Eating disorders in a national sample of hospitalized female and male veterans: detection rates and psychiatric comorbidity

Male eating disorders in midlife-possible links between excessive sports and hormones

Although eating disorders were long considered a typical female disorder, it is now clear that men are also affected. However, the literature on eating disorders in men is still very limited, and the actual extent is not known. Even less is known about the epidemiology of eating disorders in older individuals. In this focused review, we will present an update of the available data on disordered eating and eating disorders in middle-aged and older males. In addition, we will highlight the relationship of eating disorders with excessive sports as a purging method of choice for this age group and discuss the impact of age-related hormonal imbalances in aging men.

Eating disorders and disordered eating in servicemen and women: A narrative review

OBJECTIVE

Eating disorders (EDs) are mental illnesses impacting all aspects of an individual's life. Recent research has examined EDs and disordered-eating behaviors in the military, a population subject to body composition standards, fitness requirements, and extreme stress. The purpose of this narrative review was to investigate ED and disordered-eating prevalence and their risk factors in ROTC (reserve officers' training corps), active-duty, and veteran servicemembers. The secondary purpose was to provide policy recommendations to reduce the burden of these conditions in the military.

METHODS

PubMed and PsycINFO were reviewed for relevant articles. All studies including data on EDs or disordered eating in U.S. active-duty, ROTC, or veteran populations were considered.

RESULTS

Results revealed a high burden of EDs and disordered eating with bulimic- and binge-type behaviors being the most common. Servicemembers exposed to trauma, including military sexual assault, and those with comorbidities like PTSD showed a higher prevalence. Body composition and fitness testing were also associated with a higher risk. Qualitative studies suggest these conditions serve as coping mechanisms for aspects of military life.

CONCLUSIONS

The high prevalence of EDs and disordered eating in the military points toward the importance of identification, treatment, and prevention. Policy change is necessary to protect servicemembers.

Management of eating disorders for people with higher weight: clinical practice guideline

INTRODUCTION

The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population.

AIM

The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations.

METHODS

The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the 'Guidelines for Guidelines' process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience.

RECOMMENDATIONS

Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed.

CONCLUSIONS

This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.

Prevalence of Personality Disorders Across Veteran Samples: A Meta-Analysis

Despite priorities around mental health, Veteran health care organizations have historically considered personality disorders to be preexisting conditions ineligible for disability benefits. However, growing evidence suggests potentially elevated prevalence of these disorders among military and Veteran samples and attests to implications of risk. The current study provides a meta-analytic review of literature on the prevalence of personality disorders in Veteran samples. Analysis of 27 unique samples, comprising 7,161 Veterans, suggests alarmingly high rates of Veteran personality disorders. Prevalence was highest for paranoid (23%) and borderline (21%) personality disorders and lowest for histrionic (0.8%) personality disorder. Rates were generally highest among Veterans experiencing substance use or elevated suicide risk and among studies establishing diagnoses through clinical interview (versus official medical record review). Results attest to the need for Veteran health care organizations to acknowledge personality disorders in this population, through both research and treatment, and to consider reclassifying personality disorders as potential "service-connected conditions."

Disordered eating in sexual minority post-9/11 United States veterans

OBJECTIVE

It is well documented that sexual minority individuals are more likely to report disordered eating (DE) than those identifying as heterosexual. Although DE is prevalent in veterans, investigation of potential disparities in DE among sexual minority veterans is limited. This study examined rates of DE in post-9/11 United States (U.S.) veterans identifying as sexual minorities and explored their association with discrimination because of marginalized identities.

METHODS

A national sample of recently separated post-9/11 U.S. veterans were recruited. Women (N = 805; heterosexual [n = 656]; lesbian [n = 51]; bisexual [n = 98]) and men (N = 558; heterosexual [n = 540]; gay [n = 11]; bisexual [n = 7]) completed a survey assessing eating behaviors, mental health, and military experiences. Weighted correlational and regression analyses were conducted. Analyses in men were exploratory.

RESULTS

DE was prevalent across gender and sexual orientation identity groups. Women identifying as bisexual and men identifying as gay reported higher rates of DE and consequent impairment compared to veterans who identified as heterosexual. There were no differences in DE between heterosexual and lesbian female veterans, but lesbian women reported lower DE-related impairment. Experiencing any discrimination in the military was positively related to DE.

DISCUSSION

This study found evidence of disparities in DE among sexual minority U.S. military veterans. While the factors contributing to these differences, such as the role of discrimination, are not completely understood, DE is a health concern for sexual minority veterans and requires continued investigation.

PUBLIC SIGNIFICANCE

Sexual minority individuals experience disparities in disordered eating; yet, this has not been explored in military veterans. This study found that disordered eating is a significant health concerns for veteran women and men, especially among those identifying as sexual minorities. More research is needed to explore why these disparities exist, such as the role of minority stress, in order to address the unique healthcare needs of these veterans.

Prevalence of eating disorders and comorbid psychopathology in a US sample of treatment-seeking veterans

OBJECTIVE

Eating disorders (EDs) are a well-studied public health issue in the general population. Less is known, however, about the prevalence of such conditions and levels of comorbid psychopathology among military and veteran populations. The current study sought to describe the probable prevalence of EDs and levels of comorbid psychopathology using a racially diverse treatment-seeking sample of US veteran men and women.

METHOD

Veterans (N =254) presenting for routine clinical care completed self-report questionnaires assessing EDs, posttraumatic stress disorder, depression, and shame.

RESULTS

Thirty-one percent of the sample met probable criteria for either bulimia nervosa (BN), binge-eating disorder, or purging disorder. Although overall ED prevalence estimates were similar across men and women, estimates of BN were higher among Black veterans compared to White veterans or veterans who identified as a race other than Black or White. Further, mean levels of psychopathology were significantly higher in veterans with a probable ED compared to those without.

DISCUSSION

This study extends previous research and highlights the importance of establishing dedicated ED screening programs within the Veterans Health Administration.

DSM-5 eating disorder prevalence, gender differences, and mental health associations in United States military veterans

OBJECTIVE

Little is known about prevalence estimates of new and revised DSM-5 eating disorders diagnoses in general, and especially among high-risk, underserved and diverse eating disorder populations. The aim of the current study was to determine prevalence, gender differences and correlates of DSM-5 eating disorders in veterans.

METHOD

Iraq and Afghanistan war era veterans (N = 1,121, 51.2% women) completed the Eating Disorder Diagnostic Scale-5 and validated measures of eating pathology and mental health between July 2014 and September 2019.

RESULTS

Overall more women than men (32.8% vs. 18.8%, p < .001) reported symptoms consistent with a DSM-5 eating disorder. Prevalence estimates (women vs. men) for the specific diagnoses were: Anorexia Nervosa (AN; 0.0% vs. 0.0%), Bulimia Nervosa (BN; 6.1% vs. 3.5%), Binge-Eating Disorder (BED; 4.4% vs. 2.9%), Atypical AN (AAN; 13.6% vs. 4.9%), Subclinical BN (0.0% vs. 0.2%), Subclinical BED (1.4% vs. 0.6%), Purging Disorder (2.1% vs. 0.7%), and Night Eating Syndrome (NES; 5.2% vs. 6.0%). Women were more likely to have BN or AAN, and there was no difference for BED or NES among genders. The eating disorder group had a higher mean BMI, and significantly greater eating pathology and mental health symptoms than the non-eating disorder group.

