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Datta N, Hossepian K, Xie I, Gurcan HY, Behr S, Pouliadi M, Miranda C. Anorexia Nervosa Across the Lifespan: A Review of Recent Literature. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:269-277. [PMID: 38988469 PMCID: PMC11231474 DOI: 10.1176/appi.focus.20230037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
In this review, the authors provide an update on the understanding of anorexia nervosa (AN) across the lifespan. Focusing on key pieces of literature from the past 5 years, this review summarizes recent updates to DSM-5 within the domain of AN, including the addition of a new AN diagnosis: atypical anorexia. Additional sections covered in this review include improvements in the epidemiological understanding of AN across the developmental spectrum, treatment approaches that have been established as gold standard as well as new directions recently explored in treatment, and recent advancements in the biopsychosocial underpinnings of AN. Altogether, although this review captures several advancements in the field's overall conceptualization of AN, several key areas of treatment and diagnostic capacity continue to require additional focus and research.
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Affiliation(s)
- Nandini Datta
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Datta, Hossepian, Gurcan, Behr, Pouliadi, Miranda); Department of Psychiatry and Behavioral Sciences, Palo Alto University, Palo Alto, California (Xie); Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany (Behr)
| | - Kristene Hossepian
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Datta, Hossepian, Gurcan, Behr, Pouliadi, Miranda); Department of Psychiatry and Behavioral Sciences, Palo Alto University, Palo Alto, California (Xie); Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany (Behr)
| | - Isabella Xie
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Datta, Hossepian, Gurcan, Behr, Pouliadi, Miranda); Department of Psychiatry and Behavioral Sciences, Palo Alto University, Palo Alto, California (Xie); Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany (Behr)
| | - Hazal Yagmur Gurcan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Datta, Hossepian, Gurcan, Behr, Pouliadi, Miranda); Department of Psychiatry and Behavioral Sciences, Palo Alto University, Palo Alto, California (Xie); Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany (Behr)
| | - Solveig Behr
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Datta, Hossepian, Gurcan, Behr, Pouliadi, Miranda); Department of Psychiatry and Behavioral Sciences, Palo Alto University, Palo Alto, California (Xie); Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany (Behr)
| | - Marina Pouliadi
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Datta, Hossepian, Gurcan, Behr, Pouliadi, Miranda); Department of Psychiatry and Behavioral Sciences, Palo Alto University, Palo Alto, California (Xie); Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany (Behr)
| | - Christina Miranda
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Datta, Hossepian, Gurcan, Behr, Pouliadi, Miranda); Department of Psychiatry and Behavioral Sciences, Palo Alto University, Palo Alto, California (Xie); Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany (Behr)
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Tournayre L, Balbinotti MAA, Monthuy-Blanc J. Some hope for a dimensional assessment? A critical review of psychometric validated (semi-)structured interview to assess eating disorders. EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 38873932 DOI: 10.1002/erv.3115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/10/2024] [Accepted: 06/02/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Given that eating disorders (EDs) are considered one of the deadliest mental illnesses, the development of appropriate assessment instruments is a necessity. Despite the extensive literature on assessing EDs, there has been a lack of focus on semi-structured interviews. The purpose of this article is to provide a comprehensive review of psychometrically validated semi-structured interviews for EDs. METHODS Included studies (N = 24) were required to present a semi-structured interview for EDs that has been validated through a psychometric process. The APA PsycNet, MEDLINE, APA Psycinfo, Pubmed, and Health & Psychosocial Instruments databases were searched. The literature search included publications through May 2024, with no earliest year restriction. RESULTS A total of six instruments were identified and reviewed in terms of conceptual design, purpose and content, psychometric characteristics, and strengths and limitations. Three main findings were highlighted: (a) only half of the instruments are up to date; (b) the instruments are based on either a categorical or a mixed categorical-dimensional approach; and (c) the predominance of the categorical approach. CONCLUSIONS The results are discussed regarding the conceptual approaches of the instrument to provide clinical and research implications. Despite the many strengths of the instrument, additional psychometric research is needed.
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Affiliation(s)
- Lola Tournayre
- Research Unity Loricorps, Research Center of Mental Health University Institute of Montreal, Montreal, QC, Canada
- Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | - Johana Monthuy-Blanc
- Research Unity Loricorps, Research Center of Mental Health University Institute of Montreal, Montreal, QC, Canada
- Département de Sciences de l'Éducation, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Nagata JM, Vargas R, Sanders AE, Stuart E, Downey AE, Chaphekar AV, Nguyen A, Ganson KT, Buckelew SM, Garber AK. Clinical characteristics of hospitalized male adolescents and young adults with atypical anorexia nervosa. Int J Eat Disord 2024; 57:1008-1019. [PMID: 38205657 PMCID: PMC11018472 DOI: 10.1002/eat.24132] [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: 09/13/2023] [Revised: 11/22/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To describe the clinical characteristics of male adolescents and young adults hospitalized for medical complications of atypical anorexia nervosa (atypical AN) and to compare their clinical characteristics with females with atypical AN and males with anorexia nervosa (AN). METHOD A retrospective review of electronic medical records for patients with atypical AN and AN aged 9-25 admitted to the UCSF Eating Disorders Program from May 2012 to August 2020 was conducted. RESULTS Among 21 males with atypical AN (mean age 15.1 ± 2.7, mean %mBMI 102.0 ± 11.8), medical complications evidenced by admission laboratory values included anemia (52.9%), vitamin D insufficiency/deficiency (52.6%), and zinc deficiency (31.6%). Compared with females with atypical AN (n = 69), males with atypical AN had longer length of stay (11.4 vs 8.4 days, p = .004), higher prescribed kcal at discharge (4114 vs 3045 kcal, p < .001), lower heart rate nadir (40.0 vs 45.8, p = .038), higher aspartate transaminase (AST, 37.9 vs 26.2 U/L, p = .032), higher alanine transaminase (ALT, 30.6 vs 18.3 U/L, p = .005), and higher rates of anemia (52.9% vs 19.4%, p = .005), with no differences in vitamin D, zinc, and vital signs. Compared with males with AN (n = 40), males with atypical AN had no significant differences in vital signs or laboratory assessments during the hospitalization. DISCUSSION Atypical AN in males leads to significant medical comorbidity, and males with atypical AN require longer hospital stays compared to females with atypical AN. Rates of abnormal vital signs and abnormal serum laboratory values during hospital admissions do not differ in males with atypical AN compared to AN. PUBLIC SIGNIFICANCE Adolescent and young adult males with atypical anorexia nervosa experience significant medical complications. Males with atypical anorexia nervosa had longer hospitalizations and higher prescribed nutrition at discharge than females. Medical complications of atypical anorexia nervosa in male adolescents and young adults were generally equal to those of male adolescents and young adults with anorexia nervosa. Clinicians should be aware of unique medical complications of males with atypical anorexia nervosa.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503 San Francisco, CA 94143, USA
| | - Ruben Vargas
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503 San Francisco, CA 94143, USA
| | - Austin E. Sanders
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503 San Francisco, CA 94143, USA
| | - Elena Stuart
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503 San Francisco, CA 94143, USA
| | - Amanda E. Downey
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503 San Francisco, CA 94143, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 550 16th Street, Box 0503 San Francisco, CA 94143, USA
| | - Anita V. Chaphekar
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503 San Francisco, CA 94143, USA
| | - Anthony Nguyen
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503 San Francisco, CA 94143, USA
| | - Kyle T. Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Sara M. Buckelew
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503 San Francisco, CA 94143, USA
| | - Andrea K. Garber
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503 San Francisco, CA 94143, USA
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Castellini G, Cassioli E, Rossi E, Marchesoni G, Cerini G, Pastore E, De Bonfioli Cavalcabo' N, Rotella F, Mezzani B, Alterini B, Lucarelli S, Magazzini S, Corazzesi P, Caini S, Ricca V. Use and misuse of the emergency room by patients with eating disorders in a matched-cohort analysis: What can we learn from it? Psychiatry Res 2023; 328:115427. [PMID: 37647700 DOI: 10.1016/j.psychres.2023.115427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
We examined the pattern of access to hospital emergency room (hER) in 2018-2021 among patients with eating disorders (ED) from Florence, Italy, diagnosed during 1994-2018, using a matched cohort design. We included 902 ED patients and an equal number of sex-, age-, and residence-matched individuals. We fitted conditional Poisson regression models with robust variance estimator to estimate incidence rate ratios (IRR) and 95% confidence intervals. ED patients accessed hER more than twice as often as matched individuals: the IRR was 2.11 (1.21-3.70), 2.02 (1.36-3.00), and 2.49 (1.71-3.61) among AN, BN, and BED patients. Factors associated with increased hER use were older age (≥40 years; for AN patients, also younger age, <20 years), BMI ≤ 16 kg/m2 (for AN), and psychopathological severity. The rise in access to hER was particularly marked during the early phases of the COVID-19 pandemic and declined only partially thereafter. Acute psychiatric symptoms and non-specific medical conditions represented the main causes of increased access to hER. Use of hER was more often inappropriate among ED patients than matched individuals. Integration of primary and mental health care may be necessary to counteract the high and often inappropriate use of hER by patients with ED.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Giorgia Marchesoni
