1
|
Panero M, Bevione F, Sottosanti I, Longo P, Toppino F, De Bacco C, Abbate-Daga G, Martini M. The Clinical and Psychopathological Profile of Inpatients with Eating Disorders: Comparing Vomiting, Laxative Abuse, and Combined Purging Behaviors. Healthcare (Basel) 2024; 12:1858. [PMID: 39337200 PMCID: PMC11430986 DOI: 10.3390/healthcare12181858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 09/11/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES The previous literature on purging behavior in eating disorders (EDs) suggests an overall more complicated clinical picture for individuals with this symptomatology. So far, no studies have analyzed the possible differences between the specific types of purging among ED inpatients. METHODS A clinical sample of 302 inpatients with EDs was classified according to no purging behaviors, vomiting, the abuse of laxatives, and both vomiting and the abuse of laxatives. Participants completed the following questionnaires: the Eating Disorder Examination Questionnaire (EDE-Q), Frost Multidimensional Perfectionism Scale (F-MPS), State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). Clinical information was collected for each individual. RESULTS Significant differences in the four groups were evidenced in age (p < 0.001), years of illness (p < 0.001), BMI at discharge (p < 0.001), STAI state anxiety (p < 0.001), STAI trait anxiety (p < 0.001), BDI (p < 0.001), EDE-Q eating concerns (p < 0.001), EDE-Q shape concerns (p < 0.001), EDE-Q weight concerns (p < 0.001), EDE-Q global score (p < 0.001), and F-MPS parental criticism (p < 0.001). ED inpatients with purging behaviors were older, had a longer duration of illness, higher parental criticism, and worse general and eating psychopathology. No differences emerged between the specific types of purging behavior. CONCLUSIONS Purging behavior is a marker of severity in EDs independently of the specific type of purging. The appearance of any purging behavior must be regarded as a considerable red flag and be followed by an intensification of the cure.
Collapse
Affiliation(s)
- Matteo Panero
- Eating Disorders Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy; (F.B.); (I.S.); (P.L.); (F.T.); (C.D.B.); (G.A.-D.); (M.M.)
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Hill NG, Abber SR, Keel PK. The role of sexual assault history and PTSD in responses to food intake among women with bulimic-spectrum eating disorders. Eat Disord 2024; 32:266-282. [PMID: 38093449 PMCID: PMC11116069 DOI: 10.1080/10640266.2023.2293597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Sexual abuse or assault (SA) history is associated with eating disorder severity and psychiatric comorbidity, including post-traumatic stress disorder (PTSD). Beyond persistent alterations in mood and cognitions characterizing PTSD, PTSD due to SA may contribute to greater increases in negative affect and body image concerns following food intake in bulimic syndromes (BN-S). To test this, participants (n = 172) with BN-S who reported PTSD due to SA, PTSD due to other forms of trauma, or neither completed clinical interviews and momentary reports of negative affect and shape/weight preoccupation before and after food intake. Participants with PTSD, regardless of trauma source, reported higher purging frequency whereas PTSD due to SA was associated with more frequent loss of control eating. For one task, changes in negative affect following food intake differed across the three groups. Negative affect decreased significantly in participants with PTSD without SA whereas nonsignificant increases were observed in those with PTSD with SA. Results of the present study suggest that source of trauma in PTSD may impact likelihood that eating regulates affect and provide insight into ways current treatments may be adapted to better target purging in BN-S comorbid with PTSD.
Collapse
Affiliation(s)
| | - Sophie R. Abber
- Department of Psychology, Florida State University, Tallahassee, FL 32304
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, FL 32304
| |
Collapse
|
3
|
Ali SI, Keel PK. Examining the association between deficits in self-concept clarity and eating disorder severity. Eat Behav 2023; 51:101810. [PMID: 37690171 PMCID: PMC10872604 DOI: 10.1016/j.eatbeh.2023.101810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE We sought to (1) compare self-concept clarity (SCC; the degree to which a person possesses a confidently defined, internally consistent, and stable sense of self) between female participants with and without eating disorders, (2) examine associations between SCC deficits and severity of eating disorder specific and related psychopathology in individuals with eating disorders, and (3) determine if there is a unique association between SCC deficits and eating disorder severity, controlling for related psychopathology. METHOD Participants (M age = 23.16 years) with eating disorders (n = 121) and controls (n = 63) completed semi-structured clinical interviews and self-report assessments. RESULTS SCC deficits were significantly greater in the eating disorder compared to the control group. In the eating disorder group, greater SCC deficits were significantly associated with greater severity of eating pathology, depression, impulsivity, and trait anxiety. In a hierarchical regression analysis, significant associations between SCC deficits and Eating Disorder Examination (EDE) Global scores were better accounted for by shared variance with anxiety. DISCUSSION SCC deficits may reflect a transdiagnostic feature related to the severity of a range of mental health problems, suggesting potential benefit of transdiagnostic interventions.
Collapse
Affiliation(s)
- Sarrah I Ali
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
| |
Collapse
|
4
|
Forney KJ, Brown TA, Crosby RD, Klein KM, Keel PK. Evaluating the predictive validity of purging disorder by comparison to bulimia nervosa at long-term follow-up. Int J Eat Disord 2022; 55:810-819. [PMID: 35366014 PMCID: PMC9167719 DOI: 10.1002/eat.23712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The current study sought to examine the predictive validity of the purging disorder diagnosis at long-term follow-up by comparing naturalistic outcomes with bulimia nervosa. METHOD Women with purging disorder (N = 84) or bulimia nervosa (N = 133) who had completed comprehensive baseline assessments as part of one of three studies between 2000 and 2012 were sought for follow-up assessment. Nearly all (94.5%) responded to recruitment materials and 150 (69% of sought sample; 83.3% non-Hispanic white; 33.40 [7.63] years old) participated at an average of 10.59 (3.71) years follow-up. Participants completed the Eating Disorder Examination, the Structured Clinical Interview for DSM-IV, and a questionnaire battery. Diagnostic groups were compared on eating disorder (illness status, recovery status, and eating pathology) and related outcomes. Group differences in predictors of outcome were explored. RESULTS There were no significant differences in eating disorder presence (p = .70), recovery status (p = .87), and level of eating pathology (p = .17) between diagnostic groups at follow-up. Post hoc equivalence tests indicated group differences were smaller than a medium effect size (p's ≤ .005). Groups differed in diagnosis at follow-up (p = .002); diagnostic stability was more likely than cross-over to bulimia nervosa for women with baseline purging disorder (p = .004). DISCUSSION Although purging disorder and bulimia nervosa do not differ in long-term outcomes, the relative stability in clinical presentation suggests baseline group differences in clinical presentation may be useful in augmenting treatments for purging disorder. PUBLIC SIGNIFICANCE STATEMENT While purging disorder is classified as an "other specified" eating disorder, individuals who experience this disorder have comparable negative long-term outcomes as those with bulimia nervosa. This highlights the importance of screening for and treating purging disorder as a full-threshold eating disorder.
Collapse
Affiliation(s)
| | - Tiffany A. Brown
- Department of Psychological SciencesAuburn UniversityAuburnAlabamaUSA
| | - Ross D. Crosby
- Sanford Center for Biobehavioral ResearchFargoNorth DakotaUSA
- Department of Psychiatry and Behavioral ScienceUniversity of North Dakota School of Medicine and Health SciencesFargoNorth DakotaUSA
| | - Kelly M. Klein
- VA Boston Healthcare System, Brockton DivisionBrocktonMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Pamela K. Keel
- Department of PsychologyFlorida State UniversityTallahasseeFloridaUSA
| |
Collapse
|
5
|
Krug I, Giles SE, Granero R, Agüera Z, Sánchez I, Sánchez-Gonzalez J, Jimenez-Murcia S, Fernandez-Aranda F. Where does purging disorder lie on the symptomatologic and personality continuum when compared to other eating disorder subtypes? Implications for the DSM. EUROPEAN EATING DISORDERS REVIEW 2021; 30:36-49. [PMID: 34825434 DOI: 10.1002/erv.2872] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/07/2021] [Accepted: 10/26/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess the clinical significance and distinctiveness of purging disorder (PD) from other eating disorder (ED) diagnoses. METHOD Participants included 3127 women consecutively admitted to an ED treatment centre (246 PD, 465 anorexia nervosa restrictive [AN-R], 327 AN-binge purging [AN-BP], 1436 bulimia nervosa [BN], 360 binge eating disorder [BED], 177 atypical AN and 116 unspecified feeding or eating disorder [UFED]) who were diagnosed according to DSM-5 criteria. Additionally, 822 control participants were recruited from the community. All participants completed measures assessing ED symptoms (EDI-2), general psychopathology (SCL-90-R) and personality (TCI-R). RESULTS Patients with PD, when compared to controls, scored significantly higher on the EDI-2 and SCL-90-R, and most TCI-R dimensions. Most of the significant differences between PD and the other ED diagnoses emerged between PD and AN-R, followed by Atypical-AN, UFED, AN-BP and BED, with patients with PD typically reporting higher scores on the EDI-2 and SCL-90-R subscales. Significant differences between PD and BN were also present, but to a lesser extent. The findings for personality varied amongst the different ED diagnoses. CONCLUSIONS PD is a clinically significant disorder, which seems to be more similar to BN than it is to AN and the other ED subtypes.
Collapse
Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Elizabeth Giles
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Zaida Agüera
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
| | | | - Susana Jimenez-Murcia
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Fernando Fernandez-Aranda
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| |
Collapse
|
6
|
Examining cognitive and behavioural symptoms across binge/purge profiles in adolescents with eating disorders. Eat Behav 2021; 42:101516. [PMID: 33991834 DOI: 10.1016/j.eatbeh.2021.101516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 11/22/2022]
Abstract
Binge eating and purging profiles may vary in adolescents with eating disorders and this may potentially be a function of a range of cognitive and behavioural constructs. The aim was to determine whether cognitive and behavioural symptoms differed among purging profiles in 229 adolescent females (M age = 15.45). Differences were examined in three binge/purge profiles; (i) regular objective binge eating and purging (OBEP, n = 63), (ii) regular subjective binge eating and purging (SBEP, n = 41), and (iii) purging in the absence of any binge eating (P-noBE, n = 110). Adolescents with objective or subjective binge eating had significantly higher global eating disorder scores and eating, shape, and weight concerns than those without binge eating, but not more frequent compensatory behaviours. There were no significant differences on dietary restraint. The group with objective binge eating (OBEP) had significantly higher eating concerns and self-induced vomiting than adolescents with subjective binge eating (SBEP). Future research is required to understand the reasons for elevated symptoms in the OBE-P group, since the size of binge episodes is not thought to be a salient factor in binge eating. In contrast to the literature, we did not find support for a special relevance of dietary restraint to the purging only presentation (P-noBE), rather it was a universal characteristic of all binge/purge presentations. Eating concerns may be an important target in adolescents with objective binge symptoms. Future research should examine if treatment targeted at different binge/purge profiles improves efficacy of treatment in adolescents.