DISCUSSION

Approximately one-third of women, and one-fifth of men, reported symptoms consistent with a DSM-5 eating disorder diagnosis. These high prevalence estimates across genders, and associated mental health concerns, suggest an urgent need to better understand and address eating disorders in military and veteran populations.

Correlates of suicidal thoughts and attempts in males engaging in muscle dysmorphia or eating disorder symptoms

OBJECTIVE

Despite the high rates of suicidality in body dysmorphic disorder and eating disorders (EDs), research on suicidality in a related disorder, muscle dysmorphia (MD), is essentially nonexistent. Thus, this study tested relations between suicidal thoughts and behaviors and MD and ED symptoms in an online male community sample.

METHOD

A total of 464 males (M_age  = 40.3; 85% Caucasian) recruited from Amazon's Mechanical Turk completed measures that evaluated ED symptoms, MD symptoms, current suicidal ideation, and past suicide attempts.

RESULTS

Most MD and ED symptoms were correlated with current suicidal ideation and previous suicide attempts. In multivariate regression models, vomiting and appearance intolerance remained significantly related to suicidal ideation, while hard exercise and lower functional impairment were significantly related to prior suicide attempts.

CONCLUSION

Results indicate that appearance dissatisfaction, a core MD criterion, and hard exercise, a common behavioral symptom of MD, are associated with suicidality.

Identifying Individuals with Eating Disorders Using Health Administrative Data

OBJECTIVE

Eating disorders are common and have a high public health burden. However, existing clinically relevant data sources are scarce, limiting the capacity to accurately measure the burden of eating disorders. This study tests the feasibility of generating a large clinically relevant cohort of individuals with eating disorders using health administrative data.

METHODS

We developed 3 clinically relevant eating disorder prevalence cohorts using health administrative data from Ontario, Canada, between 1990 and 2014. Cohort 1 included patients with a hospitalization where an eating disorder diagnosis was the primary diagnosis, cohort 2 included patients with a hospitalization where an eating disorder diagnosis was any diagnosis, and cohort 3 included cohort 2 plus any patient with an emergency department visit with an eating disorder diagnosis.

RESULTS

Cohort 1 had 7268 patients, cohort 2 had 13,197 patients, and cohort 3 had 17,373 patients. As cohort size increased, the proportion of eating disorder patients with diagnoses of bulimia nervosa and eating disorder not otherwise specified increased. Although the cohorts differed according to demographic and clinical characteristics, these differences were small compared to the degree to which they differed from the Ontario population.

DISCUSSION

It is feasible to use health administrative data to measure the clinically relevant burden of eating disorders. The cohorts differed significantly in the eating disorder diagnostic composition. Eating disorders have a high burden, but poor data availability has resulted in fewer public health-related eating disorders studies in comparison to other mental disorders. The use of administrative data can address this evidence gap.

Polygenic risk for schizophrenia, disordered eating behaviours and body mass index in adolescents

BACKGROUND

Recent studies suggest psychotic and eating disorders can be comorbid and could have shared genetic liability. However, this comorbidity has been overlooked in the epidemiological literature.AimsTo test whether polygenic risk scores (PRS) for schizophrenia are associated with disordered eating behaviours and body mass index (BMI) in the general population.

METHOD

Using data from the Avon Longitudinal Study of Parents and Children and random-effects logistic and linear regression models, we investigated the association between PRS for schizophrenia and self-reported disordered eating behaviours (binge eating, purging, fasting and excessive exercise) and BMI at 14, 16 and 18 years.

RESULTS

Of the 6920 children with available genetic data, 4473 (64.6%) and 5069 (73.3%) had at least one disordered eating and one BMI outcome measurement, respectively. An s.d. increase in PRS was associated with greater odds of having binge eating behaviours (odds ratio, 1.36; 95% CI 1.16-1.60) and lower BMI (coefficient, -0.03; 95% CI, -0.06 to -0.01).

CONCLUSIONS

Our findings suggest the presence of shared genetic risk between schizophrenia and binge eating behaviours. Intermediate phenotypes such as impaired social cognition and irritability, previously shown to be positively correlated in this sample with schizophrenia PRS, could represent risk factors for both phenotypes. Shared genetic liability between binge eating and schizophrenia could also explain higher rates of metabolic syndrome in individuals with schizophrenia, as binge eating could be a mediator of this association in drug-naïve individuals. The finding of an association between greater PRS and lower BMI, although consistent with existing epidemiological and genetic literature, requires further investigation.Declaration of interestNone.

Role of gender in the treatment experiences of people with an eating disorder: a metasynthesis

BACKGROUND

Traditionally perceived as a disorder of women, Eating Disorders (EDs) are known to have impacts on people irrespective of their gender. This study is designed to synthesise the available qualitative research studies to more broadly understand the diverse experiences of ED and their treatment, specifically in relationship to issues of gender.

METHODS

The methodology involved a systematic search and quality appraisal of the literature published after 1980 using terms that aimed to represent the primary concepts of "role of gender" and "treatment experiences" and "eating disorders". Nine qualitative studies met the inclusion criteria. Meta-themes were inductively generated through a synthesis of data across themes from the relevant included papers.

RESULTS

Analysis of data was constructed around three meta-themes, each with subthemes. The first meta-theme "Out of sight, out of mind" depicted the experience of gender issues that were marginalised in treatment. More specifically for transgender people, when gender issues were ignored by treatment providers, this frequently led to non-disclosure of their gender identity. Furthermore, men were less likely to be assessed for an eating disorder and within this context; diagnosis of an ED and referral to specialist treatment was frequently hindered. The second meta-theme "Lack of literacy among health care providers" focused on issues related to misdiagnosis of EDs, and the question of whether this was related to a lack of health literacy amongst health professionals. The final theme "Pathways into treatment that address stigma and other barriers" highlighted the need for the development of future treatment interventions address the complex social reality of the experiencing person, including questions of gender.

CONCLUSION

Gender issues impact upon the ED experience and require broader consideration in the development and evaluation of ED treatment interventions, including the further development of gender-informed interventions.

TRIAL REGISTRATION

Protocol registered on PROSPERO 2017 CRD42017082616.

Associations between healthcare use and disordered eating among female veterans

OBJECTIVE

Individuals with eating disorders (EDs) have considerable medical and psychiatric comorbidity as well as increased healthcare use and associated costs. However, EDs remain largely undetected and understudied among veteran populations, and EDs are not routinely screened for or treated in Veterans Affairs (VA) medical settings. Research elucidating the links between disordered eating and VA and non-VA healthcare use is needed to inform policy and practice for ED screening and treatment.

