Bulimia nervosa, restrained, and unrestrained eaters: a comparison of non-binge eating behavior

OBJECTIVE

This study investigated non-binge eating behavior in bulimia nervosa, restrained and unrestrained eaters.

METHOD

Nine females with bulimia nervosa, 12 female restrained eaters, and 13 female unrestrained eaters were administered the Eating Disorder Inventory-2 (EDI-2), the Body Shape Questionnaire, the Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and the Revised Restraint Scale (RRS). All subjects were videotaped during a midday meal and their eating behavior was subsequently rated using the Eating Behaviour Rating Scale (EBRS).

RESULTS

EBRS ratings were higher for bulimic than for unrestrained subjects. Restrained subjects' ratings did not differ from those of either bulimic or unrestrained subjects. EBRS scores were positively correlated with RRS and EDI-2 total scores.

CONCLUSIONS

Bulimic subjects display aberrant eating behavior, and the extent to which subjects engage in maladaptive eating behavior is related to the degree of eating pathology. These results support the utility of the EBRS as a useful index of eating behaviors in clinical and nonclinical populations.

Activity patterns and microhabitat selection of Mallorcan midwife toad (Alytes muletensis) tadpoles in natural torrent pools

Abstract

Tadpoles of the Mallorcan midwife toad (Alytes muletensis) displayed a clear diel pattern of activity and microhabitat selection in torrent pools in Mallorca. Tadpoles spent much of the day foraging in a non-aggregated fashion in warm shallow areas, and activity peaked at 1700-1900 hr. In mid-afternoon, however, when much of the water surface was in direct sunlight, tadpoles moved away from the shallows and formed aggregations under rock overhangs at the sides of the pool. Both activity and tadpole density in the shallows dropped dramatically after dark, when there was a movement of the population back into deeper water or hiding places.

Behavioural responses of Mallorcan midwife toad tadpoles to natural and unnatural snake predators

The activity levels of Mallorcan midwife toad tadpoles, Alytes muletensis, were compared in two natural torrent pools which differed in their use by predatory viperine snakes, Natrix maura. Activity levels were lower in a pool regularly used by snakes than they were in a snake-free pool, but were reduced in both pools when snakes were experimentally introduced in nylon bags. In the presence of snakes, however, activity was more suppressed in the pool that was usually snake-free. Corresponding reductions in activity were also observed when tadpoles were treated with chemical cues from Mallorcan N. maura in a gravitational flow-through system. However, tadpoles failed to respond to chemical cues from other species of amphibian-eating snakes, or even to those from N. maura collected from a different population in mainland Spain. As none of the snakes used had previously eaten midwife toads, the responses cannot be related to previous diet, and seem to be specific to those N. maura from the island of Mallorca. As viperine snakes were probably introduced to Mallorca about 2000 years ago, the evolution of anti-predator behaviour in midwife toad tadpoles must have occurred relatively recently. Copyright 1998 The Association for the Study of Animal Behaviour.

The use of guardianship legislation for anorexia nervosa: a report of 15 cases

OBJECTIVE

This paper investigates compulsory treatment under guardianship legislation for 15 anorexia nervosa patients admitted to four eating disorders units in New South Wales (NSW), Australia, between 1991 and 1994.

METHODS

A retrospective follow-up was conducted. This involved an analysis of sociodemographic, clinical, eating and weight history, and Guardianship Order details obtained from medical records. This small sample was compared to a larger sample of anorexia nervosa patients admitted voluntarily to a specialised eating disorder unit in NSW. Further follow-up included a structured interview using the Morgan-Russell Assessment Outcome Schedule at least 1 year after admission for compulsory treatment.

RESULTS

For those treated involuntarily, a larger number came from metropolitan Sydney and a larger percentage were unemployed, were purgers and required specialist medical consultations. A significantly higher proportion came from higher socioeconomic groups, and the duration of stay in hospital while patients were under guardianship was significantly greater. A high degree of comorbidity was noted. There were similarities between those treated involuntarily and those treated voluntarily for the source of referral, marital status and Body Mass Index on admission and discharge. Only three patients accepted a follow-up interview using the Morgan-Russell Outcome Schedule. Two of them had made a good recovery.

