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Keegan E, Tchanturia K, Wade TD. Central coherence and set-shifting between nonunderweight eating disorders and anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord 2021; 54:229-243. [PMID: 33305366 DOI: 10.1002/eat.23430] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis compared previously documented inefficiencies in central coherence and set-shifting between people with nonunderweight eating disorders (bulimia nervosa and binge-eating disorder) and people with anorexia nervosa. METHOD We performed random-effects meta-analyses on 16 studies (1,112 participants) for central coherence and 38 studies (3,505 participants) for set-shifting. Random effects meta-regressions were used to test whether the effect sizes for people with nonunderweight eating disorders were significantly different from the effect sizes for people with anorexia nervosa. RESULTS People with anorexia nervosa (Hedge's g = -0.53, 95% CIs: -0.80, -0.27, p < .001) and bulimia nervosa (Hedge's g = -0.70, 95% CIs: -1.14, -0.25, p = .002), but not binge-eating disorder, had significantly poorer central coherence than healthy controls. Similarly, people with anorexia nervosa (Hedge's g = -0.38, 95% CIs: -0.50, -0.26, p < .001) and bulimia nervosa (Hedge's g = -0.55, 95% CIs: -0.81, -0.29, p < .001), but not binge-eating disorder, had significantly poorer set-shifting than healthy controls. The effect sizes for people with nonunderweight eating disorders did not significantly differ from those for people with anorexia nervosa. DISCUSSION Our meta-analysis was underpowered to make definitive judgments about people with binge-eating disorder. However, we found that people with bulimia nervosa clearly have central coherence and set-shifting inefficiencies which do not significantly differ from those observed in people with anorexia nervosa. Clinically, this suggests that people with bulimia nervosa might benefit from adjunctive approaches to address these inefficiencies, such as cognitive remediation therapy.
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Affiliation(s)
- Ella Keegan
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
| | | | - Tracey D Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
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Van Alsten SC, Duncan AE. Lifetime patterns of comorbidity in eating disorders: An approach using sequence analysis. EUROPEAN EATING DISORDERS REVIEW 2020; 28:709-723. [PMID: 32748537 DOI: 10.1002/erv.2767] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/05/2020] [Accepted: 06/29/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Eating disorders (EDs) have high rates of psychiatric comorbidity. This study aimed to characterize longitudinal patterns of comorbidities in adults with EDs. METHODS Sequence analysis and hierarchical clustering were applied to ages of onset and recency for select eating, substance, mood, and anxiety disorders from the 479 participants in the Collaborative Psychiatric Epidemiology Surveys with lifetime DSM-IV bulimia nervosa, binge eating disorder, or anorexia nervosa. External validators were compared across clusters using chi-square tests. RESULTS Five clusters were identified among individuals with any lifetime ED based on longitudinal sequence of psychiatric disorder onset and remission, characterized as: (1) multi-comorbid with early onset of comorbid disorder (46%); (2) moderate preeminent anxiety with moderate comorbidity and low ED persistence (20%); (3) late ED onset with low comorbidity (15%); (4) early onset, persistent ED with low comorbidity (14%); and (5) chronic, early onset depression (5%). Clusters were well differentiated by significant differences in age, body mass index, race, and psychiatric indicators. CONCLUSIONS This study demonstrates a new method to assess clustering of comorbidity among individuals with lifetime EDs. Having a psychiatric diagnosis prior to an ED was associated with greater psychopathology and illness duration. Information on timing of diagnoses may allow for more refined comorbidity classification.
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Affiliation(s)
- Sarah C Van Alsten
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alexis E Duncan
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
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3
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Himmerich H, Hotopf M, Shetty H, Schmidt U, Treasure J, Hayes RD, Stewart R, Chang CK. Psychiatric comorbidity as a risk factor for the mortality of people with bulimia nervosa. Soc Psychiatry Psychiatr Epidemiol 2019; 54:813-821. [PMID: 30756148 DOI: 10.1007/s00127-019-01667-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bulimia nervosa (BN) is associated with increased mortality. Frequent comorbidities of BN include substance use disorders, affective disorders and personality disorders (PD). These comorbidities may add an additional risk for mortality. METHODS We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders over an observation period from January 2007 to March 2016 for 1501 people with BN using anonymised health records data from the South London and Maudsley NHS Foundation Trust (SLaM), retrieved through its Clinical Records Interactive Search (CRIS) data resource. Mortality was ascertained through monthly linkages to the nationwide tracing system administered by the Office for National Statistics (ONS). We used Cox proportional hazards regression to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analyses were also performed to estimate effects when controlling for confounding of age, sex, ethnicity, borough, marital status and deprivation score. RESULTS A total of 18 patients with BN died during the observation period. The standardised mortality ratio (SMR) for our study cohort (against the population of England and Wales in 2012 as a standard) was 2.52 (95% CI 1.49-3.97). Cox regressions revealed significant associations of mortality with older age and male gender. Comorbid PD (HR: 3.36; 95% CI 1.05-10.73) was significantly associated with all-cause mortality, even after controlling for demographic and socioeconomic covariates. CONCLUSIONS These results highlight increased mortality in patients with BN and the importance of recognising and treating PDs in patients with BN.