METHOD

Data regarding probable EDs and VA and non-VA healthcare use was obtained through a mail survey of 198 female veterans receiving care from VA.

RESULTS

A total of 21 participants (10.6%) met probable criteria for subthreshold anorexia nervosa, bulimia nervosa, or binge-eating disorder. Negative binomial regression models revealed that female veterans with EDs reported higher frequency of VA mental healthcare use and substance use disorder treatment, above and beyond the association of comorbid PTSD and depression symptoms.

DISCUSSION

These findings confirm the high probability that female veterans with EDs are utilizing significant VA mental health resources. Screening for EDs may be particularly important in VA medical and mental health settings.

Longitudinal associations between psychotic experiences and disordered eating behaviours in adolescence: a UK population-based study

BACKGROUND

Psychotic experiences might represent non-specific markers of poor mental health in adolescence. However, only a few predominantly cross-sectional studies have tested their association with disordered eating behaviours in adolescent and adult populations. The aim of this study was to explore the association between psychotic experiences at age 13 years, and disordered eating behaviours and body-mass index (BMI) at age 18 years.

METHODS

We used data from the Avon Longitudinal Study of Parents and Children, a longitudinal birth cohort based in Avon (England, UK) including mothers with an expected delivery date between April 1, 1991, and Dec 31, 1992, and their children. Psychotic experiences (such as delusions and hallucinations) and BMI were measured at clinical assessments when children were nearly aged 13 years, and data on disordered eating behaviours (ie, presence of binge eating, purging, fasting, or excessive exercise for weight loss; any of these behaviours [included to increase statistical power]; and number of behaviours [included to investigate severity]) were obtained via a postal questionnaire that used adapted questions from the Youth Risk Behaviour Surveillance System questionnaire at approximately age 18 years. For each outcome, we ran a univariable model and four multivariable models (logistic, linear [for BMI], or negative binomial [for the number of behaviours] regression), progressively adjusting for child and maternal sociodemographic, physical, and mental health characteristics (including child's sex, and maternal age, marital status, and highest academic qualification); autistic traits at age 7 years (measured with the Social and Communication Disorder Checklist); baseline BMI at age 13 years, and depressive symptoms at baseline (ie, at age 13 years when psychotic experiences were measured: childs' symptoms measured with the Moods and feelings Questionnaire, and maternal symptoms measured at 32 weeks' gestation with the Edinburgh Postnatal Depression Scale). We imputed missing outcome and covariate data.

FINDINGS

Our sample included 6361 children, of whom 734 (12%) reported psychotic experiences at age 13 years. In univariable models, psychotic experiences were associated with greater odds of reporting any disordered eating behaviours (odds ratio [OR] 1·92, 95% CI 1·46-2·52; p<0·0001), and more severe symptoms (as measured by the number of disordered eating behaviours: 0·58, 0·32-0·84; p<0·0001) at age 18 years. These associations were slightly attenuated by adjustment for maternal and child characteristics (any disordered eating behaviours OR 1·82, 95% CI 1·35-2·44, p<0·0001; number of disordered eating behaviours 0·49, 95% CI 0·23-0·75, p<0·00001), autistic traits at age 7 years (any disordered eating behaviours OR 1·80, 95% CI 1·34-2·41, p<0·0001; number of disordered eating behaviours 0·48, 95% CI 0·22-0·74, p<0·00001), and BMI (any disordered-eating behaviours OR 1·83, 95% CI 1·36-2·46, p<0·0001; number of disordered-eating behaviours 0·32, 95% CI 0·06-0·57, p<0·00001) Adjusting for baseline depressive symptoms attenuated, but not removed, these associations (any disordered eating OR 1·50, 95% CI 1·10-2·03, p=0·010; more severe symptoms 0·32, 0·06-0·57, p=0·017). Psychotic experiences were also associated with greater binge eating, purging, and fasting behaviours, although some associations weakened after controlling for depressive symptoms. We noted no associations between psychotic experiences and excessive exercise or BMI in any of the models.

INTERPRETATION

Our findings suggested that psychotic experiences are markers of increased risk for several disordered eating behaviours in late adolescence, possibly by indicating more severe psychopathology in early adolescence. More research investigating shared risk factors for psychotic experiences and eating disorders is warranted to elucidate shared and specific causal pathways.

FUNDING

Wellcome Trust, the Royal Society, University College London Hospitals National Institute for Health Research Biomedical Research Centre, UK Medical Research Council, and the University of Bristol.

Intimate partner violence and disordered eating among male and female veterans

Intimate partner violence (IPV) affects many women and men in the United States and has been associated with numerous mental health conditions, including disordered eating (DE). Veterans may be especially vulnerable to experiencing both of these serious problems given the unique aspects and stressors relevant to military culture, including high rates of trauma exposure. We aimed to estimate the prevalence of past-year IPV among independent samples of male (N = 642) and female (N = 198) veterans and to examine the association between past-year IPV and DE. Mplus 7.0 was used to estimate associations between multiple types of IPV and DE, controlling for age, body mass index, military sexual trauma, and other military trauma. Approximately 14.86% of male veterans and 12.79% of female veterans reported experiencing some form of past-year IPV. All forms of past-year IPV, including physical, sexual, and psychological/emotional, were significantly associated with DE in both samples, after adjusting for covariates. IPV was relatively common among male and female veterans, and those who experience IPV may be particularly vulnerable to DE. Findings extend the knowledge base regarding IPV and its health effects among an understudied population, and may be a catalyst for further research and clinical inquiry to target improving psychiatric care for male and female veterans who experience IPV.

Sex-specific issues in eating disorders: a clinical and psychopathological investigation

OBJECTIVE

To highlight the characteristics of eating disorders (ED) in males, with particular attention to sex-related clinical features and psychiatric co-morbidities.

METHOD

Out of 280 persons, referred to our outpatients ED clinic between January 2011 and June 2014, 267 with complete information were included in this retrospective observational study.

RESULTS

The men/women ratio was one to five (male 16.5% vs female 83.5%) with an increasing proportion of male patients over the years. The most frequent ED in males was binge eating disorder, whereas in females anorexia nervosa and bulimia nervosa prevailed. Excessive exercising and fasting were the most common compensation behaviours in males; while self-induced vomiting and laxative-diuretic abuse were more typical in females. Among women, the most represented psychiatric co-morbidities were mood and somatoform disorders, whereas among men, anxiety and psychosis spectrum disorders were the most frequent ones. Borderline and histrionic personality disorders were prevalent in female ED, while narcissistic and antisocial personality disorders prevailed in males.

DISCUSSION

ED in men is a growing phenomenon. Male ED, compared to female ED, show differences in clinical presentation, symptoms and co-morbidities. Despite the use of clinical and psychometric evaluating tools targeting female patients, sex differences do exist and additional studies are required to investigate male specific issues in ED. Level of Evidence Level V, cross-sectional descriptive study.