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Cerini
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Elisa Pastore
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Nora De Bonfioli Cavalcabo'
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Francesco Rotella
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | | | - Brunetto Alterini
- Division of Cardiovascular and Perioperative Medicine, Careggi University Hospital, Florence, Italy
| | - Stefano Lucarelli
- Eating Disorders Unit, Central Tuscany Local Health Authority, Florence, Italy
| | - Simone Magazzini
- Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department ASL Toscana Centro, Prato, Italy
| | - Patrizia Corazzesi
- Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department ASL Toscana Centro, Prato, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
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Castellini G, Caini S, Cassioli E, Rossi E, Marchesoni G, Rotella F, De Bonfioli Cavalcabo' N, Fontana M, Mezzani B, Alterini B, Lucarelli S, Ricca V. Mortality and care of eating disorders. Acta Psychiatr Scand 2023; 147:122-133. [PMID: 36062404 PMCID: PMC10086824 DOI: 10.1111/acps.13487] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Eating disorders (EDs) are considered serious mental illnesses, with one of the highest lethality among psychiatric disorders, even though the issue of mortality due to these conditions is still controversial. The present study was aimed at comparing the mortality rate in a cohort of ED patients representative of the geographic area with that of the age and gender-matched general population of central Italy. METHODS Patients were enrolled between 1994 and 2018, among those attending the eating disorders treatment network of the Florence area (EDTN), which is a regional multidisciplinary treatment reference center for EDs covering the clinical population of the metropolitan Florence area (Italy). The life status of participants was determined through linkage with the Regional Mortality Registry. RESULTS A total of 1277 individuals with EDs were included, including 368 with Anorexia Nervosa (AN), 312 with Bulimia Nervosa (BN), and 597 individuals with Binge Eating Disorder (BED). Twenty-two patients (1.72%) died, during a median follow-up of 7.4 years. The mortality rates among ED patients did not significantly differ from that of the general population of the same age and sex with a Standardized Mortality Ratio (SMR) of 1.19, 95% CI 0.79-1.81. Only among BN patients, the mortality was significantly increased after 10 years from clinical evaluation (SMR 11.24, 95% CI 3.62-34.84). CONCLUSION The low mortality in EDs, compared to published studies, might be due to the EDTN treatment strategy, based on a large network which makes an integrated multidisciplinary team available for almost all the patients with EDs of the geographical area.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy.,Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giorgia Marchesoni
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Nora De Bonfioli Cavalcabo'
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Miriam Fontana
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | - Brunetto Alterini
- Division of Cardiovascular and Perioperative Medicine, Careggi University Hospital, Florence, Italy
| | | | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy.,Psychiatry Unit, Careggi University Hospital, Florence, Italy
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Walsh BT, Hagan KE, Lockwood C. A systematic review comparing atypical anorexia nervosa and anorexia nervosa. Int J Eat Disord 2022; 56:798-820. [PMID: 36508318 DOI: 10.1002/eat.23856] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE A description of atypical anorexia nervosa (atypical AN) was provided in DSM-5 in 2013 and a sizable literature has since developed describing the clinical features of individuals with atypical AN and comparing them to those of individuals with anorexia nervosa (AN) and those of healthy individuals. The purpose of this study was to conduct a systematic review of this literature. METHOD A systematic review following PRISMA guidelines was conducted of studies published since 2013 that compared the clinical characteristics of individuals with atypical AN to those of individuals with AN and/or healthy controls. Meta-analyses were conducted when similar measures were reported in three or more studies. RESULTS Twenty-four publications met criteria for inclusion. Their results indicated that the level of eating disorder-specific psychopathology is significantly higher among individuals with atypical AN than among controls and as high or higher as among individuals with AN while levels of non-eating disorder psychopathology are similar. Individuals with atypical AN experience many of the physiological complications associated with AN, but some complications appear less frequent. DISCUSSION The psychological symptoms and physiological complications of individuals with atypical AN are generally similar to those of individuals with AN, although there may be differences in the frequency of some physical complications. Little information is available on the course, outcome, and treatment response of individuals with atypical AN. In addition, full diagnostic criteria for atypical AN have not been developed, and the nosological relationship of atypical AN to established eating disorders such as bulimia nervosa is unclear. PUBLIC SIGNIFICANCE Atypical anorexia nervosa as described in the DSM-5 identifies individuals with many of the psychological characteristics of typical anorexia nervosa who, despite significant weight loss, are not underweight. The current systematic review found that the psychological symptoms and physiological characteristics of individuals with atypical AN are generally similar to those of individuals with AN, although there may be differences in the frequency of some physical complications.
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Affiliation(s)
- B Timothy Walsh
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Kelsey E Hagan
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Carlin Lockwood
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
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Klump KL, Di Dio AM. Combined oral contraceptive use and risk for binge eating in women: Potential gene × hormone interactions. Front Neuroendocrinol 2022; 67:101039. [PMID: 36181777 PMCID: PMC9679583 DOI: 10.1016/j.yfrne.2022.101039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022]
Abstract
Extant animal and human data suggest endogenous ovarian hormones increase risk for binge eating in females, possibly via gene × hormone interactions and hormonally induced increases in genetic influences. Approximately 85 % of women will take combined oral contraceptives (COCs) that mimic the riskiest hormonal milieu for binge eating (i.e., post-ovulation when both estrogen and progesterone are present). The purpose of this narrative review is to synthesize findings of binge eating risk in COC users. Few studies have been conducted, but results suggest that COCs may increase risk for binge eating and related phenotypes (e.g., craving for sweets), particularly in genetically vulnerable women. Larger, more systematic human and animal studies of COCs and binge eating are needed. The goal of this work should be to advance personalized medicine by identifying the extent of COC risk as well as the role of gene × hormone interactions in susceptibility.
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Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, 316 Physics Road - Room 107B, East Lansing, MI 48824-1116, United States.
| | - Alaina M Di Dio
- Department of Psychology, Oberlin College, South Hall, 121 Elm Street, Oberlin, OH 44074, United States
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Binge eating among young adults: association with sociodemographic factors, nutritional intake, dietary n-6: n-3 ratio and impulsivity. Br J Nutr 2021; 126:1431-1440. [PMID: 33441196 DOI: 10.1017/s0007114521000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Binge eating behaviour (BE) is the major symptom of binge eating disorder (BED). This study aimed to compare the nutritional intake in the presence or absence of BE, with a particular focus on dietary n-6:n-3 ratio, to assess the association between BE and impulsivity and the mediating effect of BMI on this association. A total of 450 university students (age 18-28 years) participated. The self-administered questionnaires were a semi-quantitative FFQ and the UPPS-P Impulsive Behavior Scale and the binge eating scale. The average BE score was 11·6 (se 7·388), and 20 % of the total participants scored above the cut-off of 17, thus presenting BE with 95 % CI of 16·3, 23·7 %. Our study revealed that greater BMI, higher total energy intake, greater negative urgency and positive urgency scores were significantly associated with BE. Participants with high value of dietary n-6:n-3 ratio were 1·335 more at risk to present a BE compared with those with a lower value of this ratio (P = 0·017). The relationship between BE score and UPPS domains score was not mediated by the BMI. This is the first study reporting a link between high dietary n-6:n-3 ratio and BE as well as the fact that BE was linked to both, negative and positive urgencies, and that the association between BE and impulsivity was not mediated by BMI. These findings can help to deal more efficiently with people suffering from BE, a symptom that can precede the development of BED.
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Hildebrandt T, Peyser D, Sysko R. Lessons learned developing and testing family-based interoceptive exposure for adolescents with low-weight eating disorders. Int J Eat Disord 2021; 54:2037-2045. [PMID: 34528269 PMCID: PMC8712094 DOI: 10.1002/eat.23605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) usually develops in early adolescence and is characterized by high rates of morbidity and mortality. Family-based therapy (FBT) is the leading evidence-based treatment for adolescents with AN, but not all patients experience sufficient improvement. The purpose of this manuscript is to describe the development and subsequent experience with a Family-Based Interoceptive Exposure (FBT-IE) for adolescents with a broader form of low-weight eating disorders. METHODS The novel IE-based behavioral intervention is a six-session family-based treatment module designed to directly target and modify disgust by altering the prefrontal regulation of the insula response to aversive stimuli by decreasing visceral sensitivity (e.g., bloating). Each session teaches a new skill regarding tolerating distress to visceral sensations associated with disgust and an in-vivo "IE exercise," in which the family is provided with a meal replacement shake of unknown content and caloric density. RESULTS In this novel treatment, the patient learns to tolerate disgust in the context of a challenging food stimulus as a way to increase consumption of restricted foods outside of session. CONCLUSION We discuss successes and challenges executing this treatment with patients with low-weight eating disorders and propose future directions for the intervention.