Collapse
|
7
|
Abstract
BACKGROUND The DSM-5 introduced purging disorder (PD) as an other specified feeding or eating disorder characterized by recurrent purging in the absence of binge eating. The current study sought to describe the long-term outcome of PD and to examine predictors of outcome. METHODS Women (N = 84) who met research criteria for PD completed a comprehensive battery of baseline interview and questionnaire assessments. At an average of 10.24 (3.81) years follow-up, available records indicated all women were living, and over 95% were successfully located (n = 80) while over two-thirds (n = 58) completed follow-up assessments. Eating disorder status, full recovery status, and level of eating pathology were examined as outcomes. Severity and comorbidity indicators were tested as predictors of outcome. RESULTS Although women experienced a clinically significant reduction in global eating pathology, 58% continued to meet criteria for a DSM-5 eating disorder at follow-up. Only 30% met established criteria for a full recovery. Women reported significant decreases in purging frequency, weight and shape concerns, and cognitive restraint, but did not report significant decreases in depressive and anxiety symptoms. Quality of life was impaired in the physical, psychological, and social domains. More severe weight and shape concerns at baseline predicted meeting criteria for an eating disorder at follow-up. Other baseline severity indicators and comorbidity did not predict the outcome. CONCLUSIONS Results highlight the severity and chronicity of PD as a clinically significant eating disorder. Future work should examine maintenance factors to better adapt treatments for PD.
Collapse
Affiliation(s)
- K Jean Forney
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Tiffany A Brown
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Kelly M Klein
- VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| |
Collapse
|
8
|
Naamani M, El Jamil F. Correlates of disordered eating among gay men in Lebanon. Eat Behav 2021; 40:101477. [PMID: 33549961 DOI: 10.1016/j.eatbeh.2021.101477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 01/09/2023]
Abstract
The present cross-sectional design study examined six factors and their associations with disordered eating among 129 Lebanese men who identified themselves as gay. The factors under study were self-objectification, body dissatisfaction, shame-proneness, guilt-proneness, positive minority identity, and a sense of connectedness to the lesbian, gay, bisexual, and transgender (LGBT) community. Nongovernmental organizations that advocate for LGBT individuals assisted in the recruitment of participants. Data were analyzed through a hierarchical multiple regression, and age, education level, socioeconomic status, and religious affiliation were controlled for. The control variables alone explained 6% of the variance, and the six variables of interest within this study explained an additional 25% after being entered into the model. Self-objectification and shame-proneness were significantly, positively related to disordered eating among the participants in this study. In contrast to prior research, body dissatisfaction was not significantly associated with disordered eating in the present study. Results of this study indicate that self-objectification and shame-proneness might be important issues to consider in clinical work with gay Lebanese men exhibiting disordered eating symptomatology.
Collapse
Affiliation(s)
- Mohamad Naamani
- American University of Beirut, Department of Psychology, Mail Box: Riad El-Solh, 1107 2020 Beirut, Lebanon
| | - Fatimah El Jamil
- American University of Beirut, Department of Psychology, Mail Box: Riad El-Solh, 1107 2020 Beirut, Lebanon.
| |
Collapse
|
9
|
Maske CB, Williams DL, Keel PK. Preliminary examination of insulin and amylin levels in women with purging disorder. Int J Eat Disord 2020; 53:997-1001. [PMID: 31976573 PMCID: PMC7282938 DOI: 10.1002/eat.23230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This preliminary study explored whether differences in meal-stimulated insulin or amylin release are linked to altered ingestive behaviors in individuals with bulimia nervosa (BN) or purging disorder (PD). METHOD Women with BN (n = 15), PD (n = 16), or no eating disorder (n = 18) underwent structured clinical interviews and assessments of gut hormone and subjective responses to a fixed test meal. Multilevel model analyses were used to explore whether gut hormone responses contribute to subjective responses to the test meal and whether these associations differed by group. RESULTS Insulin and amylin levels significantly increased following the test meal. Women with PD showed greater insulin release compared to those with BN, but not controls. Multilevel models support significant group X insulin interactions predicting subjective ratings of nausea and urge to vomit, with a stronger association between higher insulin responses and higher nausea and urge to vomit in women with PD and BN. Amylin responses did not differ by group. CONCLUSION Increased sensitivity to the effects of insulin on nausea and urge to vomit may be linked to purging in both PD and BN. Differences in postprandial insulin levels may be linked to purging behavior in the absence versus presence of binge eating.
Collapse
Affiliation(s)
- Calyn B. Maske
- Department of Psychology, Florida State University, Tallahassee, Florida,Program in Neuroscience, Florida State University, Tallahassee, Florida
| | - Diana L. Williams
- Department of Psychology, Florida State University, Tallahassee, Florida,Program in Neuroscience, Florida State University, Tallahassee, Florida
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, Florida
| |
Collapse
|
10
|
Davis HA, Smith GT, Keel PK. An examination of negative urgency and other impulsigenic traits in purging disorder. Eat Behav 2020; 36:101365. [PMID: 32018192 PMCID: PMC7044031 DOI: 10.1016/j.eatbeh.2020.101365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 11/25/2022]
Abstract
There is extensive evidence for the clinical significance of Purging Disorder (PD), an eating disorder characterized by recurrent purging behavior (self-induced vomiting, laxative use, and diuretic use) in the absence of binge eating and low weight (Smith, Crowther, & Lavender, 2017). Research on the personality profile of PD is still developing but evidence supports an association with impulsivity (Brown, Haedt-Matt, & Keel, 2011). The personality underpinnings of impulsive behavior include several different impulsigenic traits. To investigate personality contributors to impulsive behavior among women with PD, we compared 31 women with PD to 57 women with bulimia nervosa (BN) and 31 healthy control women on four impulsigenic traits: negative urgency, lack of premeditation, lack of perseverance, and sensation seeking. Compared to healthy controls, women with PD reported significantly greater levels of negative urgency, but no significant differences on the other traits. Compared to BN, PD was associated with significantly lower levels of negative urgency, but no other significant differences. Compared with controls, women in the BN group had significantly higher scores on lack of premeditation and lack of perseverance, but no significant difference on sensation seeking. Findings indicate negative urgency is a potentially important personality trait for distinguishing those with PD.
Collapse
Affiliation(s)
- Heather A. Davis
- Department of Psychology, University of Kentucky, Lexington, KY, United States
| | - Gregory T. Smith
- Department of Psychology, University of Kentucky, Lexington, KY, United States
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| |
Collapse
|
11
|
Arduini T, Iorio D, Patacchini E. Weight, reference points, and the onset of eating disorders. JOURNAL OF HEALTH ECONOMICS 2019; 65:170-188. [PMID: 31030114 DOI: 10.1016/j.jhealeco.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 02/11/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
We investigate whether the development of eating disorders, in the form of purging, is influenced by peers' body size through interpersonal comparisons. Using detailed information on recent cohorts of U.S. teenagers, we document a sizeable and significant negative effect of high school peers' body mass index (BMI) on purging behavior during the adolescence for females, but not for males. Interpersonal comparisons operate through the formation of a distorted self-perception: teenage girls with relatively thin female peers perceive themselves as heavier than they actually are. The girls who are more susceptible to peer influences are those having peers who are thinner, more popular, more (verbally) able, and with more educated parents.
Collapse
|
12
|
Keel PK, Haedt-Matt AA, Hildebrandt B, Bodell LP, Wolfe BE, Jimerson DC. Satiation deficits and binge eating: Probing differences between bulimia nervosa and purging disorder using an ad lib test meal. Appetite 2018; 127:119-125. [PMID: 29654850 DOI: 10.1016/j.appet.2018.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 04/02/2018] [Accepted: 04/10/2018] [Indexed: 01/28/2023]
Abstract
Purging disorder (PD) has been included as a named condition within the DSM-5 category of Other Specified Feeding or Eating Disorder and differs from bulimia nervosa (BN) in the absence of binge-eating episodes. The current study evaluated satiation through behavioral and self-report measures to understand how this construct may explain distinct symptom presentations for bulimia nervosa (BN) and purging disorder (PD). Women (N = 119) were recruited from the community if they met DSM-5 criteria for BN (n = 57), PD (n = 31), or were free of eating pathology (n = 31 controls). Participants completed structured clinical interviews and questionnaires and an ad lib test meal during which they provided reports of subjective states. Significant group differences were found on self-reported symptoms, ad lib test meal intake, and subjective responses to food intake between individuals with eating disorders and controls and between BN and PD. Further, ad lib intake was associated with self-reported frequency and size of binge episodes. In a multivariable model, the amount of food consumed during binges as reported during clinical interviews predicted amount of food consumed during the ad lib test meal, controlling for other binge-related variables. Satiation deficits distinguish BN from PD and appear to be specifically linked to the size of binge episodes. Future work should expand exploration of physiological bases of these differences to contribute to novel interventions.