Posttraumatic Stress Disorder Symptoms and Problematic Overeating Behaviors in Young Men and Women

BACKGROUND

Posttraumatic stress disorder (PTSD) is a risk factor for obesity, but the range of behaviors that contribute to this association are not known.

PURPOSE

The purpose of this study was to examine associations between self-reported PTSD symptoms in 2007, with and without comorbid depression symptoms, and three problematic overeating behaviors in 2010, and to estimate the associations of PTSD-related overeating behaviors with obesity.

METHODS

Cross-sectional and longitudinal analyses included 7438 male (n = 2478) and female (n = 4960) participants from the Growing Up Today Study (mean age 22-29 years in 2010). Three eating behavior outcomes were assessed: binge eating (eating a large amount of food in a short period of time with loss of control), top quartile of coping-motivated eating (from the Motivations to Eat scale), and top quartile of disinhibited eating (from the Three-Factor Eating Questionnaire).

RESULTS

PTSD symptoms were associated with two- to threefold increases in binge eating and top-quartile coping-motivated eating; having ≥4 PTSD symptoms, relative to no PTSD symptoms, was associated with covariate-adjusted RRs of 2.7 (95% CI 2.1, 3.4) for binge eating, 2.1 (95% CI 1.9, 2.4) for the top quartile of coping-motivated eating, and 1.5 (95% CI 1.3, 1.7) for the top quartile of disinhibited eating. There was a trend toward PTSD symptoms in 2007 predicting new onset binge eating in 2010. Having depression symptoms comorbid with PTSD symptoms further increased risk of binge eating and coping-motivated eating. All eating behaviors were associated with obesity.

CONCLUSION

Clinicians treating patients with PTSD should know of potential comorbid problematic eating behaviors that may contribute to obesity.

Reducing the burden of suffering from eating disorders: Unmet treatment needs, cost of illness, and the quest for cost-effectiveness

Eating disorders are serious mental disorders as reflected in significant impairments in health and psychosocial functioning and excess mortality. Despite the clear evidence of clinical significance and despite availability of evidence-based, effective treatments, research has shown a paradox of elevated health services use and, yet, infrequent treatment specifically targeting the eating disorder (i.e., high unmet treatment need). This review paper summarizes key studies conducted in collaboration with G. Terence Wilson and offers an update of the research literature published since 2011 in three research areas that undergirded our collaborative research project: unmet treatment needs, cost of illness, and cost-effectiveness of treatments. In regards to unmet treatment needs, epidemiological studies find that the number of individuals with an eating disorder who do not receive disorder-specific treatment continues to remain high. Cost-of-illness show that eating disorders are associated with substantial financial burdens for individuals, their family, and society, yet comprehensive examination of costs across public sectors is lacking. Cost measures vary widely, making it difficult to draw firm conclusions. Hospitalization is a major driver of medical costs incurred by individuals with an eating disorder. Only a handful of cost-effectiveness studies have been conducted, leaving policy makers with little information on which to base decisions about allocation of resources to help reduce the burden of suffering attributable to eating disorders.

Psychotic-like experiences and disordered eating in the English general population

There are no studies on psychotic-like experiences (PLEs) and disordered eating in the general population. We aimed to assess this association in the English adult population. Data from the 2007 Adult Psychiatric Morbidity Survey (APMS) were analyzed. This was a nationally representative survey comprising 7403 English adults aged ≥16 years. The Psychosis Screening Questionnaire was used to identify the past 12-month occurrence of five forms of psychotic symptoms. Questions from the five-item SCOFF screening instrument were used to identify those with eating disorder (ED) symptoms and possible ED in the past year. The prevalence of any PLE was 5.1% (female) and 5.4% (male), while that of possible ED was 9.0% (female) and 3.5% (male). After adjustment for potential confounders, possible ED was associated with hypomania/mania in females (OR=3.23 95%CI=1.002-10.39), strange experiences [females (OR=1.85 95%CI=1.07-3.20) and males (OR=3.54 95%CI=1.65-7.57)], and any PLE in males (OR=3.44 95%CI=1.85-6.39). An interaction analysis revealed that the association was stronger among males for: auditory hallucinations and uncontrolled eating; and any PLE with uncontrolled eating, food dominance, and possible ED. Clinical practitioners should be aware that PLEs and disordered eating behavior often coexist. When one condition is detected, screening for the other may be advisable, especially among males.

Longitudinal Associations Among Posttraumatic Stress Disorder, Disordered Eating, and Weight Gain in Military Men and Women

Obesity is a major health problem in the United States and a growing concern among members of the military. Posttraumatic stress disorder (PTSD) has been associated with overweight and obesity and may increase the risk of those conditions among military service members. Disordered eating behaviors have also been associated with PTSD and weight gain. However, eating disorders remain understudied in military samples. We investigated longitudinal associations among PTSD, disordered eating, and weight gain in the Millennium Cohort Study, which includes a nationally representative sample of male (n = 27,741) and female (n = 6,196) service members. PTSD at baseline (time 1; 2001-2003) was associated with disordered eating behaviors at time 2 (2004-2006), as well as weight change from time 2 to time 3 (2007-2008). Structural equation modeling results revealed that the association between PTSD and weight change from time 2 to time 3 was mediated by disordered eating symptoms. The association between PTSD and weight gain resulting from compensatory behaviors (vomiting, laxative use, fasting, overexercise) was significant for white participants only and for men but not women. PTSD was both directly and indirectly (through disordered eating) associated with weight change. These results highlight potentially important demographic differences in these associations and emphasize the need for further investigation of eating disorders in military service members.

Assessment of Eating Disorders in Women

This article reviews current eating disorder self-report and interview measures and makes recommendations for choosing assessment devices for practice and research. The authors also incorporate overviews of related measures, such as body satisfaction and restrained eating. The presentation of women with eating disorders on measures of general psychological functioning (such as the Minnesota Multiphasic Personality Inventory) is also discussed. Implications and recommendations for practice are presented, as are recommendations for future research. The lack of validation of, and urgent need for, eating disorder assessment measures with ethnic minority women is discussed throughout.

Characteristics and use of treatment modalities of patients with binge-eating disorder in the Department of Veterans Affairs

OBJECTIVE

In 2013 binge-eating disorder (BED) was recognized as a formal diagnosis, but was historically included under the diagnosis code for eating disorder not otherwise specified (EDNOS). This study compared the characteristics and use of treatment modalities in BED patients to those with EDNOS without BED (EDNOS-only) and to matched-patients with no eating disorders (NED).

METHODS

Patients were identified for this study from electronic health records in the Department of Veterans Affairs from 2000 to 2011. Patients with BED were identified using natural language processing and patients with EDNOS-only were identified by ICD-9 code (307.50). First diagnosis defined index date for these groups. NED patients were frequency matched to BED patients up to 4:1, as available, on age, sex, BMI, depression, and index month encounter. Baseline characteristics and use of treatment modalities during the post-index year were compared using t-tests or chi-square tests.