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Affiliation(s)
- Hubertus Himmerich
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Richard D Hayes
- Department of Psychological Medicine, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Chin-Kuo Chang
- Department of Psychological Medicine, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Health and Welfare, University of Taipei, No. 101, Sec. 2, Jhongcheng Rd, Shilin District, Taipei, 111, Taiwan.
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Ziobrowski H, Brewerton TD, Duncan AE. Associations between ADHD and eating disorders in relation to comorbid psychiatric disorders in a nationally representative sample. Psychiatry Res 2018; 260:53-59. [PMID: 29172099 DOI: 10.1016/j.psychres.2017.11.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 09/23/2017] [Accepted: 11/08/2017] [Indexed: 12/11/2022]
Abstract
The objective of this study was to examine whether previously observed associations of attention-deficit/hyperactivity disorder (ADHD) with eating disorders (EDs) are at least partially attributable to other underlying psychopathology. Data came from 4719 participants aged 18-44 years in the National Comorbidity Survey Replication and the National Survey of American Life. DSM-IV diagnoses were assessed using the World Health Organization Composite International Diagnostic Interview. Multinomial logistic regression assessed associations between DSM-IV lifetime and past-12 month diagnoses of ADHD with EDs in unadjusted models and in models adjusted for demographic variables and other psychopathology. Lifetime ADHD was strongly and significantly associated with lifetime bulimia nervosa (BN), binge eating disorder (BED), and any ED in unadjusted models, but not with anorexia nervosa or subthreshold BED. After adjusting for demographic variables and psychiatric comorbidities, all associations of lifetime ADHD with EDs were substantially attenuated, and only the association of ADHD with BN remained statistically significant. Similar results were found using past-12 month diagnoses. These results suggest that previously observed associations of ADHD with EDs might be due - at least in part - to additional psychiatric disorders that are often comorbid with both ADHD and EDs.
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Affiliation(s)
- Hannah Ziobrowski
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Alexis E Duncan
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
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5
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Leraas BC, Smith KE, Utzinger LM, Cao L, Engel SG, Crosby RD, Mitchell JE, Wonderlich SA. Affect-based profiles of bulimia nervosa: The utility and validity of indicators assessed in the natural environment. Psychiatry Res 2018; 259:210-215. [PMID: 29073557 PMCID: PMC5918135 DOI: 10.1016/j.psychres.2017.09.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 01/24/2023]
Abstract
Theoretical conceptualizations of bulimia nervosa (BN) emphasize the role of emotion dysregulation in the development and maintenance of symptoms, which has been supported by ecological momentary assessment studies. Given the importance of affective disturbances in BN, this study aimed to classify a sample of adult women with BN (N = 130) based on primarily momentary affective indicators, including negative and positive affect, negative and positive affective lability, and depression. Participants completed baseline assessments followed by a two-week ecological momentary assessment protocol. Latent profile analysis revealed four groups: (1) a "stable normal" group characterized by low affective lability and intensity; (2) a "stable depressed" group characterized by low affective lability and higher affect intensity; (3) an "unstable normal" group characterized by higher affective lability but lower affect intensity; and (4) an "unstable depressed" group characterized by higher affective lability and intensity. The stable depressed group evidenced the highest levels of eating psychopathology, borderline personality traits, and childhood trauma history, while the stable normal group generally evidenced the lowest levels of psychopathology. The findings demonstrate significant heterogeneity in the topography of affect experienced by individuals with BN, and suggest that chronic, intense negative affect may be particularly important to address in treatment.
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Affiliation(s)
| | - Kathryn E Smith
- Neuropsychiatric Research Institute, Fargo, ND, USA; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Linsey M Utzinger
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Li Cao
- Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Scott G Engel
- Neuropsychiatric Research Institute, Fargo, ND, USA; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, ND, USA; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - James E Mitchell
- Neuropsychiatric Research Institute, Fargo, ND, USA; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Stephen A Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND, USA; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
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Solmi M, Veronese N, Sergi G, Luchini C, Favaro A, Santonastaso P, Vancampfort D, Correll CU, Ussher M, Thapa-Chhetri N, Fornaro M, Stubbs B. The association between smoking prevalence and eating disorders: a systematic review and meta-analysis. Addiction 2016; 111:1914-1922. [PMID: 27206671 DOI: 10.1111/add.13457] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/25/2016] [Accepted: 05/18/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Cigarette smoking is associated with severe mental illness, including schizophrenia and bipolar disorder, and with morbidity and mortality, but the association with anorexia (AN), bulimia nervosa (BN) and binge eating disorder (BED) is unclear. This meta-analysis compared the odds of smoking in eating disorders (ED) (ED = AN or BN or BED) versus healthy controls (HC) and calculated the prevalence of smokers in people with ED. METHODS Three independent authors searched PubMed, MEDLINE and Scopus from database inception until 31 December 2015 for studies reporting data on life-time or current smoking prevalence in BED, BN and AN with or without control group. Meta-analyses were undertaken, calculating odds ratios (ORs) of life-time smoking in BED, BN, AN versus healthy controls (HCs) or prevalence of smoking in BED, BN and AN with 95% confidence intervals (CI). RESULTS Thirty-one studies (ED = 8517, controls = 68 335) were meta-analysed. Compared with HCs, there were significantly more smokers among people with BN (life-time OR = 2.165) and BED (life-time OR = 1.792) but not AN (life-time OR = 0.927). BED was associated with smoking the most (life-time prevalence = 47.73%) followed by BN (life-time prevalence = 39.4%) and AN (life-time prevalence = 30.8%). In BN, life-time smoking prevalence was highest in Europe. In AN, higher age moderated both life-time and current smoking prevalence, and body mass index moderated higher life-time smoking prevalence. In BN, female sex moderated higher life-time smoking prevalence. CONCLUSIONS People with binge eating disorder and bulimia nervosa are significantly more likely to be life-time smokers than healthy controls, which is not the case for anorexia nervosa.