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Affiliation(s)
- Tom Hildebrandt
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deena Peyser
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robyn Sysko
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Galmiche M, Lucas N, Déchelotte P, Deroissart C, Le Solliec MA, Rondeaux J, Azhar S, Grigioni S, Colange G, Delay J, Achamrah N, Folope V, Belmonte L, Lamarre A, Rimbert A, Saillard T, Petit A, Quillard M, Coeffier M, Gillibert A, Lambert G, Legrand R, Tavolacci MP. Plasma Peptide Concentrations and Peptide-Reactive Immunoglobulins in Patients with Eating Disorders at Inclusion in the French EDILS Cohort (Eating Disorders Inventory and Longitudinal Survey). Nutrients 2020; 12:nu12020522. [PMID: 32085628 PMCID: PMC7071399 DOI: 10.3390/nu12020522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 12/12/2022] Open
Abstract
Eating disorders (EDs) are increasingly frequent. Their pathophysiology involves disturbance of peptide signaling and the microbiota–gut–brain axis. This study analyzed peptides and corresponding immunoglobulin (Ig) concentrations in groups of ED. In 120 patients with restrictive (R), bulimic (B), and compulsive (C) ED, the plasma concentrations of leptin, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and insulin were analyzed by Milliplex and those of acyl ghrelin (AG), des-acyl ghrelin (DAG), and α-melanocyte-stimulating hormone (α-MSH) by ELISA kits. Immunoglobulin G (in response to an antigen) concentrations were analyzed by ELISA, and their affinity for the respective peptide was measured by surface plasmon resonance. The concentrations of leptin, insulin, GLP-1, and PYY were higher in C patients than in R patients. On the contrary, α-MSH, DAG, and AG concentrations were higher in R than in C patients. After adjustment for body mass index (BMI), differences among peptide concentrations were no longer different. No difference in the concentrations of the IgG was found, but the IgG concentrations were correlated with each other. Although differences of peptide concentrations exist among ED subtypes, they may be due to differences in BMI. Changes in the concentration and/or affinity of several anti-peptide IgG may contribute to the physiopathology of ED or may be related to fat mass.
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Affiliation(s)
- Marie Galmiche
- Inserm UMR1073, 76000 Rouen, France; (M.G.); (S.G.); (N.A.); (V.F.); (L.B.); (A.R.); (A.P.); (M.C.); (M.-P.T.)
- TargEDys SA, 91160 Longjumeau, France; (N.L.); (C.D.); (M.-A.L.S.); (J.R.); (S.A.); (G.L.); (R.L.)
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen, 76000 Rouen, France
| | - Nicolas Lucas
- TargEDys SA, 91160 Longjumeau, France; (N.L.); (C.D.); (M.-A.L.S.); (J.R.); (S.A.); (G.L.); (R.L.)
| | - Pierre Déchelotte
- Inserm UMR1073, 76000 Rouen, France; (M.G.); (S.G.); (N.A.); (V.F.); (L.B.); (A.R.); (A.P.); (M.C.); (M.-P.T.)
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen, 76000 Rouen, France
- Nutrition unit, University Hospital of Rouen, 76000 Rouen, France; (G.C.); (J.D.); (A.L.); (T.S.)
- Correspondence: ; Tel.: +06-08-49-66-26
| | - Camille Deroissart
- TargEDys SA, 91160 Longjumeau, France; (N.L.); (C.D.); (M.-A.L.S.); (J.R.); (S.A.); (G.L.); (R.L.)
| | - Marie-Anne Le Solliec
- TargEDys SA, 91160 Longjumeau, France; (N.L.); (C.D.); (M.-A.L.S.); (J.R.); (S.A.); (G.L.); (R.L.)
| | - Julie Rondeaux
- TargEDys SA, 91160 Longjumeau, France; (N.L.); (C.D.); (M.-A.L.S.); (J.R.); (S.A.); (G.L.); (R.L.)
| | - Saida Azhar
- TargEDys SA, 91160 Longjumeau, France; (N.L.); (C.D.); (M.-A.L.S.); (J.R.); (S.A.); (G.L.); (R.L.)
| | - Sébastien Grigioni
- Inserm UMR1073, 76000 Rouen, France; (M.G.); (S.G.); (N.A.); (V.F.); (L.B.); (A.R.); (A.P.); (M.C.); (M.-P.T.)
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen, 76000 Rouen, France
- Nutrition unit, University Hospital of Rouen, 76000 Rouen, France; (G.C.); (J.D.); (A.L.); (T.S.)
| | - Guillaume Colange
- Nutrition unit, University Hospital of Rouen, 76000 Rouen, France; (G.C.); (J.D.); (A.L.); (T.S.)
| | - Julie Delay
- Nutrition unit, University Hospital of Rouen, 76000 Rouen, France; (G.C.); (J.D.); (A.L.); (T.S.)
| | - Najate Achamrah
- Inserm UMR1073, 76000 Rouen, France; (M.G.); (S.G.); (N.A.); (V.F.); (L.B.); (A.R.); (A.P.); (M.C.); (M.-P.T.)
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen, 76000 Rouen, France
- Nutrition unit, University Hospital of Rouen, 76000 Rouen, France; (G.C.); (J.D.); (A.L.); (T.S.)
| | - Vanessa Folope
- Inserm UMR1073, 76000 Rouen, France; (M.G.); (S.G.); (N.A.); (V.F.); (L.B.); (A.R.); (A.P.); (M.C.); (M.-P.T.)
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen, 76000 Rouen, France
- Nutrition unit, University Hospital of Rouen, 76000 Rouen, France; (G.C.); (J.D.); (A.L.); (T.S.)
| | - Liliana Belmonte
- Inserm UMR1073, 76000 Rouen, France; (M.G.); (S.G.); (N.A.); (V.F.); (L.B.); (A.R.); (A.P.); (M.C.); (M.-P.T.)
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen, 76000 Rouen, France
- Nutrition unit, University Hospital of Rouen, 76000 Rouen, France; (G.C.); (J.D.); (A.L.); (T.S.)
| | - Adèle Lamarre
- Nutrition unit, University Hospital of Rouen, 76000 Rouen, France; (G.C.); (J.D.); (A.L.); (T.S.)
| | - Agnès Rimbert
- Inserm UMR1073, 76000 Rouen, France; (M.G.); (S.G.); (N.A.); (V.F.); (L.B.); (A.R.); (A.P.); (M.C.); (M.-P.T.)
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen, 76000 Rouen, France
- Nutrition unit, University Hospital of Rouen, 76000 Rouen, France; (G.C.); (J.D.); (A.L.); (T.S.)
| | - Tiphaine Saillard
- Nutrition unit, University Hospital of Rouen, 76000 Rouen, France; (G.C.); (J.D.); (A.L.); (T.S.)
| | - André Petit
- Inserm UMR1073, 76000 Rouen, France; (M.G.); (S.G.); (N.A.); (V.F.); (L.B.); (A.R.); (A.P.); (M.C.); (M.-P.T.)
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen, 76000 Rouen, France
- Nutrition unit, University Hospital of Rouen, 76000 Rouen, France; (G.C.); (J.D.); (A.L.); (T.S.)
| | - Muriel Quillard
- CIC-CRB 1404 INSERM, University Hospital of Rouen, 76000 Rouen, France;
| | - Moise Coeffier
- Inserm UMR1073, 76000 Rouen, France; (M.G.); (S.G.); (N.A.); (V.F.); (L.B.); (A.R.); (A.P.); (M.C.); (M.-P.T.)
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen, 76000 Rouen, France
- Nutrition unit, University Hospital of Rouen, 76000 Rouen, France; (G.C.); (J.D.); (A.L.); (T.S.)
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital, F 76000 Rouen, France;
| | - Grégory Lambert
- TargEDys SA, 91160 Longjumeau, France; (N.L.); (C.D.); (M.-A.L.S.); (J.R.); (S.A.); (G.L.); (R.L.)
| | - Romain Legrand
- TargEDys SA, 91160 Longjumeau, France; (N.L.); (C.D.); (M.-A.L.S.); (J.R.); (S.A.); (G.L.); (R.L.)
| | - Marie-Pierre Tavolacci
- Inserm UMR1073, 76000 Rouen, France; (M.G.); (S.G.); (N.A.); (V.F.); (L.B.); (A.R.); (A.P.); (M.C.); (M.-P.T.)
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen, 76000 Rouen, France
- CIC-CRB 1404 INSERM, University Hospital of Rouen, 76000 Rouen, France;
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11
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Tavolacci MP, Gillibert A, Zhu Soubise A, Grigioni S, Déchelotte P. Screening four broad categories of eating disorders: suitability of a clinical algorithm adapted from the SCOFF questionnaire. BMC Psychiatry 2019; 19:366. [PMID: 31752796 PMCID: PMC6868823 DOI: 10.1186/s12888-019-2338-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We evaluated the performance of a clinical algorithm (Expali™), combining two or more positive answers to SCOFF questionnaire with Body Mass Index (BMI), to identify four Broad Categories of eating disorders (ED) derived from DSM-5. METHODS The clinical algorithm (Expali™) was developed from 104 combinations of BMI levels and answers to five SCOFF questions with at least two positive answers. Two senior ED physicians allocated each combination to one of the four Broad Categories of ED derived from DSM-5: restrictive disorder, bulimic disorder, hyperphagic disorder and other unspecified ED diagnosed by ED clinicians. The performance of Expali™ was evaluated on data from 206 patients with ED. Sensitivity, specificity values and Youden index were calculated for each category. RESULTS The 206 patients were diagnosed as follows: 31.5% restrictive disorder, 18.9% bulimic disorder, 40.8% hyperphagic disorder and 8.8% other ED. The sensitivity of Expali™ for restrictive, bulimic, hyperphagic and other unspecified ED were respectively: 76.9, 69.2, 79.7 and 16.7%. The Youden index was respectively 0.73, 0.57, 0.67 and 0.07. CONCLUSIONS In a SCOFF-positive ED population (at least two positive answers), the clinical algorithm Expali™ demonstrated good suitability by correctly classifying three of the four Broad Categories of eating disorders (restrictive, bulimic and hyperphagic disorder). It could be useful both to healthcare professionals and the general population to enable earlier detection and treatment of ED and to improve patient outcomes.
