Application of artificial neural networks to eating disorders

An experimental application of Artificial Neural Networks to Eating Disorders is presented. The sample, composed of 172 cases (all women) collected at the Centre for the Diagnosis and Treatment of Eating Disorders of the 1st Medical Division of the St. Eugenio Hospital of Rome, was subdivided, on the basis of the diagnosis made by the specialist of the St. Eugenio, into four classes: Anorexia Nervosa (AN), Nervous Bulimia (NB), Binge Eating Disorders (BED) and Psychogenic Eating Disorders that are Not Otherwise Specified (PED-NOS). The data base was composed of 124 different variables: generic information, alimentary behavior, eventual treatment and hospitalization, substance use, menstrual cycles, weight and height, hematochemical and instrumental examinations, psychodiagnostic tests, etc. The goal of this experiment was to verify the accuracy of the Neural Networks in recognising anorexic and bulimic patients. This article describes 6 experiments, using a Feed Forward Neural Network, each one using different variables. Starting from only the generic variables (life styles, family environment, etc.) and hematoclinical and instrumental examinations, a Neural Networks provided 86.94% of the prediction precision. This work is meant to be a first contribution to creating diagnostic procedures for Eating Disorders, that would be simple and easy-to-use by professionals who are neither psychologists nor psychiatrists nor psychotherapists but who are, however, among the first to meet these patients and who are therefore called upon to give such patients the very first pieces of advice on seeking proper treatment.

Word Association Test and psychosexual cues in assessing persons with eating disorders

The present study aimed to detect psychosexual conflicts in patients with eating disorders using the Word Association Test which tests the perceptual sensitivity of the subject to conflictual words. We also expected patients to show concern about food and eating. 19 anorexic patients, 21 bulimic patients, and 20 control subjects without eating disorders provided associations to four groups of words: psychosexual words, food words, emotionally loaded words, and neutral words. Reaction times were recorded. Analysis showed that anorexic patients were slower than controls in responding to food-related words but bulimic patients were not significantly different from controls. Anorexic patients reacted more slowly than controls to psychosexual words. Bulimic patients were also somewhat slower than controls but faster than anorexic patients; however, these differences were not statistically significant. Results are congruent with research that points to sexual problems and delays in the psychosexual development of anorexic patients and to a lesser extent of bulimic patients.

Anorexia nervosa, major depression, and obsessive-compulsive disorder in a Down's syndrome patient

OBJECTIVE

This paper reports a case of obsessive-compulsive disorder (OCD), major depression, and anorexia nervosa in a Down's syndrome patient.

RESULTS

Mental retardation and OCD narrowed the patient's available means to control over life. First he became depressed. Perhaps because of insufficient treatment of the depression or in the context of controlling his body and inner life, anorexia nervosa developed.

DISCUSSION

His clinical presentation, diagnostics, and successful treatment of psychiatric disorders and anorexia nervosa are presented.

Psychopathological considerations on the relationship between bulimia and obsessive-compulsive disorder

The relationship between eating disorders, impulse control disorders and obsessive-compulsive disorder as part of a so-called 'obsessive-compulsive spectrum' is discussed, with particular emphasis on the relationship between eating disorders (particularly bulimia) and obsessive-compulsive disorder. The empirical studies on comorbidity, personality and familiarity are briefly reviewed. Both similarities and differences found in personality, body image, mental rumination, fears, physical exercises, rituals, impulses (bulimic binging and obsessive impulses) and purging behaviors of these patients are discussed from a psychopathological point of view. In particular the importance of distinguishing between obsessive thoughts and prevalent (dominant) thoughts is underlined; the distinctions between repetitive weight controls, physical exercises and purging behaviors of eating disorder patients on the one hand and compulsions on the other, and the distinction between binge impulses and obsessive impulses, are also stressed.

The evaluation of eating and weight symptoms in the general hospital consultation setting

Eating disorders (ED) in the medically ill population have seldom been studied. The objective of this study is to review a series of medical and surgical patients referred for psychiatric evaluation for a presumed ED. Between 1982 and 1990, a series of 65 patients were referred for psychiatric consultation to evaluate for an ED. All patients records were reviewed for demographic, medical, and psychiatric information, including medical course following the consultation. Sixty-three percent of the study population were referred by internal medicine services. The most common presenting symptoms were self-induced vomiting (39.1%), binge eating (34.4%) and weight loss (31.3%). Bulimia nervosa (n = 21), anorexia nervosa (n = 19), and no psychiatric diagnosis (n = 18) were the most frequent diagnoses. Record review suggested significant challenges to accurate eating disorder diagnoses in patients presenting with primary medical complaints.