RESULTS

There were 593 BED, 1354 EDNOS-only, and 1895 matched-NED patients identified. Only 68 patients with BED had an EDNOS diagnosis. BED patients were younger (48.7 vs. 49.8years, p=0.04), more were male (72.2% vs. 62.8%, p<0.001) and obese (BMI 40.2 vs. 37.0, p<0.001) than EDNOS-only patients. In the follow-up period fewer BED (68.0%) than EDNOS-only patients (87.6%, p<0.001), but more BED than NED patients (51.9%, p<0.001) used at least one treatment modality.

DISCUSSION

The characteristics of BED patients were different from those with EDNOS-only and NED as was their use of treatment modalities. These differences highlight the need for a separate identifier of BED.

Binge Eating among Women Veterans in Primary Care: Comorbidities and Treatment Priorities

BACKGROUND

Little is known about the clinical profile and treatment priorities of women with binge eating disorder (BED), a diagnosis new to the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. We identified comorbidities and patients' treatment priorities, because these may inform implementation of clinical services.

METHODS

Data were collected from women veteran primary care patients. Analyses compared those who screened positive for BED (BED+), and those without any binge eating symptoms (BED-).

RESULTS

Frequencies of comorbid medical and psychological disorders were high in the BED+ group. The BED+ group's self-identified most common treatment priorities were mood concerns (72.2%), weight loss (66.7%), and body image/food issues (50%). Among those with obesity, a greater proportion of the BED+ group indicated body image/food issues was their top treatment priority (12.9% vs. 2.8%; p < .01), suggesting that these patients may be more apt to seek treatment beyond weight management for their problematic eating patterns.

CONCLUSIONS

Women primary care patients with BED demonstrate high medical and psychological complexity; their subjective treatment priorities often match objective needs. These findings may inform the development of targeted BED screening practices for women with obesity in primary care settings, and the eventual adoption of patient-centered BED treatment resources.

Healthcare costs and resource utilization of patients with binge-eating disorder and eating disorder not otherwise specified in the Department of Veterans Affairs

OBJECTIVE

The objective of this study was to compare the one-year healthcare costs and utilization of patients with binge-eating disorder (BED) to patients with eating disorder not otherwise specified without BED (EDNOS-only) and to matched patients without an eating disorder (NED).

METHODS

A natural language processing (NLP) algorithm identified adults with BED from clinical notes in the Department of Veterans Affairs (VA) electronic health record database from 2000 to 2011. Patients with EDNOS-only were identified using ICD-9 code (307.50) and those with NLP-identified BED were excluded. First diagnosis date defined the index date for both groups. Patients with NED were randomly matched 4:1, as available, to patients with BED on age, sex, BMI, depression diagnosis, and index month. Patients with cost data (2005-2011) were included. Total healthcare, inpatient, outpatient, and pharmacy costs were examined. Generalized linear models were used to compare total one-year healthcare costs while adjusting for baseline patient characteristics.

RESULTS

There were 257 BED, 743 EDNOS-only, and 823 matched NED patients identified. The mean (SD) total unadjusted one-year costs, in 2011 US dollars, were $33,716 ($38,928) for BED, $37,052 ($40,719) for EDNOS-only, and $19,548 ($35,780) for NED patients. When adjusting for patient characteristics, BED patients had one-year total healthcare costs $5,589 higher than EDNOS-only (p = 0.06) and $18,152 higher than matched NED patients (p < 0.001).

DISCUSSION

This study is the first to use NLP to identify BED patients and quantify their healthcare costs and utilization. Patients with BED had similar one-year total healthcare costs to EDNOS-only patients, but significantly higher costs than patients with NED.

Eating disorders in military and veteran men and women: A systematic review

OBJECTIVE

Eating disorders (EDs) have serious consequences for psychological and physical health. They have high mortality rates and are among the most costly disorders to treat. However, EDs remain understudied in military and veteran populations. The aim of this review was to examine prevalence estimates and associated symptomatology of EDs among military and veteran men and women and to identify factors that may put these individuals at risk for the development of an ED for the purposes of improving detection, intervention, and treatment.

METHOD

A thorough literature review was conducted using the databases PsycINFO and PubMed. All articles with a focus on EDs in military/veteran samples were considered.

RESULTS

Studies reveal high prevalence estimates of EDs among military/veteran men and women. Unique features of military life may increase the risk for development of an ED, including: military sexual trauma, strict weight and physical fitness requirements, and combat exposure. A history of trauma was common in individuals diagnosed with an ED in military and veteran samples.

DISCUSSION

The high rates of EDs among military and veteran samples underscore the importance of further research, as well as the importance of screening and intervention efforts, in these understudied populations.

Consequences of Making Weight: A Review of Eating Disorder Symptoms and Diagnoses in the United States Military

Eating disorders are serious psychiatric illnesses associated with health problems. Such problems may compromise military performance, highlighting the need to establish the level of eating pathology that exists in military samples. This article qualitatively reviews prevalence estimates of eating disorder symptoms and diagnoses in military samples, providing nonmilitary estimates for context. Findings suggest that eating disorder symptoms are prevalent in cadets and active duty service members, especially when using self-report measures. The increased salience of weight in the military and increased exposure to trauma may influence risk for eating disorders. Alternatively, individuals at risk for eating disorders may self-select into the military. Overall, this review suggests that eating disorder symptoms are common in military samples and that further research is warranted.

Eating disorder symptoms and comorbid psychopathology among male and female veterans

OBJECTIVE

Eating disorder (ED) symptoms have gone mostly unexamined among veterans. The current study assessed rates of bulimia nervosa (BN) and binge eating disorder (BED) symptoms and diagnoses and their associations with common comorbidities among male and female veterans.

METHOD

Participants were US military veterans who screened positive for trauma histories and/or a probable Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) posttraumatic stress disorder (PTSD) diagnosis (n=499). Symptoms of PTSD were assessed using the Clinician-Administered PTSD Scale, and symptoms of EDs, mood, and substance use disorders were assessed using the Structured Clinical Interview for the DSM-IV.

RESULTS

Lifetime rates of BN and BED diagnoses were comparable to civilian populations, and a considerable range of lifetime and current BN and BED symptoms were identified. In multivariate models, PTSD and depression severity were most consistently associated with BN and BED symptom severity, with depression most strongly associated with EDs for women.

CONCLUSIONS

Findings highlight the importance of screening for ED symptoms among male and female veterans, particularly those that present with PTSD and depression symptomatology. Future examinations of the temporal order of such relationships and the degree to which ED symptoms and associated symptoms impact veteran functioning are warranted.

A further validation of the Minnesota Borderline Personality Disorder Scale

Previous research indicates that borderline personality disorder (BPD) is well conceptualized as a dimensional construct that can be represented using normal personality traits. A previous study successfully developed and validated a BPD measure embedded within a normal trait measure, the Minnesota Borderline Personality Disorder Scale (MBPD). The current study performed a further validation of the MBPD by examining its convergent validity, external correlates, and heritability in a sample of 429 female twins. The MBPD correlated strongly with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) screener for BPD and moderately with external correlates. Moreover, the MBPD and SCID-II screener exhibited very similar patterns of external correlations. Additionally, results indicated that the genetic and environmental influences on MBPD overlap with the genetic and environmental influences on the SCID-II screener, which suggests that these scales are measuring the same construct. These data provide further evidence for the construct validity of the MBPD.