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Affiliation(s)
- Marie-Pierre Tavolacci
- Normandie Univ, UNIROUEN, U1073, Rouen University Hospital, Clinical Investigation Center 1404, F-76000, Rouen, France.
| | - André Gillibert
- grid.41724.34Rouen University Hospital, Clinical Investigation Center 1404, F-76000 Rouen, France
| | - Aurélien Zhu Soubise
- grid.41724.34Rouen University Hospital, Clinical Investigation Center 1404, F-76000 Rouen, France
| | - Sébastien Grigioni
- grid.41724.34Department of Nutrition, Normandie Univ, UNIROUEN, U1073, Rouen University Hospital, F-76000 Rouen, France
| | - Pierre Déchelotte
- grid.41724.34Department of Nutrition, Normandie Univ, UNIROUEN, U1073, Rouen University Hospital, F-76000 Rouen, France
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12
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Abstract
The initial plans for the DSM-5 revision envisioned a paradigm shift away from traditional diagnostic categories. However, plans for a major move from descriptive to etiologic diagnoses were quickly abandoned as infeasible. Support was much broader for adding dimensional/spectrum constructs to the categorical diagnoses, although this was interpreted in various ways. Delegation of substantial autonomy to work groups with modest central coordination was seen as problematic by some work groups and positively by others. Controversies emerged around the standards for diagnostic change, and the degree to which the same standards should be used across diagnostic groups. The Summit Group was given the final task of trying to forge a consensus among the various review groups. We conclude with thoughts about the difficulty of trying to revise an entire manual all at once and the desirability of developing clear rules for change at the outset of such a diagnostic project.
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13
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Henderson ZB, Fox JR, Trayner P, Wittkowski A. Emotional development in eating disorders: A qualitative metasynthesis. Clin Psychol Psychother 2019; 26:440-457. [PMID: 30889630 PMCID: PMC6766861 DOI: 10.1002/cpp.2365] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 01/27/2023]
Abstract
Emotions are considered to be an important feature in eating disorders. The present study aimed to conduct a systematic review and metasynthesis of qualitative studies, which considered the role of emotions in eating disorders in order to gain further insight on how these individuals experience various emotions and the strategies they use to manage them. Databases including Web of Science, PsychInfo, EMBASE, Medline, and the Cochrane library were searched for qualitative studies. The search identified 16 relevant studies. Meta-ethnography was used to synthesize the data, which involved identifying the key findings and concepts of the studies and creating metaphors. The synthesis involved reciprocal translations and lines of argument approaches being applied to the present data. Results of the synthesis identified four second-order themes and one third-order theme relating to the emotional experiences of such individuals. The second-order themes were (a) negative emotional environments, (b) interpersonal vulnerability, (c) the experience of negative emotions in social contexts, and (d) the management of emotions. The third-order theme was the emotional self within a social environment. This is the first metasynthesis on emotions and eating disorders, and our synthesis highlights the important role that emotions play in the development and maintenance of eating disorders. Our model demonstrates how poor emotional development whilst growing up results in development of poor socioemotional bonds and the inability to handle negative emotions. The most significant finding of the review is that individuals use their eating disorder to manage negative emotions.
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Affiliation(s)
- Ziporah B. Henderson
- Division of Psychology and Mental Health, School of Health SciencesUniversity of ManchesterManchesterUK
| | | | - Penny Trayner
- Division of Psychology and Mental Health, School of Health SciencesUniversity of ManchesterManchesterUK
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health SciencesUniversity of ManchesterManchesterUK
- Department of Clinical Psychology, Greater Manchester Mental Health NHS Foundation TrustManchesterUK
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14
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Oldershaw A, Lavender T, Schmidt U. Are socio-emotional and neurocognitive functioning predictors of therapeutic outcomes for adults with anorexia nervosa? EUROPEAN EATING DISORDERS REVIEW 2018; 26:346-359. [PMID: 29744972 DOI: 10.1002/erv.2602] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Emotional, social, and neurocognitive factors are theorised to maintain anorexia nervosa (AN). Yet whether they predict outcomes or relate to clinical change remains unclear. METHODS Seventy-one consecutive adult outpatient eating disorder service referrals presenting with AN, who participated in a randomised controlled trial comparing 2 psychotherapies, were assessed for emotional processing, social cognition, and neurocognition pretherapy and posttherapy. Intention-to-treat analysis employed maximum-likelihood methods to model missing data. Baseline self-reported emotional processing, social cognitive, or neurocognitive task performance was entered into forward stepwise regression models with posttreatment clinical outcomes (weight, eating disorder psychopathology, psychosocial functioning) as dependent variables. Correlation analyses examined relationships between clinical and self-report/task score change. RESULTS Self-reported emotional avoidance (behavioural/cognitive avoidance, low acceptance) and submissive behaviour predicted clinical outcomes. Social cognitive (emotion recognition, emotional theory of mind) and neurocognitive performance (set-shifting, detail focus) had limited predictive ability. CONCLUSIONS Emotional avoidance and submissiveness may represent maintenance factors for AN.
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Affiliation(s)
- Anna Oldershaw
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK.,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tony Lavender
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK
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15
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Evans EH, Adamson AJ, Basterfield L, Le Couteur A, Reilly JK, Reilly JJ, Parkinson KN. Risk factors for eating disorder symptoms at 12 years of age: A 6-year longitudinal cohort study. Appetite 2017; 108:12-20. [PMID: 27612559 PMCID: PMC5152119 DOI: 10.1016/j.appet.2016.09.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 09/02/2016] [Accepted: 09/05/2016] [Indexed: 11/01/2022]
Abstract
Eating disorders pose risks to health and wellbeing in young adolescents, but prospective studies of risk factors are scarce and this has impeded prevention efforts. This longitudinal study aimed to examine risk factors for eating disorder symptoms in a population-based birth cohort of young adolescents at 12 years. Participants from the Gateshead Millennium Study birth cohort (n = 516; 262 girls and 254 boys) completed self-report questionnaire measures of eating disorder symptoms and putative risk factors at age 7 years, 9 years and 12 years, including dietary restraint, depressive symptoms and body dissatisfaction. Body mass index (BMI) was also measured at each age. Within-time correlates of eating disorder symptoms at 12 years of age were greater body dissatisfaction for both sexes and, for girls only, higher depressive symptoms. For both sexes, higher eating disorder symptoms at 9 years old significantly predicted higher eating disorder symptoms at 12 years old. Dietary restraint at 7 years old predicted boys' eating disorder symptoms at age 12, but not girls'. Factors that did not predict eating disorder symptoms at 12 years of age were BMI (any age), girls' dietary restraint at 7 years and body dissatisfaction at 7 and 9 years of age for both sexes. In this population-based study, different patterns of predictors and correlates of eating disorder symptoms were found for girls and boys. Body dissatisfaction, a purported risk factor for eating disorder symptoms in young adolescents, developed concurrently with eating disorder symptoms rather than preceding them. However, restraint at age 7 and eating disorder symptoms at age 9 years did predict 12-year eating disorder symptoms. Overall, our findings suggest that efforts to prevent disordered eating might beneficially focus on preadolescent populations.
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Affiliation(s)
- Elizabeth H Evans
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
| | - Ashley J Adamson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK.
| | - Laura Basterfield
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK.
| | - Ann Le Couteur
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
| | - Jessica K Reilly
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK.
| | - John J Reilly
- Physical Activity for Health Group, School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK.
| | - Kathryn N Parkinson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK.
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16
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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).
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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
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17
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Thomas JJ, Eddy KT, Murray HB, Tromp MDP, Hartmann AS, Stone MT, Levendusky PG, Becker AE. The impact of revised DSM-5 criteria on the relative distribution and inter-rater reliability of eating disorder diagnoses in a residential treatment setting. Psychiatry Res 2015; 229:517-23. [PMID: 26160205 DOI: 10.1016/j.psychres.2015.06.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 06/05/2015] [Accepted: 06/25/2015] [Indexed: 11/18/2022]
Abstract
This study evaluated the relative distribution and inter-rater reliability of revised DSM-5 criteria for eating disorders in a residential treatment program. Consecutive adolescent and young adult females (N=150) admitted to a residential eating disorder treatment facility were assigned both DSM-IV and DSM-5 diagnoses by a clinician (n=14) via routine clinical interview and a research assessor (n=4) via structured interview. We compared the frequency of diagnostic assignments under each taxonomy and by type of assessor. We evaluated concordance between clinician and researcher assignment through inter-rater reliability kappa and percent agreement. Significantly fewer patients received either clinician or researcher diagnoses of a residual eating disorder under DSM-5 (clinician-12.0%; researcher-31.3%) versus DSM-IV (clinician-28.7%; researcher-59.3%), with the majority of reassigned DSM-IV residual cases reclassified as DSM-5 anorexia nervosa. Researcher and clinician diagnoses showed moderate inter-rater reliability under DSM-IV (κ=.48) and DSM-5 (κ=.57), though agreement for specific DSM-5 other specified feeding or eating disorder (OSFED) presentations was poor (κ=.05). DSM-5 revisions were associated with significantly less frequent residual eating disorder diagnoses, but not with reduced inter-rater reliability. Findings support specific dimensions of clinical utility for revised DSM-5 criteria for eating disorders.
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Affiliation(s)
- Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA.