CONCLUSIONS

It was noted that the guardianship sample comprised a more severely III group than anorexic patients treated voluntarily. The nature of guardianship legislation compared to mental health law was discussed and advice offered to clinicians contemplating and implementing compulsory treatment.

Body figure perceptions and eating attitudes among Australian schoolchildren aged 8 to 12 years

OBJECTIVE

How widespread is the desire for thinness among preadolescent Australian children and are there gender differences?

METHOD

Two hundred forty-four children from Grades 3 to 6 completed the children's version of the Eating Attitudes Test (ChEAT), reported whether they had ever wanted to be thinner or tried to lose weight, and selected pictures ranging from thin to fat to depict their current and ideal body images.

RESULTS

Fifty percent of girls and 33% of boys have wanted to be thinner, and 40% and 24%, respectively, have attempted to lose weight. Percentages of girls and boys scoring above the ChEAT screening threshold for anorexia risk were 14% and 8%, respectively. ChEAT scores, attitudes and behaviors, and current and ideal figure perceptions were significantly related to body mass index (BMI).

DISCUSSION

Attitudes and behaviors were consistent with recent U.S. and Israeli findings that concerns about being overweight are prevalent among 8- to 12-year-olds. High ChEAT scores among Grade 3 children raised the question of whether very young children adequately understand this questionnaire.

Chronic fatigue syndrome and dieting disorders: diagnosis and management problems

OBJECTIVE

This paper illustrates the importance of conducting an initial and ongoing psychiatric assessment of patients with chronic fatigue syndrome in order to diagnose dieting disorders. The diagnostic issues and management problems of three case vignettes, two with anorexia nervosa and one with bulimia nervosa, are described.

METHOD

The treatment response of dieting disordered patients is generally prolonged after a previous diagnosis of chronic fatigue syndrome has been made and the patient and family favour a disease diagnosis.

RESULTS

Several management problems arise and family members may also be reluctant to accept a dieting disorder diagnosis.

CONCLUSIONS

Early detection of dieting disorders by adequate screening and assessment is necessary so that a significant reduction in morbidity may occur.

Children's perceptions of their current and ideal body sizes and body mass index

244 Australian schoolchildren aged between 8 and 12 years indicated their current and ideal body sizes by means of Collins' pictorial figures. Children's height and weight were also measured. Body-mass indices were calculated from these data, and percentile ranks estimated according to international reference data. Consistent with Collins' findings, 39% of girls and 26% of boys wanted to be thinner than they perceived themselves to be; however, this desire was strongly related to actual body size so the percentages were very different for weight categories established on the basis of Body Mass Index. In the overweight quartile, 76% of girls and 56% of boys wanted to be thinner, whereas in the underweight quartile only 10% of girls and no boys wanted to be thinner. The response of overweight children may be sensible, but the desire of some underweight girls to be even thinner is of concern. Some recent literature suggests that underweight individuals tend to overestimate their body sizes. About a half of our underweight children slightly overestimated their body sizes but only one child overestimated grossly.

Effects of pH and aluminium on the growth and feeding behaviour of smooth and palmate newt larvae

: The distribution of smooth and palmate newts (Triturus vulgaris and Triturus helveticus) may be related to water quality. This study compared the larval growth and feeding behaviour of both species under sublethal levels of aluminium and low pH. The growth of both species was inhibited to a similar degree under acidic conditions with aluminium toxicity dependent upon both low pH and developmental stage. The two species were differentially affected by low pH in terms of feeding behaviour. T. vulgaris larvae took significantly longer to snap at food under low pH than the apparently acid-tolerant T. helveticus. Aluminium had no significant effect on the feeding behaviour of either species.