Collapse
Affiliation(s)
- Pamela K Keel
- Department of Psychology, Florida State University, United States.
| | | | - Britny Hildebrandt
- Department of Psychiatry, Western Psychiatric Institute and Clinics, United States
| | | | - Barbara E Wolfe
- College of Nursing, University of Rhode Island, United States
| | - David C Jimerson
- Department of Psychiatry, Beth Israel Deaconess Medical Center, United States
| |
Collapse
|
13
|
Lydecker JA, Shea M, Grilo CM. Driven exercise in the absence of binge eating: Implications for purging disorder. Int J Eat Disord 2018; 51:139-145. [PMID: 29215743 PMCID: PMC5796839 DOI: 10.1002/eat.22811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/27/2017] [Accepted: 11/20/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Purging disorder (PD) is characterized by recurrent purging without objectively large binge-eating episodes. PD has received relatively little attention, and questions remain about the clinical significance of "purging" by exercise that is driven or compulsive (i.e., as extreme compensatory or weight-control behavior). The little available research suggests that individuals who use exercise as a compensatory behavior might have less eating-disorder psychopathology than those who purge by vomiting or laxatives, but those studies have had smaller sample sizes, defined PD using low-frequency thresholds, and defined exercise without weight-compensatory or driven elements. METHOD Participants (N = 2,017) completed a web-based survey with established measures of eating-disorder psychopathology, depression, and physical activity. Participants were categorized (regular compensatory driven exercise, PD-E, n = 297; regular compensatory vomiting/laxatives, PD-VL, n = 59; broadly defined anorexia nervosa, AN, n = 20; and no eating-disordered behaviors, NED, n = 1,658) and compared. RESULTS PD-E, PD-VL, and AN had higher eating-disorder psychopathology and physical activity than NED but did not significantly differ from each other on most domains. PD-VL and AN had higher depression than PD-E, which was higher than NED. DISCUSSION Findings suggest that among participants with regularly compensatory behaviors without binge eating, those who use exercise alone have similar levels of associated eating-disorder psychopathology as those who use vomiting/laxatives, although they have lower depression levels and overall frequency of purging. Findings provide further support for the clinical significance of PD. Clinicians and researchers should recognize the severity of driven exercise as a compensatory behavior, and the need for further epidemiological and treatment research.
Collapse
Affiliation(s)
| | - Megan Shea
- Department of Psychiatry, Yale School of Medicine,Amherst College
| | | |
Collapse
|
14
|
Smith KE, Crowther JH, Lavender JM. A review of purging disorder through meta-analysis. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 126:565-592. [PMID: 28691846 DOI: 10.1037/abn0000243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although a growing body of research has examined Purging Disorder (PD), there remains a lack of conclusive evidence regarding the diagnostic validity of PD. This meta-analysis compared PD to DSM-5 eating disorders (i.e., Anorexia Nervosa [AN], Bulimia Nervosa [BN], and Binge Eating Disorder [BED]) and controls. A comprehensive literature search identified 38 eligible studies. Group differences on indicators of course of illness and both general and eating psychopathology were assessed using standardized effect sizes. Results supported the conceptualization of PD as a clinically significant eating disorder, but findings were less clear regarding its distinctiveness from other eating disorder diagnoses. More specifically, PD significantly differed from BN and BED in natural course of illness (g = .40-.54), and PD significantly differed from AN in treatment outcome (g = .27), with PD characterized by a better prognosis. Overall, PD was more similar to AN and BED on many dimensional measures of general and eating-related psychopathology, though PD was less severe than BN in most of these domains. PD, BN, and BED groups also evidenced similar frequencies of subjective binge episodes (SBEs), yet PD evidenced less frequent SBEs than AN. There is a clear need for future studies of PD to assess validators that have not been reported comprehensively in the literature, such as mortality, medical morbidity, and course of illness. Additionally, empirical classification studies are needed to inform future classifications of PD, particularly with regard to categorical differences between PD and other eating disorders. (PsycINFO Database Record
Collapse
|
15
|
Keel PK, Eckel LA, Hildebrandt BA, Haedt-Matt AA, Appelbaum J, Jimerson DC. Disturbance of gut satiety peptide in purging disorder. Int J Eat Disord 2018; 51:53-61. [PMID: 29219202 DOI: 10.1002/eat.22806] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/06/2017] [Accepted: 11/12/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Little is known about biological factors that contribute to purging after normal amounts of food-the central feature of purging disorder (PD). This study comes from a series of nested studies examining ingestive behaviors in bulimic syndromes and specifically evaluated the satiety peptide YY (PYY) and the hunger peptide ghrelin in women with PD (n = 25), bulimia nervosa-purging (BNp) (n = 26), and controls (n = 26). Based on distinct subjective responses to a fixed meal in PD (Keel, Wolfe, Liddle, DeYoung, & Jimerson, ), we tested whether postprandial PYY response was significantly greater and ghrelin levels significantly lower in women with PD compared to controls and women with BNp. METHOD Participants completed structured clinical interviews, self-report questionnaires, and laboratory assessments of gut peptide and subjective responses to a fixed meal. RESULTS Women with PD demonstrated a significantly greater postprandial PYY response compared to women with BNp and controls, who did not differ significantly. PD women also endorsed significantly greater gastrointestinal distress, and PYY predicted gastrointestinal intestinal distress. Ghrelin levels were significantly greater in PD and BNp compared to controls, but did not differ significantly between eating disorders. Women with BNp endorsed significantly greater postprandial hunger, and ghrelin predicted hunger. DISCUSSION PD is associated with a unique disturbance in PYY response. Findings contribute to growing evidence of physiological distinctions between PD and BNp. Future research should examine whether these distinctions account for differences in clinical presentation as this could inform the development of specific interventions for patients with PD.
Collapse
Affiliation(s)
- Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, FL
| | - Lisa A Eckel
- Department of Psychology, Florida State University, Tallahassee, FL
| | | | | | | | - David C Jimerson
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA
| |
Collapse
|
16
|
Rohde P, Stice E, Gau JM. Predicting persistence of eating disorder compensatory weight control behaviors. Int J Eat Disord 2017; 50:561-568. [PMID: 27753127 PMCID: PMC5395356 DOI: 10.1002/eat.22639] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study aimed to identify variables that predicted persistence versus desistence of eating disorder-related compensatory behaviors in a high-risk factor sample of women who reported repeated compensatory behaviors at baseline. Data came from a randomized trial evaluating two brief obesity prevention interventions for college students with weight concerns. METHOD Two hundred and sixty one young women (Mean age = 19.1, 79% European American) with weight concerns were randomly assigned to one of two brief obesity prevention interventions or educational video control. Participants were assessed at baseline, post-intervention, 6- and 12-month follow-up by interview, survey, and physical measurements on 6 eating disorder features and 13 psychosocial variables hypothesized to predict onset or maintenance of eating pathology. RESULTS Approximately half (48%) reported engaging in recurrent compensatory behaviors in the year preceding study involvement. Among this subset, 61% reported persistent compensatory behaviors over 12-month follow-up. Neither study condition and adjunctive treatment, nor eating disorder features predicted persistence. Persistent compensatory behavior was significantly associated with greater sociocultural pressure to be thin, impulsivity, and substance use, and lower perceived sexual attractiveness. DISCUSSION Perceived pressure to be thin is an established risk factor for the initiation of disorder eating behaviors but also may serve as a maintenance factor for unhealthy compensatory behaviors. Impulsivity, either as a trait factor or resulting from substance misuse may contribute to poor judgment and ongoing compensatory behaviors. Additional research on factors that predict persistence of eating disordered behaviors is needed. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:561-568).
Collapse
Affiliation(s)
- Paul Rohde
- Oregon Research Institute; 1776 Millrace Drive Eugene Oregon 97403
| | - Eric Stice
- Oregon Research Institute; 1776 Millrace Drive Eugene Oregon 97403
| | - Jeff M. Gau
- Oregon Research Institute; 1776 Millrace Drive Eugene Oregon 97403
| |
Collapse
|
17
|
Goldschmidt AB, Accurso EC, O’Brien S, Fitzpatrick KK, Lock JD, Grange DL. The importance of loss of control while eating in adolescents with purging disorder. Int J Eat Disord 2016; 49:801-4. [PMID: 26969189 PMCID: PMC5318997 DOI: 10.1002/eat.22525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Although many individuals with purging disorder (PD) report loss of control (LOC) eating, it is unclear whether they differ from those who do not, or from other eating disorders involving purging and/or LOC. METHOD We compared PD with LOC (PD-LOC), PD without LOC (PD-noLOC), bulimia nervosa (BN), and anorexia nervosa-binge/purge subtype (AN-B/P) on measures of eating-related and general psychopathology in treatment-seeking adolescents. RESULTS PD-LOC comprised ∼30% of PD diagnoses. PD-LOC and PD-noLOC did not differ from one another, or from BN and AN-B/P, on most measures of psychopathology, with some exceptions. PD-noLOC was similar to AN-B/P (p = 0.99) and significantly different from BN on eating concerns (p < 0.001), while PD-LOC was similar to BN, AN-B/P, and PD-noLOC on this measure (ps ≥ 0.06). PD-LOC reported higher self-esteem than BN, AN-B/P, and PD-noLOC (ps < 0.001). DISCUSSION PD was largely similar to other eating disorders characterized by purging, regardless of whether LOC eating was present. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:801-804).
Collapse
Affiliation(s)
- Andrea B. Goldschmidt
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Erin C. Accurso
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Setareh O’Brien
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | | | - James D. Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
18
|
Forney KJ, Bodell LP, Haedt-Matt AA, Keel PK. Incremental validity of the episode size criterion in binge-eating definitions: An examination in women with purging syndromes. Int J Eat Disord 2016; 49:651-62. [PMID: 26841103 PMCID: PMC4942344 DOI: 10.1002/eat.22508] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/21/2015] [Accepted: 12/28/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Of the two primary features of binge eating, loss of control (LOC) eating is well validated while the role of eating episode size is less clear. Given the ICD-11 proposal to eliminate episode size from the binge-eating definition, the present study examined the incremental validity of the size criterion, controlling for LOC. METHOD Interview and questionnaire data come from four studies of 243 women with bulimia nervosa (n = 141) or purging disorder (n = 102). Hierarchical linear regression tested if the largest reported episode size, coded in kilocalories, explained additional variance in eating disorder features, psychopathology, personality traits, and impairment, holding constant LOC eating frequency, age, and body mass index (BMI). Analyses also tested if episode size moderated the association between LOC eating and these variables. RESULTS Holding LOC constant, episode size explained significant variance in disinhibition, trait anxiety, and eating disorder-related impairment. Episode size moderated the association of LOC eating with purging frequency and depressive symptoms, such that in the presence of larger eating episodes, LOC eating was more closely associated with these features. Neither episode size nor its interaction with LOC explained additional variance in BMI, hunger, restraint, shape concerns, state anxiety, negative urgency, or global functioning. DISCUSSION Taken together, results support the incremental validity of the size criterion, in addition to and in combination with LOC eating, for defining binge-eating episodes in purging syndromes. Future research should examine the predictive validity of episode size in both purging and nonpurging eating disorders (e.g., binge eating disorder) to inform nosological schemes. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:651-662).