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Affiliation(s)
- Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy.,Local Health Unit ULSS 17, Mental Health Department, Monselice, Padova, Italy.,Institute of Clinical Research, and Education in Medicine (IREM), Padova, Italy
| | - Nicola Veronese
- Department of Medicine, DIMED, University of Padua, Padova, Italy.,Institute of Clinical Research, and Education in Medicine (IREM), Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine, DIMED, University of Padua, Padova, Italy
| | - Claudio Luchini
- Department of Pathology and Diagnostics, Verona University and Hospital Trust, Verona, Italy
| | - Angela Favaro
- Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Davy Vancampfort
- University of Leuven, KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.,University of Leuven-KU Leuven, University Psychiatric Centre, Kortenberg-, Leuven, Belgium
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health System, Glen Oaks, New York, USA.,Hofstra Northwell School of Medicine, Hempstead, New York, USA.,The Feinstein Institute for Medical Research, Manhasset, New York, USA.,Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, London, UK
| | | | - Michele Fornaro
- New York Psychiatric Institute, Columbia University, NYC, USA
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK. .,Health Service and Population Research Department, Institute of Psychiatry, King's College, London, De Crespigny Park, London, UK.
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Saunders R, Cape J, Fearon P, Pilling S. Predicting treatment outcome in psychological treatment services by identifying latent profiles of patients. J Affect Disord 2016; 197:107-15. [PMID: 26991365 DOI: 10.1016/j.jad.2016.03.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/19/2016] [Accepted: 03/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The outcomes of psychological therapies for anxiety and depression vary across individuals and symptom domains. Being able to predict treatment response from readily available patient data at presentation has potentially important benefits in aiding decisions about the most suitable interventions for a patient. This paper presents a method of identifying subgroups of patients using latent profile analysis, and comparing response to psychological treatments between these profiles. METHODS All outpatients taken into treatment at two psychological treatment services in London, UK and who provided basic demographic information and standardized symptom measures were included in the analysis (n=16636). RESULTS Latent Profile Analysis was performed on intake data to identify statistically different groups of patients, which were then examined in longitudinal analyses to determine their capacity to predict treatment outcomes. Comparison between profiles showed considerable variation in recovery (74-15%), deterioration rates (5-20%), and levels of attrition (17-40%). Further variation in outcomes was found within the profiles when different intensities of psychological intervention were delivered. LIMITATIONS Latent profiles were identified using data from two services, so generalisability to other services should be considered. Routinely collected patient data was included, additional patient information may further enhance utility of the profiles. CONCLUSIONS These results suggest that intake data can be used to reliably classify patients into profiles that are predictive of outcome to different intensities of psychological treatment in routine care. Algorithms based on these kinds of data could be used to optimize decision-making and aid the appropriate matching of patients to treatment.
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Affiliation(s)
- Rob Saunders
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), 1-19 Torrington Place, London WC1E 7HB, United Kingdom.