From disordered eating to addiction: the "food drug" in bulimia nervosa

The high prevalence of substance abuse in individuals with bulimia nervosa (BN) and the pervasive symptom substitution in many types of drug addiction suggest that a number of substances--including food--can impair an individual's self-control, even in the presence of negative consequences. Nonetheless, the neurobiological similarities between BN and drug addiction are not clearly established. This review explores how the specific eating patterns seen in BN (binge eating and purging, with intermittent dietary restriction) are particularly addictive and differentiate BN from other eating disorders and obesity. A number of peripheral and central biological aberrations seen in BN may result in altered reward sensitivity in these individuals, particularly through effects on the dopaminergic system. Neurobiological findings support the notion that BN is an addictive disorder, which has treatment implications for therapy and pharmacological manipulations.

Severe anorexia nervosa in men: comparison with severe AN in women and analysis of mortality

OBJECTIVE

To compare clinical characteristics of men and women with severe AN and to analyze mortality in men.

METHOD

One thousand and nine patients including 23 anorectic males were hospitalized in St. Anne Hospital in Paris between 1988 and 2004. Data were collected during hospitalization. Fatal outcome was assessed in 2008.

RESULTS

Men presented significantly later age of onset, were more likely to have a history of premorbid overweight than women and less likely to have attempted suicide. Mortality in men was high (standardized mortality ratio: 8.08; 95% CI: 1.62-23.62). Several predictive factors for mortality in men were identified: lower admission body mass index (BMI), later age at admission, and AN-R subtype. All the three deceased patients had dropped out from the inpatient unit. The 10-year survival did not differ between men and women, but men died sooner after hospitalization.

DISCUSSION

Male inpatients should receive close follow-up after their discharge, especially if they have a restrictive form of AN, present low BMI, or are older at admission.

The comorbidity between eating disorders and anxiety disorders: prevalence in an eating disorder sample and anxiety disorder sample

OBJECTIVE

To investigate the prevalence of comorbid eating and anxiety disorders in women presenting for inpatient and outpatient treatment of an eating disorder and women presenting for outpatient treatment of an anxiety disorder.

METHODS

The prevalence of comorbidity was investigated from a sample of 152 women, which included 100 women presenting for treatment of an eating disorder and 52 women presenting for treatment of an anxiety disorder.

RESULTS

Of women presenting for treatment of an eating disorder, 65% also met criteria for at least one comorbid anxiety disorder; 69% of these reported the onset of the anxiety disorder to precede the onset of the eating disorder. Of the anxiety disorders diagnosed, social phobia was most frequently diagnosed (42%) followed by post-traumatic stress disorder (26%), generalised anxiety disorder (23%), obsessive-compulsive disorder (5%), panic/agoraphobia (3%) and specific phobia (2%). We also found that 13.5% of women presenting for anxiety treatment also met criteria for a comorbid eating disorder. Furthermore, 71% (n = 5) reported the onset of the anxiety disorder to precede the onset of the eating disorder.

DISCUSSION

The results of this study suggest that the prevalence of eating and anxiety disorder comorbidity is high. The present research should improve the clinical understanding of the comorbidity between eating disorders and anxiety disorders. In particular, it is anticipated that this research will have significant aetiological and therapeutic implications especially with regard to improving the clinical effectiveness of psychological treatments for eating disorders and highlighting the importance of screening for eating pathology in the clinical assessment of anxiety disorders.

Early adult sexual assault and disordered eating: the mediating role of posttraumatic stress symptoms

Although adult sexual assault has been suggested to be a risk factor for disordered eating, little is known about the pathways leading to this disorder. This study aimed to examine the mediating effect of depressive symptoms and symptoms of posttraumatic stress disorder (PTSD), in the relationship between sexual assault and disordered eating among female students. A sample of 296 French female students completed a questionnaire assessing experiences of sexual assault from age 15, PTSD symptoms, depressive symptoms, and disordered eating. Results revealed that PTSD symptoms fully mediated the effect of early adult sexual assault on disordered eating (B = 1.10, SE = 1.64), and depressive symptoms were a partial mediator of this relationship (B = 2.64, SE = 1.28). When examining both mediators simultaneously the relationship was fully mediated and neither variable emerged as a significantly stronger mediator. Our findings highlight the complex relationship between PTSD symptoms, depressive symptoms, and disordered eating following sexual assault. Further investigation into the temporal relationships between these variables would contribute to inform prevention interventions for disordered eating.

Eating disorders and schizophrenia in male patients: a review

OBJECTIVE

To understand the comorbidity of schizophrenia and eating disorders (ED) in male patients.

METHOD

A review of the published literature was made via Med- Line using the following terms: "schizophrenia" or "psychosis" in association with "eating disorders", "anorexia nervosa", "binge eating" or "bulimia nervosa", in association with the terms "comorbidity" or "comorbidities" and finally in association with the term "male", "man" or "men".

RESULTS

Groups of male patients known to suffer from schizophrenia and screened for ED suffer essentially from anorexia nervosa (0.81%). Groups of male patients screened for anorexia nervosa and then for schizophrenia demonstrate high comorbidity prevalence (36%). In general, ED symptoms diminish with psychotic episodes and recur when the psychotic episode remits. A man with an ED has a 3.6 times more risk than a woman with an ED to have comorbid schizophrenia. In men, ED present atypical features so that ED not otherwise specified (EDNOS) is relatively frequent.

DISCUSSION AND CONCLUSION

Male patients described in the literature as suffering from schizophrenia and ED fall under one of four categories: a) acute psychotic episode related to organic causes due to malnutrition; b) male patients presenting with an ED who later develops schizophrenia; c) male patients known to suffer from schizophrenia and who develops distorted eating cognitions and disordered behaviors; d) male patients suffering from schizophrenia and developing a medication-induced ED.

Do men with eating disorders differ from women in clinics, psychopathology and personality?

OBJECTIVE

To determine if male and female eating disorders differ in clinics, psychopathology and personality traits when compared with a healthy group.

METHODS

Sixty male and 60 female eating disorder individuals (16% anorexia nervosa, 42% bulimia nervosa and 42% eating disorder not otherwise specified), matched for age and diagnostic, were compared with 120 healthy-eating participants (60 male and 60 female participants). All were diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Assessment measures included Eating Disorder Inventory--2, Symptom Checklist--Revised and Temperament and Character Inventory--Revised, as well as other clinical and psychopathological indices.

RESULTS

Male eating disorder participants reported significant lower laxative abuse (p = 0.020) and significant higher vomiting episodes (p = 0.019) than female eating disorder participants. Differences on drive for thinness, body dissatisfaction and some Symptom Checklist--Revised scales were found across genders in eating disorder participants. Male eating disorder participants scored significantly lower than female participants with eating disorders on harm avoidance, reward dependence and cooperativeness.