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA
| | - Helen B Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA
| | - Marilou D P Tromp
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA
| | - Andrea S Hartmann
- Institute of Psychology, University of Osnabrück, Neuer Graben, 49074 Osnabrück, Germany
| | - Melissa T Stone
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA
| | - Philip G Levendusky
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA; Klarman Eating Disorders Center, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - Anne E Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston , MA, USA; Department of Global Health & Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, USA
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18
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Sysko R, Glasofer DR, Hildebrandt T, Klimek P, Mitchell JE, Berg KC, Peterson CB, Wonderlich SA, Walsh BT. The eating disorder assessment for DSM-5 (EDA-5): Development and validation of a structured interview for feeding and eating disorders. Int J Eat Disord 2015; 48:452-63. [PMID: 25639562 PMCID: PMC4721239 DOI: 10.1002/eat.22388] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/22/2014] [Accepted: 01/02/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Existing measures for DSM-IV eating disorder diagnoses have notable limitations, and there are important differences between DSM-IV and DSM-5 feeding and eating disorders. This study developed and validated a new semistructured interview, the Eating Disorders Assessment for DSM-5 (EDA-5). METHOD Two studies evaluated the utility of the EDA-5. Study 1 compared the diagnostic validity of the EDA-5 with the Eating Disorder Examination (EDE) and evaluated the test-retest reliability of the new measure. Study 2 compared the diagnostic validity of an EDA-5 electronic application ("App") with clinician interview and self-reported assessments. RESULTS In Study 1, the kappa for EDE and EDA-5 eating disorder diagnoses was 0.74 across all diagnoses (n = 64), with a range of κ = 0.65 for other specified feeding or eating disorder/unspecified feeding or eating disorder to κ = 0.90 for binge eating disorder. The EDA-5 test-retest kappa coefficient was 0.87 across diagnoses. For Study 2, clinical interview versus App conditions revealed a kappa of 0.83 for all eating disorder diagnoses (n = 71). Across individual diagnostic categories, kappas ranged from 0.56 for other specified feeding or eating disorder/unspecified feeding or eating disorder to 0.94 for BN. DISCUSSION High rates of agreement were found between diagnoses by EDA-5 and the EDE, and EDA-5 and clinical interviews. Because this study supports the validity of the EDA-5 to generate DSM-5 eating disorders and the reliability of these diagnoses, the EDA-5 may be an option for the assessment of anorexia nervosa, bulimia nervosa, and binge eating disorder. Additional research is needed to evaluate the utility of the EDA-5 in assessing DSM-5 feeding disorders.
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Affiliation(s)
- Robyn Sysko
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Deborah R. Glasofer
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Tom Hildebrandt
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrycja Klimek
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James E. Mitchell
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND,Neuropsychiatric Research Institute, Fargo, ND
| | - Kelly C. Berg
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Stephen A. Wonderlich
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND,Neuropsychiatric Research Institute, Fargo, ND
| | - B. Timothy Walsh
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
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19
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Abstract
The Diagnostic and Statistical Manual of Mental Disorders (i.e., DSM-5) currently recognizes three primary eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder. The origins of eating disorders are complex and remain poorly understood. However, emerging research highlights a dimensional approach to understanding the multifactorial etiology of eating disorders as a means to inform assessment, prevention, and treatment efforts. Guided by research published since 2011, this review summarizes recent findings elucidating risk factors for the development of eating disorders across the lifespan in three primary domains: (1) genetic/biological, (2) psychological, and (3) socio-environmental. Prospective empirical research in clinical samples with full-syndrome eating disorders is emphasized with added support from cross-sectional studies, where relevant. The developmental stages of puberty and the transition from adolescence to young adulthood are discussed as crucial periods for the identification and prevention of eating disorders. The importance of continuing to elucidate the mechanisms underlying gene by environmental interactions in eating disorder risk is also discussed. Finally, controversial topics in the field of eating disorder research and the clinical implications of this research are summarized.
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20
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Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clin Psychol Rev 2015; 39:83-95. [PMID: 26043394 DOI: 10.1016/j.cpr.2015.04.005] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 01/01/2023]
Abstract
This systematic review sought to examine the generation and regulation of emotion in people with Anorexia Nervosa (AN). Key databases (Medline, Embase, PsychINFO and Web of Science) were searched for peer-reviewed articles published by March 2015 yielding 131 studies relevant to emotion generation and emotion regulation (ER) processes as defined by Gross (1998). Meta-analyses determined pooled group differences between AN and healthy control (HC) groups. More maladaptive schemata were reported by people with AN than HCs, with largest pooled effects for defectiveness/shame (d=2.81), subjugation (d=1.59) and social isolation (d=1.66). Poorer awareness of and clarity over emotion generated and some elevated emotionality (disgust and shame) were reported. A greater use of 'maladaptive' ER strategies was reported by people with AN than HCs, alongside less use of 'adaptive' strategies. Pooled differences of particularly large effect were observed for: experiential avoidance (d=1.00), negative problem-solving style (d=1.06), external/social comparison (d=1.25), submissiveness (d=1.16), attention concentration (worry/rumination; d=1.44) and emotion suppression (d=1.15), particularly to avoid conflict (d=1.54). These data support the notion that emotion regulation difficulties are a factor in AN and support use of associated cognitive-affective models. The implications of these findings for further understanding AN, and developing models and related psychological interventions are discussed.
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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.
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Affiliation(s)
- Martine F Flament
- University of Ottawa Institute of Mental Health Research, Ottawa, Canada
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Hilbert A, Pike KM, Goldschmidt AB, Wilfley DE, Fairburn CG, Dohm FA, Walsh BT, Striegel Weissman R. Risk factors across the eating disorders. Psychiatry Res 2014; 220:500-6. [PMID: 25103674 PMCID: PMC4785871 DOI: 10.1016/j.psychres.2014.05.054] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 02/21/2014] [Accepted: 05/28/2014] [Indexed: 11/23/2022]
Abstract
This study sought to examine risk and onset patterns in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Women with AN (n=71), BN (n=66), BED (n=160) and non-psychiatric controls (n=323) were compared retrospectively on risk factors, symptom onset, and diagnostic migration. Eating disorder groups reported greater risk exposure than non-psychiatric controls. AN and BED differed on premorbid personality/behavioral problems, childhood obesity, and family overeating. Risk factors for BN were shared with AN and BED. Dieting was the most common onset symptom in AN, whereas binge eating was most common in BN and BED. Migration between AN and BED was rare, but more frequent between AN and BN and between BN and BED. AN and BED have distinct risk factors and onset patterns, while BN shares similar risk factors and onset patterns with both AN and BED. Results should inform future classification schemes and prevention programs.
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Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany.
| | - Kathleen M Pike
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Andrea B Goldschmidt
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Faith-Anne Dohm
- Graduate School of Education & Allied Professions, Fairfield University, Fairfield, CT, USA
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University, New York, NY, USA
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Integrating weight categories and past history into the coding of feeding and eating disorders in ICD-11. Eat Weight Disord 2014; 19:503-7. [PMID: 24362822 DOI: 10.1007/s40519-013-0089-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022] Open
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Jordan J, McIntosh VVW, Carter JD, Rowe S, Taylor K, Frampton CMA, McKenzie JM, Latner J, Joyce PR. Bulimia nervosa-nonpurging subtype: closer to the bulimia nervosa-purging subtype or to binge eating disorder? Int J Eat Disord 2014; 47:231-8. [PMID: 24282157 DOI: 10.1002/eat.22218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/30/2013] [Accepted: 10/05/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE DSM-5 has dropped subtyping of bulimia nervosa (BN), opting to continue inclusion of the somewhat contentious diagnosis of BN-nonpurging subtype (BN-NP) within a broad BN category. Some contend however that BN-NP is more like binge eating disorder (BED) than BN-P. This study examines clinical characteristics, eating disorder symptomatology, and Axis I comorbidity in BN-NP, BN-P, and BED groups to establish whether BN-NP more closely resembles BN-P or BED. METHOD Women with BN-P (n = 29), BN-NP (n = 29), and BED (n = 54) were assessed at baseline in an outpatient psychotherapy trial for those with binge eating. Measures included the Structured Clinical Interviews for DSM-IV, Eating Disorder Examination, and Eating Disorder Inventory-2. RESULTS The BN-NP subtype had BMIs between those with BN-P and BED. Both BN subtypes had higher Restraint and Drive for Thinness scores than BED. Body Dissatisfaction was highest in BN-NP and predicted BN-NP compared to BN-P. Higher Restraint and lower BMI predicted BN-NP relative to BED. BN-NP resembled BED with higher lifetime BMIs; and weight-loss clinic than eating disorder clinic attendances relative to the BN-P subtype. Psychiatric comorbidity was comparable except for higher lifetime cannabis use disorder in the BN-NP than BN-P subtype DISCUSSION These results suggest that BN-NP sits between BN-P and BED however the high distress driving inappropriate compensatory behaviors in BN-P requires specialist eating disorder treatment. These results support retaining the BN-NP group within the BN category. Further research is needed to determine whether there are meaningful differences in outcome over follow-up.
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Affiliation(s)
- Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand; Canterbury District Health Board, Christchurch, New Zealand
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Nakai Y, Nin K, Teramukai S, Taniguchi A, Fukushima M, Wonderlich SA. Typical and atypical anorexia nervosa in a Japanese sample. Int J Eat Disord 2014; 47:130-7. [PMID: 24488836 DOI: 10.1002/eat.22208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/11/2013] [Accepted: 09/19/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We examined the existence of nonfat-phobic anorexia nervosa (NFP-AN) and fat-phobic AN, with no evidence of distortions related to body shape and weight (AN-NED), in a Japanese sample and studied eating disorder pathology and psychopathology in NFP-AN and AN-NED. METHOD The study participants were 200 (52.2%) women with typical AN, 86 (22.5%) women with NFP-AN, and 97 (25.3%) women with AN-NED. Diagnosis of the three types of AN was made by structured clinical interviews. The Eating Attitudes Test (EAT) and the Eating Disorder Inventory (EDI) were administered to all the participants. RESULTS There were significant differences among the three groups in terms of duration of illness, maximum and minimum BMIs and AN subtypes. There was no transition from the NFP-AN and AN-NED groups to the typical AN group during the 2- to 7-year follow-up period. There were significant differences among the three groups in scores of the EAT, the EDI total, and all the subscales of the EDI. DISCUSSION Besides typical AN, there were two types of atypical AN in terms of fat phobia and body image disturbance in this Japanese sample. The findings of the current study suggest that there may be significant differences among the three groups in terms of eating disorder pathology and psychopathology.