Depression, dementia and disability in the elderly

A structured sample of mobile elderly patients in a rural community practice was assessed on validated rating scales for depression, dementia and disability. A total of 62% of the sample was abnormal on at least one variable. The overall prevalence of depression was 13%; the overall prevalence of dementia was either 10 or 18% depending on the criterion of Mental Test Score (MTS). Depression and dementia were related, depression being more common in females. In depressed and demented patients, MTS was age-related in those over 60 years; in depression alone, MTS was not age-related. Dementia was age-related, particularly over the age of 75. Disability increased with age and was more common in females. Disability was associated with both depression and dementia.

The structure of depressive symptoms in the elderly

In a structured sample of 100 male and 100 female minimally impaired patients, aged 60 years and over, females were more depressed. Varimax factor analysis demonstrated four factor groupings which have clinical relevance - Depression, Anxiety, Cognitive impairment, and Psychosomatic disorder; their relative importance is different in males and females. Analysis of variance of the scores of clusters generated by cluster analysis demonstrated four groups of subjects - normal, mildly depressed, moderately depressed with borderline dementia and disability, and severely depressed with moderate dementia and frank disability. In the mildly and moderately depressed, symptoms of anxiety predominated.

The treatment of bulimia nervosa

We review treatment approaches to bulimia nervosa, with particular emphasis on methodology and research design. The following treatments are considered: behaviour therapy, cognitive behaviour therapy, pharmacological treatment, group therapy, psychoanalytic psychotherapy, self-help and support groups, hypnosis and miscellaneous (family therapy and nutritional approaches). Several directions for future research and methodological recommendations are suggested.

An evaluation and follow-up investigation of a behavioural group treatment programme for obesity

This paper describes an evaluation and 2-year follow-up of a comprehensive behavioural group obesity programme. The sample was made up of three groups totalling 31 patients who were referred to the Weight Reduction Advice Service at Prince of Wales Hospital, Randwick. Patients were thoroughly screened prior to treatment and completed psychological questionnaires before and after treatment. The programme consisted of weekly, 1.5- to 2-hour sessions of formal treatment. An additional 2 sessions were held fortnightly. Treatment was conducted by a clinical psychologist, two dietitians and a physiotherapist. Outcome results for the end of treatment and at 2 years follow-up are presented. The implications of the results for the treatment of obesity are discussed.

Tetanus presenting as hypothermia

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Natural environmental cues and circadian rhythms of behaviour--a perspective

Natural environmental cycles are often extremely difficult to reproduce under laboratory conditions. Laboratory light-dark cycles differ from natural light-dark cycles in terms of intensity and spectral distribution, whilst simulated temperature cycles may differ from natural temperature cycles in waveform. The expression of a free-running rhythm depends upon the 'level' of constant conditions provided. Environmental cues affect the period, phasing, amplitude and activity-rest ratios of circadian rhythms and, if inappropriate, may result in aberrant behaviour patterns which are unlike those observed in nature.

Normal erythrocyte sedimentation rate in the elderly

Two hundred subjects aged 60-89 were selected for a study aimed at defining a reference range for the erythrocyte sedimentation rate in the elderly. The study extended a previous survey in subjects aged 20-65. The results confirmed that the sedimentation rate increases with age and that women have higher values than men but suggested that over half of elderly patients with disease would have rates within the previously defined "normal" range. It is therefore suggested that an erythrocyte sedimentation rate exceeding 19 mm in the first hour in elderly men and 22 mm in the first hour in elderly women warrants investigation.

Pressure induced rhabdomyolysis complicating an undiscovered fall

An 82-year-old man developed severe pressure-induced rhabdomyolysis after falling and remaining undiscovered on the floor. This unusually severe case is reported to illustrate the features of a condition which in milder degree may be common in old people and give rise to diagnostic confusion.

Congophilic angiopathy of the brain: a clinical and pathological report on two siblings

Clinical and histological accounts are given of a sister and brother, dying aged 61 and 56 years respectively after illnesses lasting 5-6 years marked by a progressive mental and physical disability. The family history suggested transmission by a dominant gene. The histological findings were of a very severe congophilic angiopathy confined to the brain, spinal cord and leptomeninges and giving rise to multiple haemorrhages and softenings. There were, in addition, abundant amyloid-containing "plaques" of various forms, found principally in the hippocampus and cerebellar cortex. The cases are compared with similar cases in the literature, and reasons given for regarding this condition as a separate entity rather than a variant of Alzheimer's disease.