| | - John Cape
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), 1-19 Torrington Place, London WC1E 7HB, United Kingdom
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8
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A psychological typology of females diagnosed with anorexia nervosa, bulimia nervosa or binge eating disorder. HEALTH PSYCHOLOGY REPORT 2015. [DOI: 10.5114/hpr.2015.55169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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9
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Jiménez-Murcia S, Granero R, Moragas L, Steiger H, Israel M, Aymamí N, Gómez-Peña M, Sauchelli S, Agüera Z, Sánchez I, Riesco N, Penelo E, Menchón JM, Fernández-Aranda F. Differences and Similarities Between Bulimia Nervosa, Compulsive Buying and Gambling Disorder. EUROPEAN EATING DISORDERS REVIEW 2014; 23:111-8. [DOI: 10.1002/erv.2340] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Susana Jiménez-Murcia
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
| | - Roser Granero
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Laura Moragas
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Howard Steiger
- Douglas Mental Health University Institute; Montreal Canada
| | - Mimi Israel
- Douglas Mental Health University Institute; Montreal Canada
| | - Neus Aymamí
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Sarah Sauchelli
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Zaida Agüera
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Isabel Sánchez
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Nadine Riesco
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Eva Penelo
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut; Universitat Autònoma de Barcelona; Barcelona Spain
| | - José M. Menchón
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- Ciber de Salud Mental (CIBERSAM); Instituto Salud Carlos III; Madrid Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
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Tamam L, Bican M, Keskin N. Impulse control disorders in elderly patients. Compr Psychiatry 2014; 55:1022-8. [PMID: 24405774 DOI: 10.1016/j.comppsych.2013.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/27/2013] [Accepted: 12/03/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE There is no epidemiological study on the prevalence of impulse control disorders (ICDs) in the elderly population. The studies on ICDs in elderly patients are limited and some of them are case reports about pathological gambling and kleptomania. The comorbidity of other psychiatric disorders makes diagnosis difficult and has negative effects on both treatment and the prognosis of ICDs. The aim of this study was to determine the prevalence of ICDs among elderly patients and to evaluate the related sociodemographic and clinical features. METHOD A total of 76 patients aged 60 and over who have been referred to our outpatient clinics in a one-year period were included in the study. A demographic data form was completed. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) was used to determine axis I psychiatric disorders. The prevalence of ICDs was investigated by using the modified version of the Minnesota Impulse Disorders Interview (MIDI). Impulsivity was measured with the Barratt Impulsiveness Scale Version 11 (BIS-11). The Mini-Mental State Examination (MMSE) test was performed to evaluate the cognitive status of patients and to exclude the diagnosis of dementia. In addition, all patients completed Symptom Check List-90 (SCL-90). RESULTS The prevalence rate of at least one comorbid ICD in our sample was 17%. When patients with a diagnosis of ICDs not otherwise specified (ICD-NOS) were included, the prevalence rate increased to 22.4%. The most common ICD was intermittent explosive disorder (15.8%), followed by pathological gambling (9.2%). The majority of the sample was men (54%), married (80%), had a high school education (51%), and mid-level socioeconomic status (79%). The only statistically significant difference between the sociodemographic characteristics of patients with or without ICDs was gender. The lifetime prevalence of ICDs was 34.1% in men and 8.6% in women. The prevalence of childhood conduct disorder was significantly higher in the group with ICD. There was no statistically significant difference in the number of suicide attempts, history of physical illness and family history of psychiatric disorders between the groups with or without ICDs. Comorbidity of alcohol/substance abuse was found to be 17.6% in patients with ICD whereas no cases were found in the group without ICD. CONCLUSION The result of this study has shown that approximately one fifth of patients over 60years had at least one lifetime ICD comorbidity. The prevalence rates of ICDs seem to decrease with aging. The male gender and childhood conduct disorder are related with higher prevalence rates of ICDs in elderly.
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Affiliation(s)
- Lut Tamam
- Cukurova University Faculty of Medicine, Department of Psychiatry, Adana, Turkey
| | - Mehtap Bican
- Cukurova University Faculty of Medicine, Department of Psychiatry, Adana, Turkey
| | - Necla Keskin
- Cukurova University Faculty of Medicine, Department of Psychiatry, Adana, Turkey.
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11
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Berg KC, Swanson SA, Stiles-Shields EC, Eddy KT, Peterson CB, Le Grange D. Response patterns on interview and questionnaire versions of the Eating Disorder Examination and their impact on latent structure analyses. Compr Psychiatry 2013; 54:506-16. [PMID: 23375185 PMCID: PMC3687014 DOI: 10.1016/j.comppsych.2012.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 12/04/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The purpose of this investigation was to compare the latent structures of the interview (EDE) and questionnaire (EDE-Q) versions of the Eating Disorder Examination. METHODS Participants were 280 children, adolescents, and young adults seeking eating disorder treatment. Two separate latent structure analyses (LSAs) were conducted; one used variables from the EDE as indicators and the other used the corresponding variables from the EDE-Q as indicators. RESULTS The EDE and EDE-Q models both yielded four-class solutions. Three of the four classes from the EDE-Q model demonstrated moderate to high concordance with their paired class from the EDE model. Using the EDE-Q to detect the EDE, the sensitivity and specificity of measuring certain classes varied from poor (18.6%) to excellent (93.7%). The overall concordance was moderate (κ=.49). DISCUSSION These data suggest that LSAs using the EDE and EDE-Q may be directly compared; however, differences between results may represent inconsistencies in response patterns rather than true differences in psychopathology.