Conscious and preconscious processing of food, body weight and shape, and emotion-related words in women with anorexia nervosa

OBJECTIVE

The present study was conducted to extend prior research on attention toward food and body weight and shape-related stimuli in women with eating disorders.

METHOD

A modified Stroop color-naming task was completed by women with anorexia nervosa and by control females subdivided on a measure of dietary restraint. Eating disorder-relevant word categories included words connoting fatness, words connoting thinness, low caloric density food words, high caloric density food words, and neutral, control words. Valence effects were controlled for by including positively and negatively valenced emotion words. Stimuli were presented under both unmasked and masked conditions.

RESULTS

Using unmasked stimuli, patients with anorexia nervosa, but not unrestrained or restrained eaters, had delayed color-naming latencies for both thin and fat word categories and, to a lesser extent, for high caloric density food words. No differences were observed with masked stimuli.

DISCUSSION

Our findings suggest that both thinness and fatness are especially salient to women with anorexia. The lack of effects for emotion words suggests that these findings do not reflect a valence effect. We found no evidence for preconscious attentional biases in the masked condition.

HIV-1 seropositivity and eating disorders: a case report

We report a case of bulimia nervosa in a 21-year-old HIV-positive woman whose seropositivity provoked sustained motivation for recovery from her eating disorder. To the authors' knowledge, this is the first report of HIV-1 seropositivity leading to a clinical improvement in an eating disorder. We review the literature, in which the negative impact of seropositivity has been emphasized, and we explore the complex interaction between eating disorders and HIV-1 infection, considering both nutritional and psychological factors.

Adolescent ballet school students: their quest for body weight change

Body mass index (BMI) and body type of female and male adolescent ballet dancers (n = 90) and school students (n = 156) were determined. Participants were asked for the body weight she or he would prefer, and ballet students were administered the Eating Attitudes Test-40 (EAT-40). Results between age groups and with reference values were compared. Both in dancers and controls, girls wanted to lose more body weight than boys, with female ballet dancers more than female controls. The desire for reducing body weight was expressed by female ballet dancers of all BMI percentiles and body types, with the highest difference between real and desired body weight in 11-, 13-, and 16-year-olds. In the other groups, a quest for lower body weight was expressed only by adolescents of higher BMI and pyknomorphic and/or mesomorphic body type. Female ballet dancers of all age groups sought to reach body weights below the 5th percentile or below 82% of normal body weight. Desired body weight change was influenced by BMI and body type and correlated positively with EAT-40 score.

Light therapy in the clinical management of an eating-disordered adolescent with winter exacerbation

A 17-year-old female followed for atypical eating disorder characterized by restriction was noted to worsen medically during winter months in each of 2 consecutive years. A trial of bright light therapy was initiated during the second admission. Within days of light treatment, the patient showed signs of clinical improvement in mood and eating. Within 1 month of light treatment, the patient's depression ratings decreased from a Beck Depression Inventory (BDI) score of 37 (severe) to 17 (mild/moderate). In addition, her eating improved moderately as revealed both by a slight decrease in Eating Attitudes Test (EAT) score (78 to 64) and by significant improvements in dietary intake and medical status. The present report suggests that light therapy may be a useful adjunct in the clinical management of eating-disordered youth who present with seasonal patterns of exacerbation. Controlled studies of light treatment in younger eating disorder populations are warranted.

Anorexia nervosa following gastric reduction surgery for morbid obesity

Anorexia nervosa and morbid obesity are popularly considered to be opposite ends of the eating disorder spectrum. Research and clinical experience, however, suggest common psychological factors in a subgroup of obese people. This paper details case reports of two subjects who developed anorexia nervosa following gastric reduction surgery for morbid obesity. Clinical profiles, treatment, and outcome are reported. Psychological similarities between morbid obesity and anorexia nervosa in these subjects are explored. Implications for the selection of subjects for gastric reduction surgery and management after surgery are discussed.

Is your next young patient pre-anorexic or pre-bulimic?

Eating disorders often have their roots in the preteen years. Pediatric dentists may provide the initial warning for the care of these youngsters. An introduction is provided to the demographics, diagnosis, and treatment of anorexic and bulimic young females (primarily) and males.