Tremor and senile parkinsonism

A study of 100 Day Hospital patients showed that 26 elderly patients with mild Senile Parkinsonism and varying degrees of dementia had subclinical tremor with the same frequency as Parkinson's Disease and distinguishable by amplified recordings from those of Parkinson's Disease and Senile Tremor. A significant history of cerebro-vascular disease was obtained in one-half of these patients. The recording of tremor is shown to be of value in diagnosing Parkinsonism and in assessing response to treatment.

THE SURVIVAL OF OIL SLICKS ON THE OCEAN AS A FUNCTION OF SEA STATE LIMIT1

A research program is underway to obtain a better understanding of the interaction between spilled oil and sea state in order to predict the dispersion and ultimate physical fate of oil spilled in rough water. In pursuit of this goal, a theoretical study and two laboratory experimental studies are now complete. As a consequence, the lower limit of sea state at which globular dispersion of oil can be effected by ocean turbulence is calculable. The formation of oil globules by breaking waves, the penetration of globules into the water column, and the distribution of oil under breaking wave generated turbulence can also be modeled. A possible mechanism by which a coherent oil slick breaks up into small patches of oil (“slicklets”), caused by breaking waves, is described, and a simplified one-dimensional model of this effect is proposed.

Results indicate that a 3 meter (significant wave height) sea will tend to initiate globular vertical dispersion of oil, although this process would take place over only about 13 percent of the oil slick's area. To effect a horizontal surface dispersion, breaking waves with a very long crest length are necessary, a type not ordinarily found in deep water.

A simple method of measuring tremor using a variable-capacitance transducer

A simple, inexpensive method of recording tremor, using a variable-capacitance transducer, is described. Technical details of the transducer are given, along with examples of tremor traces illustrating the transducer's ability to monitor parkinsonian patients during drug therapy.

Progressive supranuclear palsy

In the past four years, four patients with progressive supranuclear palsy have presented to the Department of Geriatric Medicine, Oxford, under the care of one of us (RAG). They were all females whose symptoms began in the sixth or seventh decade. They died from three to six years after the onset of symptoms. All had neuropathological studies which are described. The presenting characteristics included frequent falls, difficulty in walking, nuchal rigidity, abnormalities of gaze, pseudobulbar features and mild dementia. These are features particularly common in the elderly and it is suggested that the condition may be under-diagnosed.

The floating-bed

The classical concept of hospital care has gross limitations. Specialist consultation is episodic; hospitalisation has rigid admission and discharge policies. Floating-bed admission for 2 nights every 2 weeks provides an additional service which reduces the number of beds necessary for the elderly and should be able to contain the rapid increase in demand occasioned by the rising number of elderly patients, particularly those over the age of 75 years.

The clinical significance of systolic murmurs in the elderly

A group of 278 patients, over the age of 60 years, and representative of geriatric and general medical admissions to the District General Hospital in Banbury, Oxforshire, was studied to correlate the prevalence of systolic murmurs to age, sex, cardiac failure, ischaemic heart disease, dysrrhythmias, hypertension, peripherial vascular disease and anaemia. The object was to establish the clinical significance of these murmurs and test a postulate that they could not be dismissed as benign. Seventy-five per cent of the murmurs were judged to be aortic and 12 per cent mitral in origin. The prevalence of systolic murmurs increased with age from 32 per cent at 60-64 years to 57 per cent over 85 years, and was greater in females (44 per cent) than in males (34 per cent). The presence of systolic murmurs was related to the presence of cardiac failure, ischaemic heart disease, dysrrhythmias, hypertension, peripheral vascular disease and anemia. Only 8 per cent of patients with systolic murmurs had none of the above-mentioned six cardiovascular abnormalities compared with 36 per cent of patients without such a murmur, while multiple cardiovascular abnormalities were also commoner in the former group. The mortality rate in hospital was similar for patients with or without a systolic murmur.