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Scanelli G, Gualandi M, Simoni M, Manzato E. Somatic involvement assessed through a cumulative score of clinical severity in patients with eating disorders. Eat Weight Disord 2014; 19:49-59. [PMID: 24078389 DOI: 10.1007/s40519-013-0065-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/31/2013] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate the overall somatic involvement in patients with eating disorders (EDs). METHODS The medical records of 206 patients (age 15-56 years, 96.1% females) with diagnosis of anorexia nervosa (AN, n = 63, 30.6%), bulimia nervosa (BN, n = 78, 37.9%), or eating disorder not otherwise specified (EDNOS, n = 65, 31.6 %) were analyzed. A cumulative score of clinical severity (SCS) was computed according to the presence of physical, instrumental, and laboratory abnormalities, as well as to their prognostic impact. Based on the tertile distribution of SCS, three levels of severity were defined: low, medium, and high. RESULTS A medium/high level of severity was found in 63% of the whole sample, 89% of AN, 49% of BN, and 55% of EDNOS. In the whole sample, the risk of medium/high SCS was significantly and inversely related to the body mass index (BMI) and to the lifetime minimum BMI. The severity level was significantly and positively associated with diagnosis of AN, duration of amenorrhea C1 year, and presence of ED-related symptoms. EDNOS patients showed a higher risk for increased SCS than BN patients, although not significantly. CONCLUSION The non-negligible frequency of a relevant somatic involvement in patients with EDNOS suggests that a transdiagnostic scoring system might be helpful to identify ED cases at risk of medical complications.
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Dazzi F, Di Leone FG. The diagnostic classification of eating disorders: current situation, possible alternatives and future perspectives. Eat Weight Disord 2014; 19:11-9. [PMID: 24104389 DOI: 10.1007/s40519-013-0076-1] [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: 07/09/2013] [Accepted: 09/23/2013] [Indexed: 11/30/2022] Open
Abstract
The current nosography of eating disorders (ED) has various limitations in terms of validity and accuracy. The changes adopted in the DSM-5 limit some of the current problems, such as excessive prevalence of ED not otherwise specified (EDNOS) and the lack of longitudinal stability, but are unlikely to adequately capture the clinical complexity of ED. Many authors suggest the need for a thorough review of the current nosography to support evidence-based classification. In this paper, we discuss the validity of the current diagnostic categories and their possible reorganization. Furthermore, we review the main empirical models of classification and the diagnostic approach from a personality perspective, with particular attention to research and to the prognostic and therapeutic implications.
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Affiliation(s)
- F Dazzi
- Marconi University, Rome, Italy,
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Abstract
PURPOSE OF REVIEW This article reviews the modifications to eating disorders that appear in the 'Feeding and Eating Disorders' chapter of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These modifications include the addition of three disorders (avoidant/restrictive food intake disorder, rumination disorder, and pica) previously described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) section 'Feeding and Eating Disorders of Infancy or Early Childhood'; clarifications and modifications to anorexia nervosa and bulimia nervosa; and the inclusion of binge eating disorder as a formal diagnosis. RECENT FINDINGS Research suggests that the majority of individuals seeking treatment for an eating disorder are classified as eating disorder not otherwise specified based on DSM-IV criteria. Using DSM-5 criteria, many of these individuals will be reassigned to a diagnosis with greater clinical utility. A large body of research also supports the inclusion of binge eating disorder as a formal diagnosis. SUMMARY The changes to eating disorders, recommended by the Eating Disorders Work Group, aim to clarify existing criteria and to decrease the frequency with which individuals are assigned to the heterogeneous residual category, eating disorder not otherwise specified, which provides little clinical utility.
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Ahrén JC, Chiesa F, Koupil I, Magnusson C, Dalman C, Goodman A. We are family--parents, siblings, and eating disorders in a prospective total-population study of 250,000 Swedish males and females. Int J Eat Disord 2013; 46:693-700. [PMID: 23740699 DOI: 10.1002/eat.22146] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We examined how parental characteristics and other aspects of family background were associated with the development of eating disorders (ED) in males and females. METHOD We used register data and record linkage to create the prospective, total-population study the Stockholm Youth Cohort. This cohort comprises all children and adolescents who were ever residents in Stockholm County between 2001 and 2007, plus their parents and siblings. Individuals born between 1984 and 1995 (N = 249, 884) were followed up for ED from age 12 to end of 2007. We used Cox regression modeling to investigate how ED incidence was associated with family socioeconomic position, parental age, and family composition. RESULTS In total, 3,251 cases of ED (2,971 females; 280 males) were recorded. Higher parental education independently predicted a higher rate of ED in females [e.g., adjusted hazard ratio (HR) 1.69 (95% CI: 1.42, 2.02) for degree-level vs. elementary-level maternal education], but not in males [HR 0.73 (95% CI: 0.42, 1.28), p < 0.001 for gender interaction]. In females, an increasing number of full-siblings was associated with lower rate of ED [e.g., fully adjusted HR 0.92 (95% CI: 0.88, 0.97) per sibling], whereas an increasing number of half-siblings was associated with a higher rate [HR 1.05 (95% CI: 1.01, 1.09) per sibling]. DISCUSSION The effect of parental education on ED rate varies between males and females, whereas the effect of number of siblings varies according to whether they are full or half-siblings. A deeper understanding of these associations and their underlying mechanisms may provide etiological insights and inform the design of preventive interventions.
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Affiliation(s)
- Jennie C Ahrén
- CHESS (Centre for Health Equity Studies), Karolinska Institutet/Stockholm University, Stockholm, Sweden
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30
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Nakai Y, Nin K, Teramukai S, Taniguchi A, Fukushima M, Wonderlich SA. Comparison of DSM-IV diagnostic criteria versus the Broad Categories for the Diagnosis of Eating Disorders scheme in a Japanese sample. Eat Behav 2013; 14:330-5. [PMID: 23910776 DOI: 10.1016/j.eatbeh.2013.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 04/24/2013] [Accepted: 06/07/2013] [Indexed: 11/29/2022]
Abstract
The purposes of this study were to compare DSM-IV diagnostic criteria and the Broad Categories for the Diagnosis of Eating Disorders (BCD-ED) scheme in terms of the number of cases of Eating Disorder Not Otherwise Specified (EDNOS) and to test which diagnostic tool better captures the variance of psychiatric symptoms in a Japanese sample. One thousand and twenty-nine women with an eating disorder (ED) participated in this study. Assessment methods included structured clinical interviews and administration of the Eating Attitudes Test and the Eating Disorder Inventory. The BCD-ED scheme dramatically decreased the proportion of DSM-IV EDNOS from 45.1% to 1.5%. However, the categorization of patients with the BCD-ED scheme was less able to capture the variance in psychopathology scales than the DSM-IV, suggesting that the BCD-ED scheme may differentiate ED groups less effectively than the DSM-IV. These results suggest that the BCD-ED scheme may have the potential to eliminate the use of DSM-IV EDNOS, but it may have problems capturing the variance of psychiatric symptoms.
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31
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Tanofsky-Kraff M, Bulik CM, Marcus MD, Striegel RH, Wilfley DE, Wonderlich SA, Hudson JI. Binge eating disorder: the next generation of research. Int J Eat Disord 2013; 46:193-207. [PMID: 23354950 PMCID: PMC3600071 DOI: 10.1002/eat.22089] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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32
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Keel PK, Crosby RD, Hildebrandt TB, Haedt-Matt AA, Gravener JA. Evaluating new severity dimensions in the DSM-5 for bulimic syndromes using mixture modeling. Int J Eat Disord 2013; 46:108-18. [PMID: 22887026 PMCID: PMC3509271 DOI: 10.1002/eat.22050] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Proposed DSM-5 severity dimensions reveal ambiguity regarding the extent to which certain features define boundaries between similar diagnoses or represent underlying dimensions within a broader category of bulimic syndromes. The current study utilized a novel mixed modeling approach that can simultaneously model latent dimensions and latent categories to address this ambiguity. METHOD Data from structured clinical interviews in 528 adult participants were analyzed. RESULTS A three-class solution with one severity dimension that was invariant across groups provided the best-fitting model. Both latent Classes 1 and 2 included bulimic syndromes but were distinguished by greater purging and weight phobia in latent Class 1. Latent Class 3 resembled a noneating disorder class. External validation analyses supported significant differences among empirically derived groups. DISCUSSION Weight phobia contributes to categorical distinctiveness among bulimic syndromes whereas other features (purging, binge eating, and weight) may do so only in specific combinations. Uniform severity criteria may be appropriate across bulimic syndromes.