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Affiliation(s)
- Kelly C. Berg
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Sonja A. Swanson
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | | | - Kamryn T. Eddy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Daniel Le Grange
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
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12
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Lavender JM, Wonderlich SA, Crosby RD, Engel SG, Mitchell JE, Crow SJ, Peterson CB, Le Grange D. Personality-based subtypes of anorexia nervosa: examining validity and utility using baseline clinical variables and ecological momentary assessment. Behav Res Ther 2013; 51:512-7. [PMID: 23792181 DOI: 10.1016/j.brat.2013.05.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/06/2013] [Accepted: 05/10/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study sought to empirically derive and validate clinically relevant personality-based subtypes of anorexia nervosa (AN). METHODS Women (N = 116) with full or subthreshold AN completed baseline measures of personality, clinical variables, and eating disorder (ED) symptoms, followed by two weeks of ecological momentary assessment (EMA). A latent profile analysis was conducted to identify personality subtypes, which were compared on baseline clinical variables and EMA variables. RESULTS The best-fitting model supported three subtypes: underregulated, overregulated, and low psychopathology. The underregulated subtype (characterized by high Stimulus Seeking, Self-Harm, and Oppositionality) displayed greater baseline ED symptoms, as well as lower positive affect and greater negative affect, self-discrepancy, and binge eating in the natural environment. The overregulated subtype (characterized by high Compulsivity and low Stimulus Seeking) was more likely to have a lifetime obsessive-compulsive disorder diagnosis and exhibited greater perfectionism; levels of negative affect, positive affect, and self-discrepancy in this group were intermediate between the other subtypes. The low psychopathology subtype (characterized by normative personality) displayed the lowest levels of baseline ED symptoms, co-occurring disorders, and ED behaviors measured via EMA. CONCLUSIONS Findings support the validity of these personality-based subtypes, suggesting the potential utility of addressing within-diagnosis heterogeneity in the treatment of AN.
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Affiliation(s)
- Jason M Lavender
- Neuropsychiatric Research Institute, 120 South 8th Street, Fargo, ND 58103, USA.
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Wildes JE, Marcus MD. Alternative methods of classifying eating disorders: models incorporating comorbid psychopathology and associated features. Clin Psychol Rev 2013; 33:383-94. [PMID: 23416343 DOI: 10.1016/j.cpr.2013.01.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/30/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
There is increasing recognition of the limitations of current approaches to psychiatric classification. Nowhere is this more apparent than in the eating disorders (EDs). Several alternative methods of classifying EDs have been proposed, which can be divided into two major groups: 1) those that have classified individuals on the basis of disordered eating symptoms; and, 2) those that have classified individuals on the basis of comorbid psychopathology and associated features. Several reviews have addressed symptom-based approaches to ED classification, but we are aware of no paper that has critically examined comorbidity-based systems. Thus, in this paper, we review models of classifying EDs that incorporate information about comorbid psychopathology and associated features. Early approaches are described first, followed by more recent scholarly contributions to comorbidity-based ED classification. Importantly, several areas of overlap among the classification schemes are identified that may have implications for future research. In particular, we note similarities between early models and newer studies in the salience of impulsivity, compulsivity, distress, and inhibition versus risk taking. Finally, we close with directions for future work, with an emphasis on neurobiologically-informed research to elucidate basic behavioral and neuropsychological correlates of comorbidity-based ED classes, as well as implications for treatment.
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Affiliation(s)
- Jennifer E Wildes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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14
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Waxman SE. A systematic review of impulsivity in eating disorders. EUROPEAN EATING DISORDERS REVIEW 2010; 17:408-25. [PMID: 19548249 DOI: 10.1002/erv.952] [Citation(s) in RCA: 187] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of this paper is to conduct a systematic review of the current literature that examines impulsivity in individuals with eating disorders (ED). Studies were obtained from Embase, Pubmed and Psycinfo, and were included if they assessed impulsivity in individuals over 18 years of age with an ED diagnosis and published in the last 10 years. The methodological quality of the studies was rated. Twelve studies were included in this review, with methodological quality varying across studies. Findings suggest that impulsivity is best assessed multi-modally, with a combination of self-report, behavioural and physiological measures. In general, impulsivity was found to differentiate individuals with EDs from controls, as well as across diagnostic subtypes. The current findings have important clinical implications for our understanding and treatment of both impulsivity and eating disorders.
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Finzi-Dottan R, Zubery E. The role of depression and anxiety in impulsive and obsessive-compulsive behaviors among anorexic and bulimic patients. Eat Disord 2009; 17:162-82. [PMID: 19242845 DOI: 10.1080/10640260802714654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Eating disorders are believed to range across a spectrum of varying degrees of obsessive-compulsive and impulsive behavior. Sixty anorexic (mean age = 19.8; sd = 5.9) and 109 bulimic (mean age = 26.9; sd = 11.3) female patients completed self-report questionnaires assessing obsessive-compulsiveness, impulsivity, depression and anxiety, as well as two eating disorder scales. Results yielded significantly higher levels of impulsivity and negative body image in the bulimic compared to the anorexic group. Regression analysis predicting impulsivity showed that bulimia and negative body image were the main contributors. Regression analysis for predicting obsessive-compulsive behavior suggested that depression and anxiety obscure the link between anorexia and obsessive-compulsive behavior, and a high BMI intensifies the association between anxiety and obsessive-compulsive behavior. The high rates of both impulsivity and obsessive-compulsiveness found in both groups, and their association with the severity of the eating disorder, may suggest that impulsivity and obsessive-compulsiveness are not mutually exclusive and can both be found among anorexic and bulimic patients.