Mothers with anorexia nervosa who underfeed their children: their recognition and management

BACKGROUND

Women with anorexia nervosa have a reduced fertility but they may have borne children before the onset of their illness or after partial recovery. Little is known on how to identify the anorexic mothers who underfeed their children and how to manage them. This article aims to remedy these gaps.

METHODS

The clinical scientific method is the only means of identifying the children of anorexic mothers who are at risk. Eight such mothers were identified as a result of obtaining serial measurements of the children's weights and heights over time. Tanner-Whitehouse charts were used to plot weight for age and height for age. A simple rating scale was devised to measure the acceptance of treatment involving both mother and child.

RESULTS

Nine children (eight boys and one girl) were found to have suffered food deprivation: with severe reduction in weight-for-age in six and in height-for-age in eight. Five siblings were not affected. Catch-up growth was correlated with the degree of engagement in treatment of both mother and child. Long-term treatment of one mother, combining family therapy with admissions to hospital, resulted in catch-up growth in her two sons.

CONCLUSIONS

The mechanisms underlying the privation of the children stem from the anorexic mother's abnormal concerns with body size extending to her children. The children may become unduly accepting of the underfeeding. It is essential to obtain the confidence of anorexic mothers suspected of underfeeding their children and to adopt a whole family approach to treatment.

[Anorexia nervosa in a patient with type-1 diabetes mellitus]

Female patient, 21 years of age, with diabetes mellitus type I, admitted due to progressive weight loss, with a recent history of impaired glycemic control, ketosis and amenorrhea for 12 months. Studies were conducted in order to exclude an endocrine or malignant disorder. After nutritional, endocrine and psychiatric evaluation, the diagnosis of anorexia nervosa, was made. Therapeutic results and clinical course after the first year are shown. The case raises important problems, especially within diabetic population, puzzling the clues for diagnosis and therapy.

[Mental anorexia]

After a brief theoretical introduction on mental anorexia the authors present a clinical case with this pathology, a male patient, which is rare in this pathology, who had been admitted to the Psychiatric Department of S. Francisco Xavier Hospital in 1994. Firstly the authors present a brief chronological summary of the patient's history in order to focus on the insidious development of this pathological process with increasing severity. Secondly the essential features of the disease are explained for the clinical evaluation of this patient. Finally the therapeutic approach is presented, drafted in a multidisciplinary perspective.

Normal and neurotic perfectionism in eating disorders: an interactive model

OBJECTIVE

Previous nonclinical research found that both normal (or adaptive) and neurotic (or maladaptive) perfectionism were related, in the positive direction, to attitudes and behaviors associated with eating disorders. However, based on a related body of research, it was hypothesized that these two aspects of perfectionism would relate to body esteem in an interactive rather than an additive fashion.

METHOD

Anorexic and bulimic patients (n = 123) were assessed on multidimensional aspects of perfectionism, neuroticism, and body esteem.

RESULTS

Predictions were confirmed. Normal perfectionism was positively associated with body esteem, but only when levels of neurotic perfectionism were low. Conversely, body-image disparagement was most pronounced when normal and neurotic perfectionism were both elevated.

DISCUSSION

These findings demonstrate that the interpretation of simple relationships among personality variables--at least in the area of body image and eating disorder research--may provide a misleading picture.

Beyond body image: the integration of feminist and transcultural theories in the understanding of self starvation

OBJECTIVE

The present study represents an intersection between cross-cultural theorizing and teminist scholarship. It is an attempt to provoke as well as augment prevailing biomedical models that esteem fear of fatness as the primary motivation for voluntary starvation in anorexic women.

METHOD

Recent studies of eating disturbance in both Eastern and Western societies are invoked to demonstrate the ways in which women straddling two worlds, be it generational, work-family, cultural or traditional and modern, may employ food denial as an instrumental means of negotiating the transition, disconnection, and oppression that they uniformly endure.

RESULTS

A feminist/transcultural interpretation of the literature suggests that by construing anorexia nervosa as a body image disorder or Western culture-bound syndrome, extant models miss the broader contexts and varied meanings of food refusal.

DISCUSSION

The implications of cross-disciplinary perspectives for theory building and treatment are discussed, acknowledging not only the gendered nature of eating disorders but their embodiment of power differentials as well.