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Affiliation(s)
- Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, Florida,Corresponding Author: Pamela K. Keel, Ph.D., Professor, Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306.
| | - Ross D. Crosby
- Neuropsychiatric Research Institute and Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Thomas B. Hildebrandt
- Eating and Weight Disorders Program, Mount Sinai School of Medicine, New York, New York
| | | | - Julie A. Gravener
- Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, New York
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Machado PPP, Gonçalves S, Hoek HW. DSM-5 reduces the proportion of EDNOS cases: evidence from community samples. Int J Eat Disord 2013; 46:60-5. [PMID: 22815201 DOI: 10.1002/eat.22040] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Eating Disorder Not Otherwise Specified (EDNOS) constitute the most common eating disorder among those seeking treatment at eating disorder facilities; they are even more common among persons with eating disorders the community. This study compares the impact of applying the revised diagnostic criteria proposed by the DSM-5 workgroup, and the broad categories for the diagnosis of eating disorders (BCD-ED) proposed by Walsh and Sysko on the prevalence of EDNOS. METHOD In two nationwide epidemiological studies the prevalence of eating disorders among female high school (n = 2,028) and university students (n = 1,020) was examined using DSM-IV criteria. We used a two-stage design, administering a questionnaire in the first stage and an interview in the second stage. RESULTS In the combined samples 118 cases of eating disorders (DSM-IV) were detected, of which 86 were diagnosed as EDNOS (72.9%). Application of the DSM-5 criteria reduced the number of EDNOS cases to 60 (50.8%) or to 52 (44%), when using a BMI <18.5 as cutoff for "significantly low weight" criterion in AN; with the use of BCD-ED criteria, only 5 (4.2%) cases of EDNOS remained. DISCUSSION Proposed criteria set for DSM-5 substantially reduce the number of EDNOS cases. However, the BCD-ED scheme further reduces its proportion, almost eliminating it.
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Affiliation(s)
- Paulo P P Machado
- Psychotherapy and Psychopathology Research Unit-CIPsi, School of Psychology, University of Minho, Braga, Portugal.
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34
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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: 30] [Impact Index Per Article: 2.7] [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.
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Affiliation(s)
- Jonathan M Mond
- Research School of Psychology, Australian National University, Canberra ACT 0200, Australia
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36
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Lavender A, Startup H, Naumann U, Samarawickrema N, Dejong H, Kenyon M, van den Eynde F, Schmidt U. Emotional and social mind training: a randomised controlled trial of a new group-based treatment for bulimia nervosa. PLoS One 2012; 7:e46047. [PMID: 23118850 PMCID: PMC3485274 DOI: 10.1371/journal.pone.0046047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/28/2012] [Indexed: 11/18/2022] Open
Abstract
Objective There is a need to improve treatment for individuals with bulimic disorders. It was hypothesised that a focus in treatment on broader emotional and social/interpersonal issues underlying eating disorders would increase treatment efficacy. This study tested a novel treatment based on the above hypothesis, an Emotional and Social Mind Training Group (ESM), against a Cognitive Behavioural Therapy Group (CBT) treatment. Method 74 participants were randomised to either ESM or CBT Group treatment programmes. All participants were offered 13 group and 4 individual sessions. The primary outcome measure was the Eating Disorder Examination (EDE) Global score. Assessments were carried out at baseline, end of treatment (four months) and follow-up (six months). Results There were no differences in outcome between the two treatments. No moderators of treatment outcome were identified. Adherence rates were higher for participants in the ESM group. Discussion This suggests that ESM may be a viable alternative to CBT for some individuals. Further research will be required to identify and preferentially allocate suitable individuals accordingly. Trial Registration ISRCTN61115988
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Affiliation(s)
- Anna Lavender
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom.
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37
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Nakai Y, Fukushima M, Taniguchi A, Nin K, Teramukai S. Comparison of DSM-IV Versus Proposed DSM-5 Diagnostic Criteria for Eating Disorders in a Japanese Sample. EUROPEAN EATING DISORDERS REVIEW 2012; 21:8-14. [DOI: 10.1002/erv.2203] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Mitsuo Fukushima
- Division of Clinical Nutrition and Internal Medicine; Okayama Prefectural University; Okayama; Japan
| | | | - Kazuko Nin
- School of Health Sciences, Faculty of Medicine; Kyoto University; Japan
| | - Satoshi Teramukai
- Department of Clinical Trial Design and Management Translational Research Center; Kyoto University Hospital; Kyoto; Japan
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Abstract
Bulimia nervosa (BN) is a distressing condition. Its pathogenesis is not fully understood. Neurocognitive functioning, and particularly inhibitory control, is a potential biomarker that may improve our understanding of BN. A few small-scale studies have used the classical Stroop Colour Word Test (SCWT) in BN with contradictory findings. We examined SCWT performance in a large sample of people with BN (N=72), eating disorder not otherwise specified--bulimic type (N=43) and healthy controls (N=50). The results found no difference between groups on Stroop interference effect. These findings question the utility of the classical SCWT as an assessment tool in examining executive functioning in BN.
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Le Grange D, Swanson SA, Crow SJ, Merikangas KR. Eating disorder not otherwise specified presentation in the US population. Int J Eat Disord 2012; 45:711-8. [PMID: 22407912 PMCID: PMC4408273 DOI: 10.1002/eat.22006] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/31/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine prevalence and clinical correlates of eating disorder not otherwise specified (EDNOS) in the US population. METHOD Two cross-sectional surveys of adults and adolescents used the WHO CIDI to assess DSM-IV criteria for anorexia nervosa (AN), bulimia nervosa (BN), and EDNOS. RESULTS Lifetime prevalence of EDNOS was 4.78% in adolescents and 4.64% in adults. The majority of adolescents and adults with an eating disorder presented with EDNOS. Three-quarters of participants with EDNOS met criteria for comorbid disorders, while one-quarter endorsed suicidality. Severity correlates were equally prevalent in EDNOS and AN, whereas comparisons between EDNOS and BN varied by specific correlate and sample. Adolescents with subthreshold AN (SAN) endorsed more anxiety than AN (p < .05), and adolescents and adults with SAN endorsed more suicidal plans than AN (p's < .05). DISCUSSION Findings increase our understanding of the clinical relevance of EDNOS. Eating disorder diagnostic nomenclature requires modification to capture the full spectrum. © 2012 by Wiley Periodicals, Inc. Int J Eat Disord 2012.
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Affiliation(s)
- Daniel Le Grange
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL
| | - Sonja A. Swanson
- Department of Epidemiology, Harvard School of Public Health, Boston, MA,Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Kathleen R. Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD
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Goyal S, Balhara YPS, Khandelwal SK. Revisiting Classification of Eating Disorders-toward Diagnostic and Statistical Manual of Mental Disorders-5 and International Statistical Classification of Diseases and Related Health Problems-11. Indian J Psychol Med 2012; 34:290-6. [PMID: 23440448 PMCID: PMC3573585 DOI: 10.4103/0253-7176.106041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Two of the most commonly used nosological systems- International Statistical Classification of Diseases and Related Health Problems (ICD)-10 and Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV are under revision. This process has generated a lot of interesting debates with regards to future of the current diagnostic categories. In fact, the status of categorical approach in the upcoming versions of ICD and DSM is also being debated. The current article focuses on the debate with regards to the eating disorders. The existing classification of eating disorders has been criticized for its limitations. A host of new diagnostic categories have been recommended for inclusion in the upcoming revisions. Also the structure of the existing categories has also been put under scrutiny.
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Affiliation(s)
- Shrigopal Goyal
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Current classification of eating disorders is failing to classify most clinical presentations; ignores continuities between child, adolescent and adult manifestations; and requires frequent changes of diagnosis to accommodate the natural course of these disorders. The classification is divorced from clinical practice, and investigators of clinical trials have felt compelled to introduce unsystematic modifications. Classification of feeding and eating disorders in ICD-11 requires substantial changes to remediate the shortcomings. We review evidence on the developmental and cross-cultural differences and continuities, course and distinctive features of feeding and eating disorders. We make the following recommendations: a) feeding and eating disorders should be merged into a single grouping with categories applicable across age groups; b) the category of anorexia nervosa should be broadened through dropping the requirement for amenorrhoea, extending the weight criterion to any significant underweight, and extending the cognitive criterion to include developmentally and culturally relevant presentations; c) a severity qualifier "with dangerously low body weight" should distinguish the severe cases of anorexia nervosa that carry the riskiest prognosis; d) bulimia nervosa should be extended to include subjective binge eating; e) binge eating disorder should be included as a specific category defined by subjective or objective binge eating in the absence of regular compensatory behaviour; f) combined eating disorder should classify subjects who sequentially or concurrently fulfil criteria for both anorexia and bulimia nervosa; g) avoidant/restrictive food intake disorder should classify restricted food intake in children or adults that is not accompanied by body weight and shape related psychopathology; h) a uniform minimum duration criterion of four weeks should apply.
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Trace SE, Thornton LM, Root TL, Mazzeo SE, Lichtenstein P, Pedersen NL, Bulik CM. Effects of reducing the frequency and duration criteria for binge eating on lifetime prevalence of bulimia nervosa and binge eating disorder: implications for DSM-5. Int J Eat Disord 2012; 45:531-6. [PMID: 21882218 PMCID: PMC3235235 DOI: 10.1002/eat.20955] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We assessed the impact of reducing the binge eating frequency and duration thresholds on the diagnostic criteria for bulimia nervosa (BN) and binge eating disorder (BED). METHOD We estimated the lifetime population prevalence of BN and BED in 13,295 female twins from the Swedish Twin study of Adults: Genes and Environment employing a range of frequency and duration thresholds. External validation (risk to cotwin) was used to investigate empirical evidence for an optimal binge eating frequency threshold. RESULTS The lifetime prevalence estimates of BN and BED increased linearly as the frequency criterion decreased. As the required duration increased, the prevalence of BED decreased slightly. Discontinuity in cotwin risk was observed in BN between at least four times per month and at least five times per month. This model could not be fit for BED. DISCUSSION The proposed changes to the DSM-5 binge eating frequency and duration criteria would allow for better detection of binge eating pathology without resulting in a markedly higher lifetime prevalence of BN or BED.