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Sandager N, Peterson CB, Allen S, Henderson KE, Crow S, Thuras P. Tobacco use and comorbidity in bulimia nervosa. Int J Eat Disord 2008; 41:734-8. [PMID: 18570194 DOI: 10.1002/eat.20572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare comorbid psychopathology and substance use among women with bulimia nervosa (BN) based on smoking status. METHOD Forty women diagnosed with BN (20 smokers, 20 nonsmokers) completed written self-report measures of depressive symptoms, substance use, and alcohol abuse. RESULTS Smokers reported more symptoms of depression and alcohol abuse and were more likely to use alcohol than nonsmokers, whereas caffeine consumption did not significantly differ between the two groups. CONCLUSION Smokers with BN may represent a distinct subtype characterized by high rates of comorbid depression and alcohol abuse.
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Affiliation(s)
- Nora Sandager
- Department of Psychiatry, University of Minnesota, Minneapolis, USA.
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17
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Striegel-Moore RH, Franko DL. Should binge eating disorder be included in the DSM-V? A critical review of the state of the evidence. Annu Rev Clin Psychol 2008; 4:305-24. [PMID: 18370619 DOI: 10.1146/annurev.clinpsy.4.022007.141149] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Binge eating disorder (BED) was introduced in 1994 as a provisional eating disorder diagnosis. The core symptom is recurrent binge eating in the absence of inappropriate compensatory behaviors and/or extreme dietary restraint. This review examines the status of the literature on BED according to five criteria that have been proposed to determine whether BED warrants inclusion in the psychiatric nosology as a distinct eating disorder. We conclude that each of these criteria was met. There is a commonly accepted definition of and assessment approach to BED. The clinical utility and validity of BED have been established, and BED is distinguishable from both bulimia nervosa and obesity. BED should be included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.
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Fernández-Aranda F, Pinheiro AP, Thornton LM, Berrettini WH, Crow S, Fichter MM, Halmi KA, Kaplan AS, Keel P, Mitchell J, Rotondo A, Strober M, Woodside DB, Kaye WH, Bulik CM. Impulse control disorders in women with eating disorders. Psychiatry Res 2008; 157:147-57. [PMID: 17961717 DOI: 10.1016/j.psychres.2007.02.011] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Revised: 09/29/2006] [Accepted: 02/11/2007] [Indexed: 01/04/2023]
Abstract
We compared symptom patterns, severity of illness, and comorbidity in individuals with eating disorders with and without impulse control disorders (ICD), and documented the temporal pattern of illness onset. Lifetime ICD were present in 16.6% of 709 women with a history of eating disorders. The most common syndromes were compulsive buying disorder and kleptomania. ICD occurred more in individuals with binge eating subtypes, and were associated with significantly greater use of laxatives, diuretics, appetite suppressants and fasting, and with greater body image disturbance, higher harm avoidance, neuroticism, cognitive impulsivity, and lower self-directedness. In addition, individuals with ICD were more likely to have obsessive-compulsive disorder, any anxiety disorder, specific phobia, depression, cluster B personality disorder, avoidant personality disorder, and to use psychoactive substances. Among those with ICD, 62% reported the ICD predated the eating disorder and 45% reported the onset of both disorders within the same 3-year window. The presence of a lifetime ICD appears to be limited to eating disorders marked by binge eating and to be associated with worse eating-related psychopathology, more pathological personality traits, and more frequent comorbid Axis I and II conditions. Untreated ICD may complicate recovery from eating disorders.
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Jordan J, Joyce PR, Carter FA, Horn J, McIntosh VVW, Luty SE, McKenzie JM, Frampton CMA, Mulder RT, Bulik CM. Specific and nonspecific comorbidity in anorexia nervosa. Int J Eat Disord 2008; 41:47-56. [PMID: 17868127 DOI: 10.1002/eat.20463] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This article reports lifetime Axis I and II comorbidity in women with anorexia nervosa (AN), and ascertains specific and nonspecific comorbidity in AN compared to clinical samples of women with bulimia nervosa (BN) or major depression (DEP). METHOD Outpatient AN (n = 56), BN (n = 132), and DEP (n = 100) samples were assessed using Structured Clinical Interviews I and II for DSM-III-R. Baseline data were compared using univariate statistics and logistic regression. RESULTS In the AN sample as a whole, specific elevations were found for prevalences of obsessive compulsive disorder. The AN-binge eating purging subtype (AN-BP) and the BN sample had elevated prevalences of Cluster B personality disorders. Cluster C prevalences were elevated across samples. CONCLUSION Evidence of AN-specific, eating disorder-specific, and nonspecific comorbidity illustrates the heterogeneity in AN. Further research is need to examine the relative impact of specific and nonspecific comorbidity in AN subtypes and AN as a whole.