CONCLUSIONS

Although eating disorder clinical features were similar across genders, male eating disorder participants had less body image concern and general psychopathology than female eating disorder participants.

Comorbidity and age of onset of eating disorders in gay men, lesbians, and bisexuals

This study examines the prevalence of psychiatric disorders among lesbian, gay, and bisexual (LGB) men with eating disorders. A total of 388 white, black, and Latino LGB men and women were sampled from community venues. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of anorexia, bulimia, and binge eating disorder were assessed using the World Health Organization's Composite International Diagnostic Interview. Gay and bisexual men with eating disorders were more likely to have an anxiety or substance abuse disorder than gay and bisexual men without eating disorders, whereas lesbian and bisexual women with eating disorders were more likely to have a mood disorder than lesbian and bisexual women without an eating disorder. For individuals diagnosed with an eating and anxiety or major depressive disorder, the onset of the psychiatric disorder was more likely to precede the onset of the eating disorder. Researchers should study potential explanations of the relationship between eating and psychiatric disorders among LGB men and women.

Male eating disorders and therapy: a controlled pilot study with one year follow-up

OBJECTIVES

To examine whether outpatient treatment for male patients with bulimic symptomatology is as effective as it is for females.

METHOD

The outcome of 19 male patients was compared to that of 150 female eating disorder (ED) individuals after a group CBT treatment.

RESULTS

A reduction in ED symptomatology was observed after treatment for both genders. Main effects for gender indicated that after collapsing across the mean pre/post values, lower mean scores were found for men in the EAT-40, in the EDI-total score and in the following EDI subscales: "drive for thinness", "body dissatisfaction" and "interoceptive awareness".

CONCLUSIONS

A group CBT treatment appears to be effective for male and female ED patients.

A cross-lagged evaluation of eating disorder symptomatology and substance-use problems

OBJECTIVE

The purpose of this study was to conduct a temporal examination of the associations among disordered eating behaviors, substance use, and use-related negative consequences in female college students-a population at high risk for developing eating and substance-use disorders.

METHOD

Participants completed assessments of disordered eating behaviors, alcohol and drug use, and use-related negative consequences.

RESULTS

Results support previous research suggesting that disordered eating behaviors are more strongly associated with alcohol- and substance-related problems rather than use per se. With respect to temporal precedence, results indicated that binge eating preceded alcohol-use problems, but a bidirectional relationship was found for vomiting. With regard to drug problems, laxatives use preceded drug problems, whereas drug problems preceded fasting. These associations were not better accounted for by pre-existing eating or substance-use problems or psychiatric distress (e.g., depression, anxiety).

CONCLUSIONS

This study further supports the importance of assessing consequences, in addition to use patterns, when examining substance use in individuals demonstrating threshold and subthreshold eating-disordered behaviors.

Prospective associations between depressive symptoms and eating disorder symptoms among adolescent girls

OBJECTIVE

Although eating disorders are frequently associated with depression, evidence regarding which problem predicts the other is conflicting, and little research has addressed the developmental course of this relation. This study examined longitudinal associations between depression and eating pathology across adolescence.

METHOD

Participants were 754 girls participating in the community-based Minnesota Twin Family Study. Depressive symptoms and eating pathology were assessed at approximately ages 11, 14, and 17.

RESULTS

As expected, substantial continuity in both eating pathology and depressive symptoms occurred across time. Analysis of cross-lag paths controlling for earlier levels of symptoms indicated that overall levels of eating pathology predicted later depressive symptoms from 11 to 14 and from 14 to 17.

CONCLUSION

Adolescent girls with high levels of eating-related pathology appear to be at risk for later depression.

Eating disorders, trauma, and comorbidity: focus on PTSD

This paper reviews the relationships among eating disorders (EDs), trauma, and comorbid psychiatric disorders, with a particular focus on posttraumatic stress disorder (PTSD). There have been a number of significant conclusions in the literature, applicable to clinical practice, which are essential to the understanding of the relationships between EDs and trauma. These are summarized as follows: a) childhood sexual abuse (CSA) is a nonspecific risk factor for EDs; b) the spectrum of trauma linked to EDs has been extended from CSA to include a variety of other forms of abuse and neglect; c) trauma is more common in bulimic EDs compared to nonbulimic EDs; d) findings linking EDs with trauma have been extended to children and adolescents with EDs; e) findings linking EDs with trauma have been extended to boys and men with EDs; f) multiple episodes or forms of trauma are associated with EDs; g) trauma is not necessarily associated with greater ED severity; h) trauma is associated with greater comorbidity (including and often mediated by PTSD) in ED subjects; i) partial or subthreshold PTSD may also be a risk factor for BN and bulimic symptoms; and j) the trauma and PTSD or its symptoms must be expressly and satisfactorily addressed in order to facilitate full recovery from the ED and all associated comorbidity.

Eating disorders in diverse lesbian, gay, and bisexual populations

OBJECTIVE

This study estimates the prevalence of eating disorders in lesbian, gay, and bisexual (LGB) men and women, and examines the association between participation in the gay community and eating disorder prevalence in gay and bisexual men.

METHOD

One hundred and twenty six white heterosexuals and 388 white, black, Latino LGB men and women were sampled from community venues. DSM-IV diagnoses of anorexia, bulimia, and binge eating disorder were assessed using the World Health Organization's Composite International Diagnostic Interview.

RESULTS

Gay and bisexual men had significantly higher prevalence estimates of eating disorders than heterosexual men. There were no differences in eating disorder prevalence between lesbian and bisexual women and heterosexual women, or across gender or racial groups. Attending a gay recreational group was significantly related to eating disorder prevalence in gay and bisexual men.

CONCLUSION

Researchers should study the causes of the high prevalence of eating disorders among gay and bisexual men.

The co-morbidity of eating disorders and anxiety disorders: a review

OBJECTIVE

To critically review the literature examining the co-morbidity between eating disorders and anxiety disorders.

METHOD

A review of the literature on the co-morbidity between anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified and the anxiety disorders of OCD, PTSD, social anxiety, GAD, panic and agoraphobia.

RESULTS

Of the empirical studies undertaken, it is clear that anxiety disorders are significantly more frequent in subjects with eating disorders than the general community. Researchers have shown that often anxiety disorders pre-date eating disorders, leading to a suggestion that early onset anxiety may predispose individuals to developing an eating disorder. To date however, the research presents strikingly inconsistent findings, thus complicating our understanding of eating disorder and anxiety co-morbidity. Furthermore, despite indications that eating disorder prevalence amongst individuals presenting for anxiety treatment may be high, there is a distinct lack of research in this area.

DISCUSSION

This review critically examines the available research to date on the co-morbidity of eating disorders and anxiety disorders. Some of the methodological limitations of previous research are presented, in order to highlight the issues which warrant further scientific investigation in this area.