Collapse
Affiliation(s)
- K. Jean Forney
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Lindsay P. Bodell
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, Florida,Correspondence to: Pamela K. Keel, Ph.D., Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306.
| |
Collapse
|
19
|
Farstad SM, McGeown LM, von Ranson KM. Eating disorders and personality, 2004–2016: A systematic review and meta-analysis. Clin Psychol Rev 2016. [DOI: 10.1016/j.cpr.2016.04.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
20
|
Solmi F, Hotopf M, Hatch SL, Treasure J, Micali N. Eating disorders in a multi-ethnic inner-city UK sample: prevalence, comorbidity and service use. Soc Psychiatry Psychiatr Epidemiol 2016; 51:369-81. [PMID: 26631229 DOI: 10.1007/s00127-015-1146-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 10/15/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE No studies have investigated the prevalence of eating disorders (ED) according to DSM-5 criteria and few have explored their comorbidity and service use in the general population in the UK. We aimed to estimate the prevalence, comorbidity, and service use in individuals with ED in a multi-ethnic inner city sample. METHODS A total of 1698 individuals (age 16/90) were screened for ED in the first phase of the South East London Community Health Study and 145 were followed up with a diagnostic interview. Data was weighed for survey design and Chi Square tests were used to investigate socio-demographic distribution, comorbidity and service use in participants with ED. RESULTS The point prevalence of ED was 4.4 % (Binge Eating Disorder (BED) 3.6 %; Bulimia Nervosa (BN) 0.8 %) and 7.4 % when including sub-threshold diagnoses (Purging Disorder (PD) 0.6 %; Other Specified Feeding and Eating Disorders (OSFED) 2.4 %). No cases of AN were identified. Purging Disorder was the ED with the highest proportion of comorbid disorders. A minority of participants with ED had accessed specialist care services. CONCLUSIONS ED are common, the comorbidity of ED was in line with previous studies and no ethnic differences were identified. Although PD is not a full diagnosis in DSM-5, we found some evidence of high comorbidity with other disorders, that needs to be replicated using larger samples. Service use was low across ED diagnoses, despite high levels of comorbidity.
Collapse
Affiliation(s)
- F Solmi
- Behavioural and Brain Science Unit, Institute of Child Health, University College London, London, UK.
- Division of Psychiatry, University College London, Gower Street, London, UK.
| | - M Hotopf
- Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - S L Hatch
- Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - J Treasure
- Eating Disorders Department, Institute of Psychiatry, King's College London, London, UK
| | - N Micali
- Behavioural and Brain Science Unit, Institute of Child Health, University College London, London, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
21
|
Riley EN, Davis HA, Combs JL, Jordan CE, Smith GT. Nonsuicidal Self-injury as a Risk Factor for Purging Onset: Negatively Reinforced Behaviours that Reduce Emotional Distress. EUROPEAN EATING DISORDERS REVIEW 2016; 24:78-82. [PMID: 26373703 PMCID: PMC4681665 DOI: 10.1002/erv.2407] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/21/2015] [Accepted: 08/24/2015] [Indexed: 11/07/2022]
Abstract
Both nonsuicidal self-injury (NSSI) and purging behaviour are thought to involve harm to the self. The acquired capability for self-harm model holds that engaging in one self-harming behaviour increases the capability to tolerate harm to the self, thus increasing risk for engaging on other such behaviours. In addition, both behaviours are thought to serve the similar function of relief from distress. We thus tested whether engagement in one of these behaviours predicts the subsequent onset of the other. In a longitudinal design, 1158 first-year college women were assessed for purging and NSSI at two time points. Engagement in NSSI at time 1 predicted the college onset of purging behaviour 9 months later (OR = 2.20, p < .04, CI = 1.07-4.19) beyond prediction from time 1 binge behaviour, and purging behaviour at time 1 predicted the subsequent onset of NSSI (OR = 6.54, p < .01, CI = 1.71-25.04). These findings are consistent with the acquired capability for harm model and with the possibility that the two behaviours serve a similar function.
Collapse
Affiliation(s)
- Elizabeth N. Riley
- The University of Kentucky Department of Psychology 125 Kastle Hall Lexington, KY 40506-0044
| | - Heather A. Davis
- The University of Kentucky Department of Psychology 125 Kastle Hall Lexington, KY 40506-0044
| | - Jessica L. Combs
- The University of Kentucky Department of Psychology 125 Kastle Hall Lexington, KY 40506-0044
| | - Carol E. Jordan
- The University of Kentucky Department of Psychology 125 Kastle Hall Lexington, KY 40506-0044
| | - Gregory T. Smith
- The University of Kentucky Department of Psychology 125 Kastle Hall Lexington, KY 40506-0044
| |
Collapse
|
22
|
Forbush KT, Richardson JH, Bohrer BK. Clinicians' practices regarding blind versus open weighing among patients with eating disorders. Int J Eat Disord 2015; 48:905-11. [PMID: 25504058 DOI: 10.1002/eat.22369] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Empirically supported treatments for eating disorders, such as cognitive-behavioral therapy and family-based treatment, stress the importance of weighing patients during therapy and using this information as part of treatment. However, weighing practices vary widely across eating disorders professionals, including those that purport to provide empirically supported interventions. OBJECTIVES To characterize clinicians' practices regarding the decision to share (open weighing) or withhold (blind weighing) weight information with patients, a topic that has received limited prior attention. METHOD Clinicians (N = 114; 85% female) who regularly treat individuals with an eating disorder completed an online survey to identify factors that might impact their decision to practice blind or open weighing. RESULTS Approximately half of the clinicians reported generally using open weighing procedures (n = 53; 46.49%). Endorsement of cognitive-behavioral or family-based therapeutic orientation was not significantly associated with open weighing. However, clinicians who endorsed therapeutic modalities that do not specifically encourage open weighing were significantly more likely to engage in blind weighing. Clinicians working with clients with anorexia nervosa were significantly more likely to practice blind weighing, compared to clients with other eating disorder diagnoses, and cognitive or emotional impairment from malnutrition emerged as the strongest predictor of clinicians' decisions to practice blind weighing, controlling for all other variables. DISCUSSION Development of specific training modules may be useful for improving adherence to empirically supported protocols that recommend open weighing. More importantly, however, our results highlight the need for future treatment studies to identify whether blind or open weighing is beneficial for improving patient outcomes.
Collapse
Affiliation(s)
- Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | - Jonathan H Richardson
- Charis Center for Eating Disorders, Indiana University Health/Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | | |
Collapse
|
23
|
Murray SB, Anderson LK. Deconstructing "Atypical" Eating Disorders: an Overview of Emerging Eating Disorder Phenotypes. Curr Psychiatry Rep 2015; 17:86. [PMID: 26377946 DOI: 10.1007/s11920-015-0624-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recent changes to the diagnostic framework of eating disorders (ED's) in DSM-5 were introduced to reduce the large preponderance of cases falling within the residual and undifferentiated category. However, current reports continue to illustrate overrepresentation of cases in this residual category, suggesting that clinical reality comprises more diverse ED psychopathology than is accounted for in the current diagnostic spectrum. However, with emerging evidence preliminarily delineating several additional distinct phenotypes, we aim to provide a narrative overview of emerging ED phenotypes which (i) are not currently located as a specific diagnostic category in diagnostic criteria for ED's, (ii) centrally feature ED psychopathology, and (iii) have emerging empirical evidence suggesting the distinct nature of the syndrome. A greater awareness of these emerging phenotypes will likely facilitate accurate diagnostic practice and may also serve to facilitate further empirical efforts.
Collapse
Affiliation(s)
- Stuart B Murray
- Eating Disorders Treatment & Research Center, Department of Psychiatry, University of California San Diego, 4510 Executive Drive, Suite 310, San Diego, CA, 92121, USA.
| | - Leslie K Anderson
- Eating Disorders Treatment & Research Center, Department of Psychiatry, University of California San Diego, 4510 Executive Drive, Suite 310, San Diego, CA, 92121, USA
| |
Collapse
|
24
|
Flament MF, Henderson K, Buchholz A, Obeid N, Nguyen HNT, Birmingham M, Goldfield G. Weight Status and DSM-5 Diagnoses of Eating Disorders in Adolescents From the Community. J Am Acad Child Adolesc Psychiatry 2015; 54:403-411.e2. [PMID: 25901777 DOI: 10.1016/j.jaac.2015.01.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/09/2014] [Accepted: 02/12/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To estimate jointly the point prevalence of weight and eating disorders in a community sample of adolescents; to investigate psychosocial correlates of thinness, overweight, and obesity, and of full- and subthreshold eating disorders (EDs); and to examine the relationships between weight status and prevalence of EDs. METHOD A total of 3,043 Canadian adolescents (1,254 males and 1,789 females; mean age = 14.19 years, SD = 1.61 years) completed self-report questionnaires, including the Eating Disorder Diagnostic Scale, and measures of psychosocial functioning. Objective weight and height were collected, and weight status was defined according to the International Obesity Task Force body mass index growth curve centiles. RESULTS In all, 29.5% (95% CI = 26.7, 32.5) of males and 22.8% (95% CI = 20.5, 25.2) of females were overweight or obese. A total of 2.2% (95% CI = 1.5, 3.2) of males and 4.5% (95% CI = 4.4, 4.5) of females met DSM-5 criteria for an ED; in addition, 1.1% (95% CI = 0.7, 1.9) of males and 5.1% (95% CI = 4.0, 6.5) of females were identified with a subthreshold ED. Both full- and subthreshold EDs were significantly associated with markedly impaired psychosocial functioning. There was a significant relationship between prevalence of EDs and weight status, with an increased risk for a bulimic disorder in obese relative to normal-weight males (odds ratio [OR] = 7.86) and females (OR = 3.27). CONCLUSION This study provides estimates for the prevalence of DSM-5 EDs in adolescents, further support for their impact on mental health, and new evidence for an association between bulimic disorders and obesity. Results call for an integrated approach in research and prevention regarding the whole spectrum of eating- and weight-related disorders.