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Affiliation(s)
- Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand.
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20
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Wade TD. Epidemiology of eating disorders: creating opportunities to move the current classification paradigm forward. Int J Eat Disord 2007; 40 Suppl:S27-30. [PMID: 17868126 DOI: 10.1002/eat.20456] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia.
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21
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Duncan AE, Bucholz KK, Neuman RJ, Agrawal A, Madden PAF, Heath AC. Clustering of eating disorder symptoms in a general population female twin sample: a latent class analysis. Psychol Med 2007; 37:1097-1107. [PMID: 17472759 DOI: 10.1017/s0033291707000505] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous studies have reported that the current DSM-IV eating disorder (ED) criteria do not adequately describe ED symptomatology. The objective of the current study was to examine the clustering of ED symptoms in a general population sample using latent class analysis (LCA). METHOD ED symptoms from 3723 female young adult twins (mean age 22) were analyzed using LCA, and resulting classes were compared on external validators reflecting ED and other co-morbid psychiatric diagnoses, substance use disorders (SUDs), and suicidality. RESULTS The optimal solution consisted of five latent classes characterized as: (1) Unaffected; (2) Low Weight Gain; (3) Weight Concerned; (4) Dieters; and (5) ED. Members of the ED class had significantly higher prevalence of co-morbid psychiatric disorders, SUDs, and suicidality than the Unaffected and Low Weight Gain classes, and elevated rates of suicidality and major depression compared to the Weight Concerned and Dieter classes, which differed from each other primarily in terms of current body mass index (BMI). Dieter class members were more likely to be overweight and obese and less likely to be underweight than Weight Concerned class members. The majority of women with an ED diagnosis were assigned to the ED class, and few differences were found between ED class members with and without an ED diagnosis. CONCLUSIONS The results add to the evidence that many women with significant ED psychopathology are not being identified by the DSM-IV ED categories.
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Affiliation(s)
- Alexis E Duncan
- Department of Psychiatry and Midwest Alcoholism Research Center, Washington University School of Medicine, St Louis, MO 63110, USA.
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Ris MD, Ammerman RT, Waller N, Walz N, Oppenheimer S, Brown TM, Enrile BG, Yeates KO. Taxonicity of nonverbal learning disabilities in spina bifida. J Int Neuropsychol Soc 2007; 13:50-8. [PMID: 17166303 DOI: 10.1017/s1355617707070087] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Revised: 07/14/2006] [Accepted: 08/03/2006] [Indexed: 11/06/2022]
Abstract
As currently defined, it is not clear whether Nonverbal Learning Disabilities (NLD) should be considered a matter of kind or magnitude (Meehl, 1995). The taxonicity of NLD, or the degree to which it is best construed as discrete versus continuous, has not been investigated using methods devised for this purpose. Latent Class Analysis (LCA) is a method for finding subtypes of latent classes from multivariate categorical data. This study represents an application of LCA on a sample of children and adolescents with spina bifida myelomeningocele (SBM) (N = 44), those presenting with features of NLD (N = 28) but no medical condition, and control volunteers (N = 44). The two-class solution provided evidence for the presence of a taxon with an estimated base-rate in the SBM group of .57. Indicator validities (the conditional probabilities of indicator endorsement in each latent class) suggest a somewhat different priority for defining NLD than is typically used by researchers investigating this disorder. A high degree of correspondence between LCA classifications and those based on a more conventional algorithm provided evidence for the validity of this approach.
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Affiliation(s)
- M Douglas Ris
- Department of Pediatrics and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Fernández-Aranda F, Jiménez-Murcia S, Alvarez-Moya EM, Granero R, Vallejo J, Bulik CM. Impulse control disorders in eating disorders: clinical and therapeutic implications. Compr Psychiatry 2006; 47:482-8. [PMID: 17067872 DOI: 10.1016/j.comppsych.2006.03.002] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 02/03/2006] [Accepted: 03/15/2006] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Few studies have explored impulse control disorders (ICDs) in women with bulimia nervosa (BN). We explored the prevalence of lifetime ICDs in women with BN, compared the severity of eating disorder symptoms in women with BN with and without ICD, and compared their personality profiles to females with one form of ICD, namely, pathologic gambling. METHOD A total sample of 269 female patients consecutively admitted to our unit participated in the current study (173 BN without comorbid ICD [BN - ICD]; 54 BN with comorbid ICD [BN + ICD]; and 42 pathologic gamblers [PG]). All participants were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. EVALUATION Assessment measures included the Symptom Checklist-90 revised and the Temperament and Character Inventory-revised, as well as a number of other clinical and psychopathologic indices. RESULTS In BN, the observed lifetime prevalence of ICD was 23.8%. Lifetime compulsive buying (17.6%) and intermittent explosive disorder (13.2%) were the most frequently reported ICD. Bulimia nervosa subtype was not significantly associated with lifetime ICD (P = .051) or with ICD subtype (P = .253). After using multinomial regression models, we observed that BN + ICD and PG showed the highest scores on novelty seeking (P < .0001). But BN + ICD women had the lowest scores on self-directedness (P < .03) and higher scores on general psychopathology (P < .01) and drug abuse (P < .01). CONCLUSIONS Individuals with BN + lifetime ICD presented more extreme personality profiles, especially on novelty seeking and impulsivity, and general psychopathology than individuals with BN without ICD. On some personality traits, those BN + ICD more closely resembled individuals with PG than those with BN without ICD.
