environments assumption.

The Equal Environments Assumption (EEA) in twin studies of eating pathology was investigated by examining the hypothesis that twin resemblance for eating attitudes and behaviors is affected by their degree of physical similarity. Eating attitudes and behaviors were assessed in 338 female adolescent twin pairs with a revised version of the Eating Disorder Inventory (EDI). General physical similarity as well as body size/shape similarity were assessed using ratings of color photographs, ratings of body shape, and body mass index. All physical similarity assessments were conducted blind to twin zygosity. Significant associations between physical similarity and twin similarity for eating attitudes and behaviors were not found. Mean EDI within-twin pair absolute difference scores did not differ significantly among more versus less physically-similar groups. Additionally, correlation and regression analyses failed to find a significant association between EDI absolute difference scores and physical similarity indices. The current findings provide support for the EEA in twin studies of eating attitudes and behaviors.

Adolescent↗
PubMed2006

[Eating disorders and diabetes mellitus].

Adolescent and young women with type 1 diabetes mellitus demonstrate a more than random coincidence with bulimia nervosa. However, the prevalence of eating disorders that do not fulfil the criteria of bulimia nervosa is also raised in women of this age group yet without diabetes mellitus. The comorbidity of type 1 diabetes and an eating disorder poses a risk factor in the development of diabetic follow-up diseases. Patients with an eating disorder and type 1 diabetes are characterized by an insufficient metabolic control and the early development of diabetic complications such as a retinopathy. The binge eating disorder, according to research aspects initially a new eating disorder entity, may especially be observed in overweight and obesity. Even if a binge eating disorder in persons with a type 2 diabetes does not occur more frequently than in those metabolically healthy persons, it does depict a risk factor for an accelerated weight gain which as rule involves an increase of insulin resistance.

Comorbidity↗
PubMed2003

Eating disorders and aggressiveness among adolescents.

OBJECTIVE: To explore the links between propensity to aggression and eating disorders in a sample of school-aged adolescents in a northeastern area of Italy. METHOD: In a mixed male-female sample of 1000 adolescents (10% of the district's population aged 15-19 years) we administered the Eating Attitudes Test, the Bulimic Investigatory Test of Edinburgh and the Body Attitudes Test, as measures of abnormal eating attitudes and behaviours, and the Aggression Questionnaire, as a measure of the propensity to aggression. RESULTS: Females scored significantly higher than males at all eating disorders inventories (P < 0.0001). Males scored higher than females at the Aggression Questionnaire. In both genders, there was a positive correlation between scores at any of the eating disorders inventories and those at the Aggression Questionnaire (P < 0.0001). CONCLUSION: Overtly expressed aggression might have a negative impact on the course of eating disorders and on the compliance with treatment, also enhancing the risk of suicide.

Adolescent↗