Collapse
Affiliation(s)
- Martine F Flament
- University of Ottawa Institute of Mental Health Research, Ottawa, Canada.
| | | | - Annick Buchholz
- Children's Hospital of Eastern Ontario (CHEO) Centre for Healthy Active Living, the CHEO Research Institute, and Carleton University, Ottawa
| | - Nicole Obeid
- CHEO Eating Disorders Program, the CHEO Research Institute, and the University of Ottawa, Ottawa
| | | | - Meagan Birmingham
- University of Ottawa Institute of Mental Health Research, Ottawa, Canada
| | | |
Collapse
|
25
|
Dossat AM, Bodell LP, Williams DL, Eckel LA, Keel PK. Preliminary examination of glucagon-like peptide-1 levels in women with purging disorder and bulimia nervosa. Int J Eat Disord 2015; 48:199-205. [PMID: 24590464 PMCID: PMC4155021 DOI: 10.1002/eat.22264] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study examined pre- and postprandial glucagon-like peptide 1 (GLP-1) levels in women with bulimia nervosa (BN), purging disorder (PD), and non-eating disorder control women to better understand whether alterations in satiation-related hormones in BN may be linked to binge-eating episodes or other altered ingestive behaviors. METHOD Participants included women with BN (n = 19), PD (n = 14), or controls (n = 14). Participants provided subjective ratings for hunger and fullness and plasma samples before and after consumption of a standardized test meal. RESULTS As expected, GLP-1 levels increased significantly following test meal consumption; however, participants with BN displayed significantly lower GLP-1 levels compared to PD and control participants both before and after consumption of the test meal. There were no significant differences between PD and control participants in GLP-1 levels, but individuals with PD displayed significantly higher levels of fullness throughout the test meal as compared to both control and BN participants. DISCUSSION Our findings provide preliminary evidence that reduced GLP-1 levels in individuals with BN may be associated with binge-eating episodes. Additionally, increased fullness in individuals with PD does not appear to be accounted for by exaggerated postprandial GLP-1 release.
Collapse
Affiliation(s)
- Amanda M. Dossat
- Department of Biomedical Sciences, Florida State University, Tallahassee, Florida,Program in Neuroscience, Florida State University, Tallahassee, Florida
| | - Lindsay P. Bodell
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Diana L. Williams
- Department of Psychology, Florida State University, Tallahassee, Florida,Program in Neuroscience, Florida State University, Tallahassee, Florida
| | - Lisa A. Eckel
- Department of Psychology, Florida State University, Tallahassee, Florida,Program in Neuroscience, Florida State University, Tallahassee, Florida
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, Florida,Correspondence to: Pamela K. Keel, Ph.D., Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306.
| |
Collapse
|
26
|
Haedt-Matt AA, Keel PK. Affect regulation and purging: An ecological momentary assessment study in purging disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 124:399-411. [PMID: 25688426 DOI: 10.1037/a0038815] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research suggests that affect may play an important role in the propensity to purge among women with purging disorder (PD). However, prior work has been constrained to cross-sectional or laboratory designs, which impact temporal interpretations and ecological validity. This study examined negative affect (NA) and positive affect (PA) in triggering and maintaining purging in PD using ecological momentary assessment. Women with PD (N = 24) made multiple daily ratings of affect and behavior for 2 weeks. Multilevel models examined associations between affect and purging at different levels of analysis, including a novel analytic approach to address the specificity of changes in affect relative to purging behavior by comparing trajectories of change on purge versus nonpurge days. For trajectories of affect over time, NA increased before purging and decreased following purging on purge days; however, only the decrease in NA following purging was significantly different from the trajectory of NA on nonpurge days. Conversely, PA failed to increase before purging on purge days compared with a matched time-point on nonpurge days. These findings suggest unique roles of PA in triggering and NA in maintaining purging in PD and support models in which purging functions to regulate affect. For comparisons of ratings before and after purging, NA increased and PA decreased after purging, highlighting how different analytic strategies produce different findings requiring integration into affect regulation models. These data provide insight into why women with PD purge after consuming normal amounts of food, a crucial first step for developing effective interventions.
Collapse
|
27
|
Solmi F, Sonneville KR, Easter A, Horton NJ, Crosby RD, Treasure J, Rodriguez A, Jarvelin MR, Field AE, Micali N. Prevalence of purging at age 16 and associations with negative outcomes among girls in three community-based cohorts. J Child Psychol Psychiatry 2015; 56:87-96. [PMID: 24975817 PMCID: PMC4303957 DOI: 10.1111/jcpp.12283] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The comorbidity of purging behaviours, such as vomiting, inappropriate use of laxatives, diuretics or slimming medications, has been examined in literature. However, most studies do not include adolescents, individuals who purge in the absence of binge eating, or those purging at subclinical frequency. This study examines the prevalence of purging among 16-year-old girls across three countries and their association with substance use and psychological comorbidity. METHODS Data were obtained by questionnaire in 3 population-based cohorts (Avon Longitudinal Study of Parents and Children (ALSPAC), United Kingdom, n = 1,608; Growing Up Today Study (GUTS), USA, n = 3,504; North Finland Birth Cohort (NFBC85/86), Finland, n = 2,306). Multivariate logistic regressions were employed to estimate associations between purging and outcomes. Four models were fit adjusting for binge eating and potential confounders of these associations. RESULTS In ALSPAC, 9.7% of girls reported purging in the 12-months prior to assessment, 7.3% in GUTS, and 3.5% in NFBC. In all 3 cohorts, purging was associated with adverse outcomes such as binge drinking (ALSPAC: odds ratio (OR) = 2.0, 95% confidence interval (CI) = 1.4-2.9; GUTS: OR = 2.5, 95% CI = 1.5-4.0; NFBC: OR = 1.7, 95% CI = 1.0-2.8), drug use (ALSPAC: OR = 2.9, 95% CI = 1.8-4.7; GUTS: OR = 4.5, 95% CI = 2.8-7.3; NFBC: OR = 4.1, 95% CI = 2.6-6.6), depressive symptoms in ALSPAC (OR = 2.2, 95% CI = 1.5-3.1) and GUTS(OR = 3.7, 95% CI = 2.2-6.3), and several psychopathology measures including clinical anxiety/depression in NFBC (OR = 11.2, 95% CI = 3.9, 31.7). CONCLUSIONS Results show a higher prevalence of purging behaviours among girls in the United Kingdom compared to those in the United States and Finland. Our findings support evidence highlighting that purging in adolescence is associated with negative outcomes, independent of its frequency and binge eating.
Collapse
Affiliation(s)
- Francesca Solmi
- Behavioural & Brain Sciences Unit, Institute of Child Health, University College LondonLondon, UK
| | - Kendrin R Sonneville
- Division of Adolescence Medicine, Boston's Children Hospital, Harvard Medical SchoolBoston, MA, USA
| | - Abigail Easter
- Behavioural & Brain Sciences Unit, Institute of Child Health, University College LondonLondon, UK
| | - Nicholas J Horton
- Department of Mathematics & Statistics, Amherst CollegeAmherst, MA, USA
| | - Ross D Crosby
- Department of Neuroscience, Neuropsychiatric Research Institute, University of North DakotaFargo, ND, USA
| | - Janet Treasure
- Eating Disorder Unit, Institute of Psychiatry, King's College LondonLondon, UK
| | - Alina Rodriguez
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College LondonLondon, UK,Mid Sweden University, Department of Psychology, Campus ÖstersundÖstersund, Sweden
| | - Marjo-Riitta Jarvelin
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College LondonLondon, UK,Institute of Health Sciences, University of OuluOulu, Finland,Biocenter Oulu, University of OuluOulu, Finland,Unit of Primary Care, Oulu University Hospital, OYSOulu, Finland,Department of Children and Young People and Families, National Institute for Health and WelfareOulu, Finland
| | - Alison E Field
- Division of Adolescence Medicine, Boston's Children Hospital, Harvard Medical SchoolBoston, MA, USA
| | - Nadia Micali
- Behavioural & Brain Sciences Unit, Institute of Child Health, University College LondonLondon, UK
| |
Collapse
|
28
|
Flament MF, Buchholz A, Henderson K, Obeid N, Maras D, Schubert N, Paterniti S, Goldfield G. Comparative distribution and validity of DSM-IV and DSM-5 diagnoses of eating disorders in adolescents from the community. EUROPEAN EATING DISORDERS REVIEW 2014; 23:100-10. [PMID: 25524758 DOI: 10.1002/erv.2339] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/20/2014] [Accepted: 11/22/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVES DSM-5 changes for eating disorders (EDs) aimed to reduce preponderance of non-specified cases and increase validity of specific diagnoses. The objectives were to estimate the combined effect of changes on prevalence of EDs in adolescents and examine validity of diagnostic groupings. METHOD A total of 3043 adolescents (1254 boys and 1789 girls, Mage = 14.19 years, SD = 1.61) completed self-report questionnaires including the Eating Disorder Diagnostic Scale. RESULTS Prevalence of full-threshold EDs increased from 1.8% (DSM-IV) to 3.7% (DSM-5), with a higher prevalence of bulimia nervosa (1.6%) and the addition of the diagnosis of purging disorder (1.4%); prevalence of binge eating disorder was unchanged (0.5%), and non-specified cases decreased from 5.1% (DSM-IV) to 3.4% (DSM-5). Validation analyses demonstrated that DSM-5 ED subgroups better captured variance in psychopathology than DSM-IV subgroups. DISCUSSION Findings extend results from previous prevalence and validation studies into the adolescent age range. Improved diagnostic categories should facilitate identification of EDs and indicate targeted treatments.