Psychosocial factors in the onset of eating disorders: responses to life-events and difficulties

A number of studies have proposed a role for stress in the onset of eating disorders. Initially the focus was on the life-events and difficulties themselves. However, the aim of this study was to examine the coping and support elicited in response to the crises that precipitate onset of eating disorders. Thirty-two women who had developed an eating disorder within four years of presentation were administered semi-structured interviews asking about events and difficulties in the year before onset, as well as how they coped and the support they received. Twenty women with no history of eating disorders acted as a comparison group. Results show that the onset of anorexic symptoms is associated with cognitive avoidance in response to a crisis while the onset of bulimic symptoms is associated with cognitive rumination. In addition, women who developed an eating disorder were more likely to be helpless in response to the crisis than women who did not develop an eating disorder. It is concluded that coping interventions may be useful in terms of primary and relapse prevention.

Family functioning and life events in the outcome of adolescent anorexia nervosa

BACKGROUND

This study investigates the outcome of anorexia nervosa in adolescents in relation to precipitating life events and changes in family functioning over time.

METHOD

Thirty-five adolescents with anorexia nervosa and their mothers were administered measures of life events and family functioning at initial assessment and 1 and 2 year follow-up, when outcome was also assessed.

RESULTS

Fifty-five per cent of patients had a good outcome. Patients from initially well-functioning families or those with precipitating life events improved more in the first year, than those with dysfunctional families or without events. Subjects perceived a deterioration in family functioning at 1 year follow-up but an improvement at 2 years. Mothers reported no changes.

CONCLUSIONS

Approximately half of a series of early onset cases of anorexia nervosa can be expected to recover by 2 years. Healthy family functioning and presence of a precipitating life event predict good short-term outcome. The relationships between subjects' perceptions of family functioning and their recovery from anorexia nervosa is discussed.

Cultural and historical aspects of eating disorders

A review of cultural and historical accounts of anorexia nervosa indicates that this disorder is found primarily in Westernized societies during periods of relative affluence and greater social opportunities for women. Some hypotheses regarding the vulnerability to eating disorders are proposed to the basis of these data.

Eating disorders and the dental practitioner

Eating disorders are an increasing problem for society and the medical professions. The dental practitioner has an important role both in identifying the illnesses and in minimising its affects on the dentition. This paper highlights the features of the most common eating disorders and discusses the possible role of the dental profession in the long-term care of patients suffering from the problem.

The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study

OBJECTIVE

To assess the long-term course of recovery and relapse and predictors of outcome in anorexia nervosa.

METHOD

A naturalistic, longitudinal prospective design was used to assess recovery and relapse in patients ascertained through a university-based specialty treatment program. Patients were assessed semiannually for 5 years and annually thereafter over 10-15 years from the time of their index admission. Recovery was defined in terms of varying levels of symptom remission maintained for no fewer than 8 consecutive weeks.

RESULTS

Nearly 30% of patients had relapses following hospital discharge, prior to clinical recovery. However, most patients were weight recovered and menstruating regularly by the end of follow-up, with nearly 76% of the cohort meeting criteria for full recovery. Relapse after recovery was relatively uncommon. Of note, time to recovery was protracted, ranging from 57-79 months depending on definition of recovery. Among restrictors at intake, nearly 30% developed binge eating, occurring within 5 years of intake. A variety of predictors of chronic outcome and binge eating were identified. There were no deaths in the cohort.

CONCLUSION

The course of anorexia nervosa is protracted. Predictors of outcome are surprisingly few, but those identified are in keeping with previous accounts. The intensive treatment received by these patients may account for the lower levels of morbidity and mortality when considered in relation to other reports in the follow-up literature.

MCMI-II personality scale scores among women with anorexia nervosa or bulimia nervosa

Issues of personality psychopathology among women who experience eating disorders are of interest to both researchers and clinicians. The MCMI-II (Millon, 1987) may be a useful instrument for use with this population as it measures 13 categories of personality psychopathology. It is surprising to note that no report of MCMI-II scores among women with eating disorders has been published. In this study, adult women with anorexia nervosa, restricting type (n = 27) or binge-eating/purging type (n = 33), or bulimia nervosa, purging type (n = 105), completed the MCMI-II at initial assessment. Significant differences were found as a function of diagnostic group and the overall pattern of elevated scores illustrated prominent personality features of the sample as a whole. Results are discussed with regard to congruence with previous research and the potential implications for understanding the psychodynamics of eating disorders.