Beliefs and their relationship to eating attitudes and depressive symptoms in men

OBJECTIVE

The applicability of the cognitive model of eating disorders, particularly the role of deeper level beliefs, has not yet been investigated in men. The current study investigated the relationship between negative self-beliefs, underlying assumptions about weight, shape and eating, eating attitudes and depressive symptoms in a student sample of young men.

METHOD

Fifty-six young male students completed self-report questionnaires, including measures of deeper level beliefs previously found to be typical of women with eating disorders and women with disturbed eating attitudes.

RESULTS

Eating attitudes in the student sample of young men were best predicted by one underlying assumption, i.e. control over eating. Depressive symptoms were best predicted by negative self-beliefs.

CONCLUSION

Negative self-beliefs and underlying assumptions about weight, shape and eating relate to eating attitudes and depressive symptoms in a student sample of young men as would be predicted by cognitive theory. Cognitive models of eating disorders, particularly those incorporating deeper level beliefs may, therefore, be applicable to young men.

Psychiatric comorbidities of female inpatients with eating disorders

OBJECTIVE

We analyze 27 point-prevalent DSM-IV Axis I comorbidities for eating disorder inpatients.

METHODS

The sample included 2436 female inpatients treated between January 1, 1995, and December 31, 2000, for primary DSM-IV diagnoses of anorexia, bulimia, and eating disorder not otherwise specified. Analyses were multivariate analysis of variance and multinomial logistic regression; sociodemographics and severity-of-illness measures were controlled.

RESULTS

Ninety-seven percent of patients evidenced > or = 1 comorbid diagnoses; 94% evidenced comorbid mood disorders, largely unipolar depression, with no differences across eating disorders; 56% evidenced anxiety disorders, with no differences across eating disorders; and 22% evidenced substance use disorders, with significant differences across eating disorders (p < .0001). Five specific diagnoses differed across eating disorders. Alcohol abuse/dependence was twice as likely with bulimia (p < .0001); polysubstance abuse/dependence three times as likely with bulimia (p < .0001); obsessive-compulsive disorder twice as likely with restricting and binge/purge anorexia (p < .01); posttraumatic stress disorder twice as likely with binge-purge anorexia (p < .05); schizophrenia/other psychoses three times more likely with restricting anorexia (p < .05) and two times with binge-purge anorexia (p < .05).

CONCLUSIONS

New findings emerged: extremely high comorbidity regardless of eating disorder, ubiquitous depression across all eating disorders, no difference in overall rate of anxiety disorders across eating disorders, greater posttraumatic stress disorder in binge-purge anorexia, more psychotic diagnoses in anorexia. Certain previous findings were confirmed: more obsessive-compulsive disorder in anorexia; more substance use in bulimia; and a replicated comorbidity rank-ordering for eating disorder patients: mood, anxiety, and substance use disorders, respectively.

Personality disorder traits evident by early adulthood and risk for eating and weight problems during middle adulthood

OBJECTIVE

The current article investigates the association of personality disorder (PD) with the subsequent development of eating and weight problems.

METHOD

Psychiatric interviews were administered to a community-based sample of 658 individuals at mean ages 14, 16, 22, and 33 years.

RESULTS

Individuals with PD by age 22 were at an elevated risk for eating disorders at mean age 33 years. PDs were associated with risk for onset of binge eating, purging, daily dietary restriction, and obesity among individuals without a history of these problems. Borderline and histrionic PD symptoms were associated with recurrent binging and purging at mean age 33 years. Antisocial and schizotypal symptoms were associated with recurrent binging and obesity at mean age 33 years. Depressive PD symptoms were associated with recurrent binging and dietary restriction at mean age 33 years.

CONCLUSION

PD symptoms, evident by early adulthood, may be associated with the risk for the development of eating and weight problems by middle adulthood.

Stress plays a role in the association between cognitive constructs and measures of eating disorders in male subjects

OBJECTIVE

Several theorists have hypothesized that stressful situations may trigger abnormal eating and even eating disorders in predisposed people. The purpose of this study was to assess whether a stressful situation would reveal an association between perfectionism and low self-esteem, and measures of eating disorder symptoms in male high school students.

METHOD

A sample of 61 male high school students completed the Eating Disorder Inventory, the Multidimensional Perfectionism Scale, and the Self Liking and Competence Scale three times: on an average school day, on the day of an exam and on the day the subjects received the results of that exam. Linear regression analysis was carried out to verify whether the dimensions of perfectionism were associated with the measures of eating disorders.

RESULTS

Interoceptive awareness was associated with 'Bulimia' only during the stressful situation and with 'Drive for thinness' both in stress and non stress situations. Other results were contradictory and difficult to interpret.

DISCUSSION

The results suggest that in nonclinical male individuals stress might bring out a previously absent association between some psychological predisposing factors for eating disorders and an actual desire or plan for ED related thoughts and behaviours. Such a finding suggests that stress may stimulate behaviours related to eating disorders in a predisposed personality. A central role may be played by interoceptive awareness in male subjects.

Eating disorder symptoms among female anxiety disorder patients in clinical practice: the importance of anxiety comorbidity assessment

This exploratory study investigated the relationship between anxiety disorders, anxiety comorbidity, and eating disorder (ED) symptoms in clinical practice, and examined the naturalistic detection of ED when diagnoses were based on the Anxiety Disorders Interview Schedule (ADIS). Two hundred and fifty-seven female patients completed an ED questionnaire and were assessed with the ADIS. Although ED frequency did not differ among anxiety disorder diagnoses, regression analyses revealed that social phobia (SP) and posttraumatic stress disorder (PTSD) accounted for unique variance in eating pathology. Questionnaire results indicated that almost 12% of patients met criteria for a possible ED. Clinicians using the ADIS evidenced good specificity but were not sensitive to detecting ED, missing 80% of possible cases. Results support possible links between ED, social phobia and PTSD and highlight the importance of assessing anxiety comorbidity when examining the relationship between ED and anxiety disorders. Results also suggest that formal screening for ED among female anxiety patients may be warranted.

Investigating the structure of the eating inventory (three-factor eating questionnaire): a confirmatory approach

OBJECTIVE

To investigate the internal structure of the Eating Inventory using confirmatory factor analytic (CFA) methods.

METHOD

Female participants in a population-based twin study (N = 1,510) completed a reduced version of the Eating Inventory as part of a larger study of eating behaviors. Two CFA estimation methods were implemented using LISREL and Mplus to evaluate three different factor structures reported in the literature.

RESULTS

Overall results for Stunkard and Messick's (1985) three-factor model indicated a poor fit to these data. The structure reported by Ganley resulted in an improper solution with factor correlations over 1 and several loadings estimated near 0 or with negative signs. The model proposed by Hyland et al. also fit poorly for all three models, the pattern of loadings on the Restraint factor proved most difficult to interpret.

DISCUSSION

This study represents the first application of these confirmatory methods to the three subscales of the Eating Inventory. The instrument, as administered in this study, did not conform well to the structures proposed in previous studies. Because the Eating Inventory is recommended as a treatment planning tool, poor replication of the constructs purported to be assessed by this instrument underscores the importance of further internal validation research.