Collapse
Affiliation(s)
- Martine F Flament
- University of Ottawa Institute of Mental Health Research, Ottawa, Canada
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Swanson SA, Brown TA, Crosby RD, Keel PK. What are we missing? The costs versus benefits of skip rule designs. Int J Methods Psychiatr Res 2014; 23:474-85. [PMID: 24030679 PMCID: PMC4676724 DOI: 10.1002/mpr.1396] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 06/07/2012] [Accepted: 07/12/2012] [Indexed: 11/06/2022] Open
Abstract
Many research diagnostic interviews employ skip rules, such that some questions are only asked based on answers to prior questions. In the context of large-scale epidemiological studies, skip rules are important to study feasibility by reducing the time, money, and participant burden required for assessment. However, less is understood about information lost when questions are skipped. This study examines the relative prevalence, clinical significance, and additional time required to assess eating disorder symptom patterns skipped in the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to understand the costs and benefits of following skip rules. Data come from the second stage of a two-stage cohort sample (N = 400) in which the SCID-I eating disorders module was administered without following skip rules. Results were weighted to correct for the sampling framework. Over a third of subjects endorsed symptoms that would have been missed had skip rules been followed. Uncaptured symptom patterns were associated with increased psychosocial impairment, and the additional time required to assess all symptoms averaged 1.8 minutes per participant. Clinically significant symptom patterns are missed by the SCID-I and similar diagnostic tools, suggesting that epidemiologic studies using such instruments under-estimate the prevalence and public health impact of mental disorders.
Collapse
Affiliation(s)
- Sonja A Swanson
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | | | | | | |
Collapse
|
30
|
Swanson SA, Horton NJ, Crosby RD, Micali N, Sonneville KR, Eddy K, Field AE. A latent class analysis to empirically describe eating disorders through developmental stages. Int J Eat Disord 2014; 47:762-72. [PMID: 24909947 PMCID: PMC4211958 DOI: 10.1002/eat.22308] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/18/2014] [Accepted: 05/20/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The current standards for classifying eating disorders were primarily informed by adult, clinical study populations, while it is unknown whether an empirically based classification system can be supported across preadolescence through young adulthood. Using latent class analyses, we sought to empirically classify disordered eating in females from preadolescence to young adulthood, and assess the association between classes and adverse outcomes. METHOD Latent class models were fit using observations from the 9,039 girls participating in the growing up today study, an on-going cohort following participants annually or biennially since 1996 when they were ages 9-14 years. Associations between classes and drug use, binge drinking, and depressive symptoms were assessed using generalized estimating equations. RESULTS Across age groups, there was evidence of six classes: a large asymptomatic class, a class characterized by shape/weight concerns, a class characterized by overeating without loss of control, and three resembling full and subthreshold binge eating disorder, purging disorder, and bulimia nervosa. Relative prevalences of classes varied across developmental stages, with symptomatic classes increasing in prevalence with increasing age. Symptomatic classes were associated with concurrent and incident drug use, binge drinking, and high depressive symptoms. DISCUSSION A classification system resembling broader definitions of DSM-5 diagnoses along with two further subclinical symptomatic classes may be a useful framework for studying disordered eating among adolescent and young adult females.
Collapse
Affiliation(s)
- Sonja A. Swanson
- Department of Epidemiology, Harvard School of Public Health, Boston MA
| | | | - Ross D. Crosby
- Neuropsychiatric Research Institute and Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Nadia Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK
| | - Kendrin R. Sonneville
- Division of Adolescent Medicine, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - Kamryn Eddy
- Harris Center for Education and Advocacy in Eating Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Alison E. Field
- Department of Epidemiology, Harvard School of Public Health, Boston MA,Division of Adolescent Medicine, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
31
|
Allen KL, Byrne SM, Crosby RD. Distinguishing Between Risk Factors for Bulimia Nervosa, Binge Eating Disorder, and Purging Disorder. J Youth Adolesc 2014; 44:1580-91. [PMID: 25233874 DOI: 10.1007/s10964-014-0186-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/08/2014] [Indexed: 01/01/2023]
Abstract
Binge eating disorder and purging disorder have gained recognition as distinct eating disorder diagnoses, but risk factors for these conditions have not yet been established. This study aimed to evaluate a prospective, mediational model of risk for the full range of binge eating and purging eating disorders, with attention to possible diagnostic differences. Specific aims were to determine, first, whether eating, weight and shape concerns at age 14 would mediate the relationship between parent-perceived childhood overweight at age 10 and a binge eating or purging eating disorder between age 15 and 20, and, second, whether this mediational model would differ across bulimia nervosa, binge eating disorder, and purging disorder. Participants (N = 1,160; 51 % female) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to age 20. Eating disorders were assessed via self-report questionnaires when participants were aged 14, 17 and 20. There were 146 participants (82 % female) with a binge eating or purging eating disorder with onset between age 15 and 20 [bulimia nervosa = 81 (86 % female), binge eating disorder = 43 (74 % female), purging disorder = 22 (77 % female)]. Simple mediation analysis with bootstrapping was used to test the hypothesized model of risk, with early adolescent eating, weight and shape concerns positioned as a mediator between parent-perceived childhood overweight and later onset of a binge eating or purging eating disorder. Subsequently, a conditional process model (a moderated mediation model) was specified to determine if model pathways differed significantly by eating disorder diagnosis. In the simple mediation model, there was a significant indirect effect of parent-perceived childhood overweight on risk for a binge eating or purging eating disorder in late adolescence, mediated by eating, weight and shape concerns in early adolescence. In the conditional process model, this significant indirect effect was not moderated by eating disorder group. The results support a prospective model of risk that applies to bulimia nervosa, binge eating disorder and purging disorder. Common prevention approaches may be possible for bulimia nervosa, binge eating disorder and purging disorder.
Collapse
Affiliation(s)
- Karina L Allen
- School of Psychology, The University of Western Australia, M304, 35 Stirling Hwy, Crawley, WA, 6009, Australia,
| | | | | |
Collapse
|
32
|
Latner JD, Mond JM, Kelly MC, Haynes SN, Hay PJ. The Loss of Control Over Eating Scale: development and psychometric evaluation. Int J Eat Disord 2014; 47:647-59. [PMID: 24862351 DOI: 10.1002/eat.22296] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/21/2014] [Accepted: 04/27/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study describes the development, content validity, and convergent validity of the Loss of Control over Eating Scale (LOCES). METHOD An initial pool of 56 items covering 13 facets of loss-of-control eating was assembled by reviewing qualitative literature, clinical descriptions, and research on binge eating. Eating disorder experts (n = 34) and eating disorder clients (n = 22) rated each proposed item's clarity and relevance to the construct of loss-of-control eating, rated 13 facets for their relevance to the construct, and provided open-ended feedback about the items and facets. Based on the experts' and clients' quantitative and qualitative feedback, scale items were clarified, 28 items were added, and 10 were deleted. University students (n = 476; 70% female, mean age = 20.4 years) completed the resulting 74-item questionnaire, rating how often they had the experience identified in the item while eating in the last 4 weeks. They also completed the measures of eating disturbance, general distress, functional impairment, and general self-control. RESULTS The resulting 24-item LOCES (Cronbach's α = .96) retained items with highest item-total correlations and coverage of the 12 construct facets that experts rated as important. The LOCES was significantly correlated with eating disturbances, general distress, functional impairment, and general self-control. Three subfactors were identified: behavioral, cognitive/dissociative, and positive/euphoric aspects of loss-of-control eating. A brief, seven-item version of the LOCES was developed and validated. DISCUSSION A thorough process of development, content validation, and psychometric evaluation in multiple samples yielded the multifaceted LOCES and its brief form. These instruments may be useful in assessing loss-of-control eating in both clinical and nonclinical settings.
Collapse
Affiliation(s)
- Janet D Latner
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | | | | | | | | |
Collapse
|
33
|
Allen KL, Byrne SM, Hii H, van Eekelen A, Mattes E, Foster JK. Neurocognitive functioning in adolescents with eating disorders: a population-based study. Cogn Neuropsychiatry 2014; 18:355-75. [PMID: 22803827 DOI: 10.1080/13546805.2012.698592] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Neurocognitive deficits have been identified in eating disorders, including anorexia nervosa and bulimia nervosa. However, current data do not allow for firm conclusions regarding the nature or extent of these deficits. The current study aimed to evaluate neurocognitive functioning in a population-based sample of adolescents with and without eating disorders. METHODS Participants (N=669) were drawn from the Western Australian Pregnancy Cohort (Raine) Study. Cognitive testing was conducted using the computerised CogState assessment battery. Eating disorder symptoms were assessed using questions adapted from the Child Eating Disorder Examination and Eating Disorder Examination-Questionnaire. Adolescents who met full or partial criteria for a DSM-IV eating disorder (n=58) were compared to adolescents with no significant eating pathology (n=592). RESULTS The eating disorder sample showed impaired performance on measures of executive functioning, including global processing and set shifting, but performed better than control participants on measures of visual attention and vigilance. CONCLUSIONS This is the first study to evaluate neurocognitive functioning in a population-based sample of adolescents with eating disorders. Support is provided for weak central coherence and set-shifting difficulties early in the course of eating disorders. Research is needed to determine if these deficits precede and predict eating disorder onset.
Collapse
Affiliation(s)
- Karina L Allen
- a Telethon Institute for Child Health Research, Centre for Child Health Research , University of Western Australia , Subiaco , Western Australia
| | | | | | | | | | | |
Collapse
|
34
|
Forney KJ, Haedt-Matt AA, Keel PK. The role of loss of control eating in purging disorder. Int J Eat Disord 2014; 47:244-51. [PMID: 24185981 PMCID: PMC3947436 DOI: 10.1002/eat.22212] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 07/02/2013] [Accepted: 09/30/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Purging Disorder (PD), an Other Specified Feeding or Eating Disorder (APA, 2013), is characterized by recurrent purging in the absence of binge eating. Though objectively large binge episodes are not present, individuals with PD may experience a loss of control (LOC) while eating a normal or small amounts of food. The present study sought to examine the role of LOC eating in PD using archival data from 101 women with PD. METHOD Participants completed diagnostic interviews and self-report questionnaires. Analyses examined the relationship between LOC eating and eating disorder features, psychopathology, personality traits, and impairment in bivariate models and then in multivariate models controlling for purging frequency, age, and body mass index. RESULTS Across bivariate and multivariate models, LOC eating frequency was associated with greater disinhibition around food, hunger, depressive symptoms, negative urgency, distress, and impairment. DISCUSSION LOC eating is a clinically significant feature of PD and should be considered in future definitions of PD. Future research should examine whether LOC eating better represents a dimension of severity in PD or a specifier that may impact treatment response or course.