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Duncan AE, Neuman RJ, Kramer JR, Kuperman S, Hesselbrock VM, Bucholz KK. Lifetime psychiatric comorbidity of alcohol dependence and bulimia nervosa in women. Drug Alcohol Depend 2006; 84:122-32. [PMID: 16455211 DOI: 10.1016/j.drugalcdep.2006.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Revised: 01/05/2006] [Accepted: 01/11/2006] [Indexed: 11/29/2022]
Abstract
Previous work from our group revealed two groups of women with bulimia nervosa (BN), one with, and one without alcohol dependence (AD). The current study sought to determine whether women with lifetime BN and AD (BN+AD+) were more similar to women with BN and no AD (BN+AD-) or to women with AD and no BN (BN-AD+) in terms of lifetime psychiatric comorbidity and psychological functioning. Data on BN and AD from 407 female relatives in a family study of alcoholism were used to create three mutually exclusive groups: BN+AD+ (n=30), BN+AD- (n=55), and BN-AD+ (n=322). Bivariate analyses revealed fewer differences between BN+AD+ and BN-AD+ women than between BN+AD+ and BN+AD- women. BN+AD+ women were more likely than BN+AD- women to have drug dependence, conduct disorder, and suicidality, and were more likely to have major depression, lower GAF scores, and to engage in unsafe sex than both BN+AD- and BN-AD+ women. After adjusting for other psychopathology and demographic variables, BN+AD+ women were more likely than BN+AD- women to have major depression, drug dependence, and tobacco dependence and more likely than BN-AD+ women to have major depression and obsessive-compulsive disorder. These results suggest that BN+AD+ women exhibit more severe psychopathology than either BN+AD- or BN-AD+ women and may represent a distinct subgroup within bulimia nervosa or alcohol dependence.
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Affiliation(s)
- Alexis E Duncan
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Cortese S, Isnard P, Frelut ML, Michel G, Quantin L, Guedeney A, Falissard B, Acquaviva E, Dalla Bernardina B, Mouren MC. Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents. Int J Obes (Lond) 2006; 31:340-6. [PMID: 16733525 DOI: 10.1038/sj.ijo.0803400] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Preliminary evidence suggests a comorbidity between attention-deficit/hyperactivity disorder (ADHD) and obesity. This study was carried out to identify the clinical characteristics of obese adolescents with a higher probability of ADHD and advance the understanding of the potential factors underlying the comorbidity between obesity and ADHD. We evaluated the association between ADHD symptoms and bulimic behaviors, depressive and anxiety symptoms, degree of obesity, pubertal stage, age and gender in a clinical sample of obese adolescents. DESIGN Cross-sectional study. SUBJECTS Ninety-nine severely obese adolescents aged 12-17 years. MEASUREMENTS Subjects filled out the Bulimic Investigatory Test, Edinburgh, the Beck Depression Inventory and the State-Trait Anxiety Inventory for Children. Their parents completed the Conners Parent Rating Scale, which assesses ADHD symptoms. The degree of overweight was expressed as body mass index-z score. Puberty development was clinically assessed on the basis of Tanner stages. RESULTS Bulimic behaviors were significantly associated with ADHD symptoms after controlling for depressive and anxiety symptoms. The degree of overweight, pubertal stage, age and gender were not significantly associated with ADHD symptoms. CONCLUSION Obese adolescents with bulimic behaviors may have a higher probability to present with ADHD symptoms independently from associated depressive or anxiety symptoms. The degree of overweight, pubertal stage, age and gender might not be useful for detecting obese adolescents with ADHD symptoms. Therefore, we suggest systematic screening for ADHD in obese adolescents with bulimic behaviors. Further studies are needed to understand which specific dimension of ADHD primarily accounts for the association with bulimic behaviors. Future research should also investigate the causal link between bulimic behaviors and ADHD and explore potential common neurobiological alterations. This may lead to a better understanding of the effectiveness of stimulants for the treatment of bulimic behaviors in obese subjects.
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Affiliation(s)
- S Cortese
- AP-HP, Service de Psychopathologie de l'Enfant et de l'Adolescent, Hôpital Robert Debré, Paris, France
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Abstract
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.
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Affiliation(s)
- Barton J Blinder
- Department of Psychiatry and Human Behavior, University of California, Irvine, 400 Newport Center Drive, Newport Beach, California 92660, USA.
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