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Affiliation(s)
- Sara E. Trace
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Tammy L. Root
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Suzanne E. Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Paul Lichtenstein
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Nancy L. Pedersen
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden,Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA,Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA,Correspondence to: Dr. Bulik, Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160, Voice: (919) 843 1689 Fax: (919) 843 8802,
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Sysko R, Roberto CA, Barnes RD, Grilo CM, Attia E, Walsh BT. Test-retest reliability of the proposed DSM-5 eating disorder diagnostic criteria. Psychiatry Res 2012; 196:302-8. [PMID: 22401974 PMCID: PMC3361586 DOI: 10.1016/j.psychres.2011.12.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 12/06/2011] [Accepted: 12/12/2011] [Indexed: 02/07/2023]
Abstract
The proposed DSM-5 classification scheme for eating disorders includes both major and minor changes to the existing DSM-IV diagnostic criteria. It is not known what effect these modifications will have on the ability to make reliable diagnoses. Two studies were conducted to evaluate the short-term test-retest reliability of the proposed DSM-5 eating disorder diagnoses: anorexia nervosa, bulimia nervosa, binge eating disorder, and feeding and eating conditions not elsewhere classified. Participants completed two independent telephone interviews with research assessors (n=70 Study 1; n=55 Study 2). Fair to substantial agreements (κ=0.80 and 0.54) were observed across eating disorder diagnoses in Study 1 and Study 2, respectively. Acceptable rates of agreement were identified for the individual eating disorder diagnoses, including DSM-5 anorexia nervosa (κ's of 0.81 to 0.97), bulimia nervosa (κ=0.84), binge eating disorder (κ's of 0.75 and 0.61), and feeding and eating disorders not elsewhere classified (κ's of 0.70 and 0.46). Further, improved short-term test-retest reliability was noted when using the DSM-5, in comparison to DSM-IV, criteria for binge eating disorder. Thus, these studies found that trained interviewers can reliably diagnose eating disorders using the proposed DSM-5 criteria; however, additional data from general practice settings and community samples are needed.
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Affiliation(s)
- Robyn Sysko
- New York State Psychiatric Institute, New York, NY, USA.
| | - Christina A. Roberto
- Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Psychology, Yale University, New Haven, CT, USA,School of Epidemiology & Public Health, Yale University, New Haven, CT, USA
| | | | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Psychology, Yale University, New Haven, CT, USA
| | - Evelyn Attia
- Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - B. Timothy Walsh
- Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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Birgegård A, Norring C, Clinton D. DSM-IV versus DSM-5: implementation of proposed DSM-5 criteria in a large naturalistic database. Int J Eat Disord 2012; 45:353-61. [PMID: 22506283 DOI: 10.1002/eat.20968] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Problems with the current DSM-IV eating disorder (ED) section have resulted in proposed changes toward the upcoming DSM-5 (http://www.dsm5.org/ProposedRevisions/Pages/EatingDisorders.aspx). We investigated consequences of these by implementing the proposal in a large naturalistic database. METHOD Patients were 2,584 children/adolescents and adults enrolled at specialized ED clinics in Sweden. DSM-IV diagnoses anorexia nervosa, bulimia nervosa, and "not otherwise specified" examples were compared with DSM-5 anorexia, bulimia, and binge ED, as well as atypical anorexia, subthreshold bulimia, and binge eating, purging disorder, and the residual unspecified category. Assessment methods included a semistructured diagnostic interview and self-ratings of ED and psychiatric symptoms. RESULTS We studied age-separated diagnostic distributions and explained variance in clinical variables associated with the two systems. Results showed some improvement of diagnostic specification as well as a slight increase in explained variance. DISCUSSION Remaining problems with the proposed changes were also highlighted, and possible further refinement is discussed.
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Affiliation(s)
- Andreas Birgegård
- KA¨TS, Z8:02 Karolinska University Hospital, SE-17176 Stockholm, Sweden.
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Kenyon M, Samarawickrema N, Dejong H, Van den Eynde F, Startup H, Lavender A, Goodman-Smith E, Schmidt U. Theory of mind in bulimia nervosa. Int J Eat Disord 2012; 45:377-84. [PMID: 22212956 DOI: 10.1002/eat.20967] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to investigate theory of mind (ToM) in individuals with bulimia nervosa (BN), an area neglected by empirical research despite social functioning difficulties in this disorder and evidence of ToM deficits in people with anorexia nervosa (AN). METHOD ToM was assessed in 48 BN and 34 Eating Disorder Not Otherwise Specified BN-type (EDNOS-BN) outpatients and 57 healthy controls (HCs) using the Reading the Mind in the Eyes and the Reading the Mind in the Films (RMF), an ecologically valid task novel to BN research. RESULTS Overall performance in BN and EDNOS-BN groups was equivalent to HCs on both tasks. Individuals with BN had enhanced negative emotion recognition on the RMF. DISCUSSION Individuals with AN and BN have distinct socio-cognitive profiles. Further research into social cognition is required to establish the link between interpersonal difficulties and psychopathology in people with BN.
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Affiliation(s)
- Martha Kenyon
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, United Kingdom.
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Hebebrand J, Bulik CM. Critical appraisal of the provisional DSM-5 criteria for anorexia nervosa and an alternative proposal. Int J Eat Disord 2011; 44:665-78. [PMID: 22072403 DOI: 10.1002/eat.20875] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2010] [Indexed: 11/10/2022]
Abstract
DSM-V will be highly influential in shaping conceptions and perceptions of eating disorders by the lay public, patients, and health care providers over the next 10-15 years. DSM not only influences how medical and mental health care professionals diagnose and treat patients but also impacts health insurance policies, research funding, and clinical trials. Revisions to diagnostic criteria must be carefully considered, empirically based, and consistent with current thinking both within the field and across relevant fields. Resultant criteria should be descriptive and non-judgmental and based on empirical findings without recourse to assumed etiologies. In this forum, we review problems with the current DSM IV diagnostic criteria, concerns with the proposed DSM-5 diagnostic criteria, and present an alternative classification scheme for anorexia nervosa (AN), which more accurately captures the phenomenology of the disorder and is congruent in terminology with other fields of biomedicine.
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Affiliation(s)
- Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, University of Duisburg-Essen, Essen, Germany.
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Van den Eynde F, Samarawickrema N, Kenyon M, DeJong H, Lavender A, Startup H, Schmidt U. A study of neurocognition in bulimia nervosa and eating disorder not otherwise specified-bulimia type. J Clin Exp Neuropsychol 2011; 34:67-77. [PMID: 22059531 DOI: 10.1080/13803395.2011.621891] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Neurocognition in bulimia nervosa (BN) is under-researched. This study investigated aspects of attention (d2-Letter Cancellation Task), inhibitory control (Stroop and go/no-go task), and decision making (Game of Dice Task) in 40 people with BN, 30 with eating disorder not otherwise specified-BN type (EDNOS-BN), and 65 healthy controls (HCs). The National Adult Reading Test (NART) and Depression Anxiety Stress Scale (DASS-21) were also administered. Analyses of covariance (covariates: age, NART, and DASS-21) showed that people with BN and EDNOS-BN performed as well as HCs on all tasks. Attention task performance was poorer in the EDNOS-BN than in the BN group.
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Affiliation(s)
- Frederique Van den Eynde
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
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Sysko R, Walsh BT. Does the broad categories for the diagnosis of eating disorders (BCD-ED) scheme reduce the frequency of eating disorder not otherwise specified? Int J Eat Disord 2011; 44:625-9. [PMID: 21997426 PMCID: PMC3046223 DOI: 10.1002/eat.20860] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2010] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study evaluated whether the Broad Categories for the Diagnosis of Eating Disorders (BCD-ED) proposal (Walsh and Sysko, Int J Eat Disord, 42, 754-764, 2009) reduces the number of individuals who receive a DSM-IV eating disorder not otherwise specified (EDNOS) diagnosis. METHOD Individuals calling a tertiary care facility completed a brief telephone interview and were classified into a DSM-IV eating disorder category (anorexia nervosa, bulimia nervosa, EDNOS). Subsequently, the proposed DSM-5 criteria for eating disorders and the BCD-ED scheme were also applied. RESULTS A total of 247 individuals with telephone interview data met criteria for an eating disorder, including 97 (39.3%) with an EDNOS. Of patients with an EDNOS diagnosis, 97.6% were reclassified using the BCD-ED scheme. DISCUSSION The BCD-ED scheme has the potential to virtually eliminate the use of DSM-IV EDNOS; however, additional data are needed to document its validity and clinical utility.
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Affiliation(s)
- Robyn Sysko
- Columbia Center forEating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, New York 10032, USA.
| | - B. Timothy Walsh
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
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Gender-related Risk and Protective Factors for Depressive Symptoms and Disordered Eating in Adolescence: A 4-year Longitudinal Study. J Youth Adolesc 2011; 41:607-22. [DOI: 10.1007/s10964-011-9718-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 09/23/2011] [Indexed: 01/28/2023]
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