Collapse
Affiliation(s)
- K. Jean Forney
- Department of Psychology, Florida State University, Tallahassee, Florida
| | | | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, Florida,Correspondence to: Pamela K. Keel, Ph.D., Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306.
| |
Collapse
|
35
|
Munn-Chernoff MA, Duncan AE, Grant JD, Wade TD, Agrawal A, Bucholz KK, Madden PAF, Martin NG, Heath AC. A twin study of alcohol dependence, binge eating, and compensatory behaviors. J Stud Alcohol Drugs 2014; 74:664-73. [PMID: 23948525 DOI: 10.15288/jsad.2013.74.664] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Rates of alcohol dependence are elevated in women with eating disorders who engage in binge eating or compensatory behaviors compared with women with eating disorders who do not report binge eating or compensatory behaviors and with healthy controls. Alcohol dependence, binge eating, and compensatory behaviors are heritable; however, it is unclear whether a shared genetic liability contributes to the phenotypic association among these traits, and little information exists regarding this shared liability in men. We investigated genetic and environmental correlations among alcohol dependence, binge eating, and compensatory behaviors in male and female twins. METHOD Participants included 5,993 same- and opposite-sex twins from the Australian Twin Registry who completed a modified version of the Semi-Structured Assessment for the Genetics of Alcoholism that assessed lifetime alcohol dependence and binge eating as defined in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Compensatory behaviors were assessed via a general health questionnaire in women only. Biometrical twin models estimated genetic and environmental influences on alcohol dependence, binge eating, and compensatory behaviors. RESULTS In women, the multivariate twin model suggested that additive genetic and nonshared environmental effects influenced alcohol dependence, binge eating, and compensatory behaviors, with heritability estimates ranging from 38% to 53%. The best-fitting sex-limitation model was a common effects model that equated all genetic and nonshared environmental influences in men and women. The heritability estimates were 50% and 38% for alcohol dependence and binge eating, respectively. Overall, there were significant genetic correlations between alcohol dependence and binge eating, alcohol dependence and compensatory behaviors, and binge eating and compensatory behaviors. CONCLUSIONS These findings indicate that common genetic factors may underlie the vulnerability to alcohol dependence and the liability to binge eating and compensatory behaviors.
Collapse
Affiliation(s)
- Melissa A Munn-Chernoff
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri 63110, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Purging disorder: a pathway to death? A review of 11 cases. Eat Weight Disord 2014; 19:21-9. [PMID: 24198060 DOI: 10.1007/s40519-013-0082-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/26/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE With data from the Christina-Barz-Study, we report mortality rates and predictors of death in purging disorder (PurD) as well as additional information concerning the fatal cases. METHOD The study was conducted with 225 consecutively admitted inpatients during the years 1999-2005. About 9 years later, fatal cases were identified by local registration office records. The standardised mortality ratio (SMR) was calculated through mortality tables of the Federal Office of Statistics, Germany. To identify predictors of death, survival analyses were performed. Spouses, relatives or doctors of the deceased were consulted by interview or questionnaire for further information of pathogenesis and circumstances of death. RESULTS Six of the 225 sample individuals could not be located for the follow-up. Eleven of 219 former inpatients had died during the follow-up interval. The crude mortality rate was 5.0%. The SMR was 3.90 [95% confidence interval (2.05; 7.21)]. Age at admission and presence of one or more co-morbid somatic illnesses at admission were factors associated with a shorter time period until death. DISCUSSION Our data indicate that there is a higher number of deaths within the study population than expected. Paying particular attention to age and the severity of co-morbid somatic symptoms could improve the outcome of patients with PurD.
Collapse
|
37
|
Intrasexual Competition and Other Theories of Eating Restriction. EVOLUTIONARY PSYCHOLOGY 2014. [DOI: 10.1007/978-1-4939-0314-6_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
38
|
Solmi F, Hatch SL, Hotopf M, Treasure J, Micali N. Prevalence and correlates of disordered eating in a general population sample: the South East London Community Health (SELCoH) study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1335-46. [PMID: 24441522 PMCID: PMC4108843 DOI: 10.1007/s00127-014-0822-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 01/05/2014] [Indexed: 10/27/2022]
Abstract
PURPOSE Disordered eating has been shown to be more prevalent than full eating disorders diagnoses. However, research on its prevalence, socio-demographic, psychological correlates, and patterns of service use in multi-ethnic samples is still limited. This paper explores these associations in a South London-based (UK) sample. METHODS The South East London Community Health (SELCoH) study is a general population survey (N = 1,698) of individuals aged 16+. Disordered eating was defined as ≥2 positive answers at the SCOFF questionnaire. Crude and adjusted logistic and multinomial logistic regression models were fit to investigate associations between socio-demographic characteristics, disordered eating, psychiatric comorbidity, and service use. RESULTS A total of 164 (10 %) participants reported disordered eating and the majority were from ethnic minorities. In adjusted models, Asian ethnicity was associated with purging, loss of control eating and preoccupation with food. Individuals with disordered eating had higher odds of screening positive for post-traumatic stress disorder and personality disorders and of having anxiety/mood disorders, suicidal ideation/attempts, hazardous levels of drinking, and used drugs in the previous year. Only 36 % of individuals with disordered eating had sought professional help in the previous 12 months mostly through their general practitioner (27.4 %), followed by psychotherapists (12.8 %) and mental health specialists (5.5 %). CONCLUSION This study found a high prevalence of disordered eating, especially amongst ethnic minorities, and associations with a number of psychiatric conditions. Overall few participants accessed specialist services. These findings suggest that both disordered eating manifestations amongst ethnic minorities and access to care need better investigation.
Collapse
Affiliation(s)
- F. Solmi
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, 30 Guilford Street, WC1N 1EH, London, UK
| | - S. L. Hatch
- Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK
| | - M. Hotopf
- Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK
| | - J. Treasure
- Eating Disorders Department, Institute of Psychiatry, King’s College London, London, UK
| | - N. Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, 30 Guilford Street, WC1N 1EH, London, UK
| |
Collapse
|
39
|
Allen KL, Byrne SM, Kusel MMH, Hart PH, Whitehouse AJO. Maternal vitamin D levels during pregnancy and offspring eating disorder risk in adolescence. Int J Eat Disord 2013; 46:669-76. [PMID: 23804538 DOI: 10.1002/eat.22147] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 04/24/2013] [Accepted: 04/27/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine if maternal vitamin D concentrations at 18 weeks gestation predict offspring eating disorder risk in adolescence. METHOD Participants were 526 Caucasian mother-child dyads from the Western Australian Pregnancy Cohort (Raine) Study. The Raine Study has followed participants from 18 weeks gestation to 20 years of age. Maternal serum 25(OH)-vitamin D concentrations were measured at 18 weeks pregnancy and grouped into quartiles. Offspring eating disorder symptoms were assessed at ages 14, 17 and 20 years. Core analyses were limited to female offspring (n = 308). RESULTS Maternal 25(OH)-vitamin D quartiles were a significant predictor of eating disorder risk in female offspring, in multivariate logistic regression models. Vitamin D in the lowest quartile was associated with a 1.8-fold increase in eating disorder risk relative to concentrations in the highest quartile. This association also accounted for the relationship between offspring season of birth and eating disorder risk. Results were significant after adjusting for sociodemographic characteristics, body mass index and depressive symptoms. DISCUSSION This is the first study to link low gestational vitamin D to increased eating disorder risk in female offspring of Caucasian mothers. Research is needed to extend these findings and to consider how gestational vitamin D may relate to the pathogenesis of eating disorders.
Collapse
Affiliation(s)
- Karina L Allen
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, West Perth, Western Australia; School of Psychology, The University of Western Australia, Crawley, Western Australia
| | | | | | | | | |
Collapse
|
40
|
Calorie estimation accuracy and menu labeling perceptions among individuals with and without binge eating and/or purging disorders. Eat Weight Disord 2013; 18:255-61. [PMID: 23760909 DOI: 10.1007/s40519-013-0035-x] [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: 11/14/2011] [Accepted: 10/24/2012] [Indexed: 10/26/2022] Open
Abstract
Menu labeling is a public health policy that requires chain restaurants in the USA to post kilocalorie information on their menus to help consumers make informed choices. However, there is concern that such a policy might promote disordered eating. This web-based study compared individuals with self-reported binge eating disorder (N = 52), bulimia nervosa (N = 25), and purging disorder (N = 17) and those without eating disorders (No ED) (N = 277) on restaurant calorie information knowledge and perceptions of menu labeling legislation. On average, people answered 1.46 ± 1.08 questions correctly (out of 6) (25%) on a calorie information quiz and 92% of the sample was in favor of menu labeling. The findings did not differ based on eating disorder, dieting, or weight status, or race/ethnicity. The results indicated that people have difficulty estimating the calories in restaurant meals and individuals with and without eating disorders are largely in favor of menu labeling laws.
Collapse
|
41
|
Bulik CM. Are we really paddling as fast as we can? Reflections on why eating disorders treatment and research always seem to be one step behind: commentary on Hay, Mitchell, and Stice & Becker: Prevention and treatment. Int J Eat Disord 2013; 46:489-91. [PMID: 23658097 DOI: 10.1002/eat.22119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Cynthia M Bulik
- University of North Carolina, Chapel Hill, North Carolina 27599-7160, USA.
| |
Collapse
|
42
|
Knoph C, Holle AV, Zerwas S, Torgersen L, Tambs K, Stoltenberg C, Bulik CM, Reichborn-Kjennerud T. Course and predictors of maternal eating disorders in the postpartum period. Int J Eat Disord 2013; 46:355-68. [PMID: 23307499 PMCID: PMC3622173 DOI: 10.1002/eat.22088] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate course and predictors of eating disorders in the postpartum period. METHOD A total of 77,807 women, participating in the Norwegian Mother and Child Cohort Study (MoBa), completed questionnaires during pregnancy including items covering DSM-IV criteria for prepregnancy anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS-P), and binge eating disorder (BED). Additional questionnaires were completed at 18 and 36 months postpartum. RESULTS Proportions of women remitting at 18 months and 36 months postpartum were 50% and 59% for AN, 39% and 30% for BN, 46% and 57% for EDNOS-P, and 45% and 42% for BED, respectively. However, disordered eating persisted in a substantial proportion of women meeting criteria for either full or subthreshold eating disorders. BN during pregnancy increased the risk for continuation of BN. BMI and psychological distress were significantly associated with course of BED. DISCUSSION This is the first large-scale population-based study on course of eating disorders in the postpartum period. The results indicated that disordered eating persists in a substantial proportion of women with prepregnancy eating disorders. Health care professionals working with women in this phase of life need to pay specific attention to eating disorder symptoms and behaviors.
Collapse
Affiliation(s)
- Cecilie Knoph
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Ann Von Holle
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Leila Torgersen
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristian Tambs
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Camilla Stoltenberg
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway,Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ted Reichborn-Kjennerud
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway,Department of Psychiatry, University of Oslo, Oslo, Norway
| |
Collapse
|
43
|
Koch S, Quadflieg N, Fichter M. Purging disorder: a comparison to established eating disorders with purging behaviour. EUROPEAN EATING DISORDERS REVIEW 2013; 21:265-75. [PMID: 23629831 DOI: 10.1002/erv.2231] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study is part of the larger Christina Barz Study, and it compared consecutively admitted patients with purging disorder (PurD; N = 225) with consecutively admitted patients with anorexia nervosa binge eating/purging subtype (AN-bp; N = 503) and bulimia nervosa purging subtype (BN-p; N = 756). Participants answered self-rating questionnaires on admission, at the end of inpatient treatment, and in a 5-year follow-up. Patients with PurD reported lower severity of general psychopathology than patients with AN-bp and lower severity of eating disorder symptoms than patients with AN-bp and BN-p on admission. Eating disorder symptoms of patients with PurD improved less during the course than of the comparison groups. Diagnostic perseverance was stronger in the PurD group than for patients with AN-bp; mortality was higher than for patients with BN-p. Predictors for better outcome differed for the groups. Our results provide new data about the long-term course of patients with PurD and indicate clinical relevance of the disorder.
Collapse
Affiliation(s)
- Sonja Koch
- Department of Psychiatry, University of Munich, Germany
| | | | | |
Collapse
|
44
|
Early Onset Binge Eating and Purging Eating Disorders: Course and Outcome in a Population-Based Study of Adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2013; 41:1083-96. [DOI: 10.1007/s10802-013-9747-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
45
|
Watson HJ, Fursland A, Bulik CM, Nathan P. Subjective binge eating with compensatory behaviors: a variant presentation of bulimia nervosa. Int J Eat Disord 2013; 46:119-26. [PMID: 22911884 DOI: 10.1002/eat.22052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine whether a variant bulimic-type presentation, whereby one meets criteria for bulimia nervosa (BN) except that binge eating episodes are not objectively large (i.e., "subjective bulimia nervosa," SBN), has comparable clinical severity to established eating disorders, particularly BN. METHOD Treatment-seeking adults with BN (N = 112), SBN (N = 28), anorexia nervosa restricting type (AN-R) (N = 45), and AN-binge/purge type (AN-B/P) (N = 24) were compared. RESULTS Overall, SBN could not be meaningfully distinguished from BN. SBN and BN had equivalent eating pathology, depression and anxiety symptoms, low quality of life, impulsivity, Axis I comorbidity, and lifetime psychiatric history, and comparable clinical severity to AN-R and AN-B/P. DISCUSSION Individuals with SBN, differing from BN only by the smaller size of their binge eating episodes, had a form of eating disorder comparable in clinical severity to threshold AN and BN and warranting clinical attention. Health professionals and the community require greater awareness of this variant to optimize detection, treatment-seeking, and outcomes.
Collapse
Affiliation(s)
- Hunna J Watson
- Center for Clinical Interventions, Department of Health in Western Australia, Perth, Australia.
| | | | | | | |
Collapse
|
46
|
Smith KE, Crowther JH. An exploratory investigation of purging disorder. Eat Behav 2013; 14:26-34. [PMID: 23265398 DOI: 10.1016/j.eatbeh.2012.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/23/2012] [Accepted: 10/03/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Purging Disorder (PD) is an understudied pattern of behaviors within the Eating Disorder Not Otherwise Specified (EDNOS) category. Such categorization may suggest that PD is not clinically significant as other eating disorders. However, evidence has suggested that PD is associated with significant impairments in psychosocial functioning and well-being. Despite the apparent clinical significance of PD, it remains to be determined if PD is distinct from other clinically significant eating disorders. The present study sought to assess the phenomenology, clinical significance, and distinctiveness of PD. METHOD Group scores on measures of eating pathology, body image disturbance, and psychological correlates were compared using MANOVA among a female undergraduate sample (N=94) meeting diagnostic criteria for PD (n=20), Bulimia Nervosa (BN; n=35), restrained eating (n=18), and healthy controls (n=21). RESULTS Overall, results indicated the PD group reported less severe symptoms than BN but more severe symptoms than controls. The PD and restraint groups were similar on most variables (including subjective binge behavior), with the exception of perfectionism and hunger. DISCUSSION Findings support the conceptualization of PD as existing along a spectrum of bulimic spectrum disorders rather than as a distinct diagnostic category.
Collapse
|
47
|
Clinical characteristics and distinctiveness of DSM-5 eating disorder diagnoses: findings from a large naturalistic clinical database. J Eat Disord 2013; 1:31. [PMID: 24999410 PMCID: PMC4081791 DOI: 10.1186/2050-2974-1-31] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 06/11/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND DSM-IV eating disorder (ED) diagnoses have been criticized for lack of clinical utility, diagnostic instability, and over-inclusiveness of the residual category "ED not otherwise specified" (EDNOS). Revisions made in DSM-5 attempt to generate a more scientifically valid and clinically relevant system of ED classification. The aim with the present study was to examine clinical characteristics and distinctiveness of the new DSM-5 ED diagnoses, especially concerning purging disorder (PD). METHODS Using a large naturalistic Swedish ED database, 2233 adult women were diagnosed using DSM-5. Initial and 1-year follow-up psychopathology data were analyzed. Measures included the Eating Disorder Examination Questionnaire, Structural Eating Disorder Interview, Clinical Impairment Assessment, Structural Analysis of Social Behavior, Comprehensive Psychiatric Rating Scale, and Structured Clinical Interview for DSM-IV Axis I Disorders. RESULTS Few meaningful differences emerged between anorexia nervosa binge/purge subtype (ANB/P), PD, and bulimia nervosa (BN). Unspecified Feeding and Eating Disorders (UFED) showed significantly less severity compared to other groups. CONCLUSIONS PD does not appear to constitute a distinct diagnosis, the distinction between atypical AN and PD requires clarification, and minimum inclusion criteria for UFED are needed. Further sub-classification is unlikely to improve clinical utility. Instead, better delineation of commonalities is important.
Collapse
|
48
|
Brownstone LM, Bardone-Cone AM, Fitzsimmons-Craft EE, Printz KS, Le Grange D, Mitchell JE, Crow SJ, Peterson CB, Crosby RD, Klein MH, Wonderlich SA, Joiner TE. Subjective and objective binge eating in relation to eating disorder symptomatology, negative affect, and personality dimensions. Int J Eat Disord 2013; 46:66-76. [PMID: 23109272 PMCID: PMC3832259 DOI: 10.1002/eat.22066] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The current study explored the clinical meaningfulness of distinguishing subjective (SBE) from objective binge eating (OBE) among individuals with threshold/subthreshold bulimia nervosa (BN). We examined relations between OBEs and SBEs and eating disorder symptoms, negative affect, and personality dimensions using both a group comparison and a continuous approach. METHOD Participants were 204 adult females meeting criteria for threshold/subthreshold BN who completed questionnaires related to disordered eating, affect, and personality. RESULTS Group comparisons indicated that SBE and OBE groups did not significantly differ on eating disorder pathology or negative affect, but did differ on two personality dimensions (cognitive distortion and attentional impulsivity). Using the continuous approach, we found that frequencies of SBEs (not OBEs) accounted for unique variance in weight/shape concern, diuretic use frequency, depressive symptoms, anxiety, social avoidance, insecure attachment, and cognitive distortion. DISCUSSION SBEs in the context of BN may indicate broader areas of psychopathology.
Collapse
Affiliation(s)
| | | | | | | | - Daniel Le Grange
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago
| | | | | | | | - Ross D. Crosby
- Department of Clinical Neuroscience, University of North Dakota
| | | | | | | |
Collapse
|
49
|
Mond JM. Classification of bulimic-type eating disorders: from DSM-IV to DSM-5. J Eat Disord 2013; 1:33. [PMID: 24999412 PMCID: PMC4081768 DOI: 10.1186/2050-2974-1-33] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 06/28/2013] [Indexed: 12/12/2022] Open
Abstract
Proposed changes to the classification of bulimic-type eating disorders in the lead up to the publication of DSM-5 are reviewed. Several of the proposed changes, including according formal diagnostic status to binge eating disorder (BED), removing the separation of bulimia nervosa (BN) into purging and non-purging subtypes, and reducing the binge frequency threshold from twice per week to once per week for both BN and (BED), have considerable empirical evidence to support them and will likely have the effect of facilitating clinical practice, improving access to care, improving public and professional awareness and understanding of these disorders and stimulating the additional research needed to address at least some problematic issues. However, the omission of any reference to variants of BN characterized by subjective, but not objective, binge eating episodes, and to the undue influence of weight or shape on self-evaluation or similar cognitive criterion in relation to the diagnosis of BED, is regrettable, given their potential to inform clinical and research practice and given that there is considerable evidence to support specific reference to these distinctions. Other aspects of the proposed criteria, such as retention of behavioral indicators of impaired control associated with binge eating and the presence of marked distress regarding binge eating among the diagnostic for BED, appear anomalous in that there is little or no evidence to support their validity or clinical utility. It is hoped that these issues will be addressed in final phase of the DSM-5 development process.
Collapse
Affiliation(s)
- Jonathan M Mond
- Research School of Psychology, Australian National University, Canberra ACT 0200, Australia
| |
Collapse
|
50
|
Genetic Variation at the TPH2 Gene Influences Impulsivity in Addition to Eating Disorders. Behav Genet 2012; 43:24-33. [DOI: 10.1007/s10519-012-9569-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 11/28/2012] [Indexed: 10/27/2022]
|