Feelings: what questions best discriminate women with and without eating disorders?

Not all body image constructs are created equal: Predicting eating disorder outcomes from preoccupation, dissatisfaction, and overvaluation

OBJECTIVE

Diverse terminology has been used to operationalize body image disturbance in eating disorders. However, the differential validity of these terms and their underlying constructs to predict outcomes among heterogeneous eating disorders is unknown. This study evaluated the validity of body image constructs to predict eating disorder and negative psychological symptoms concurrently and prospectively over 2 years in a transdiagnostic clinical sample.

METHODS

Women with heterogeneous eating disorder diagnoses (n = 448) completed assessments at baseline, 12-month, and 24-month follow-up. Cross-sectional and cross-lagged generalized linear models examined effects of three body image constructs (i.e., weight and shape preoccupation, overvaluation, and dissatisfaction) on concurrent and subsequent outcomes (i.e., global eating disorder symptoms, binge eating, purging, fasting, self-esteem, and depression).

RESULTS

In concurrent analyses, preoccupation was significantly associated with all outcomes (ps = .01 to <.001), overvaluation with all outcomes (ps = .01 to <.001) except binge eating (p = .06), and dissatisfaction with all outcomes (ps < .001) except purging (p = .38). In prospective analyses, preoccupation predicted Eating Disorder Examination global (p = .003) and fasting (p < .001), overvaluation predicted binge eating (p = .01), and body dissatisfaction did not predict any outcomes.

DISCUSSION

Preoccupation, overvaluation, and dissatisfaction are differentially related to eating disorder and psychiatric outcomes, indicating that no one body image construct can capture clinical risk in eating disorders. Preoccupation was the most consistent concurrent and longitudinal predictor; this construct may warrant further attention in assessment and diagnosis. Further investigation of these constructs in diverse samples is encouraged.

Body weight dissatisfaction before, during and after pregnancy: a comparison of women with and without eating disorders

PURPOSE

We examined prospectively changes in current BMI and body weight dissatisfaction in women with and without eating disorders (EDs) during and after pregnancy compared to prepregnancy.

METHODS

We assessed pregnant women with (ED group, N = 18) and without an ED (Control group, N = 129) using current BMI and the discrepancy between current and desired BMI (body weight dissatisfaction). This is a measure representative of overall body dissatisfaction. Women were assessed retrospectively for prepregnancy, and prospectively at weeks 12-14 (first trimester), weeks 24-26 (second trimester) and weeks 34-36 (third trimester) during pregnancy and 3, 6 and 12 months after.

RESULTS

Compared with prepregnancy, current BMI for the ED group increased at trimester two and three and returned to prepregnancy levels postpartum, while current BMI for the Control group increased at trimester one, two, three, and remained above their prepregnancy BMI at 3, 6 and 12 months postpartum. Compared with prepregnancy levels, body weight dissatisfaction for the ED group improved at 6 and 12 months postpartum, while body weight dissatisfaction for the Control group increased at trimester two and three, and remained greater at 3 and 6 months postpartum before returning to prepregnancy levels at 12 months postpartum. Maximum dissatisfaction occurs in trimester three for both the ED (mean 2.98, SD 2.74) and Control groups (mean 2.93, SD 3.22).

CONCLUSIONS

Body dissatisfaction does not improve during pregnancy in women with or without EDs. Body weight dissatisfaction remained unchanged for women with EDs during pregnancy, before a decrease at 6 and 12 months postpartum. Body weight dissatisfaction increased for women without EDs, and remained elevated until 6 months postpartum. Despite this, women with and without EDs gained significant weight during pregnancy This suggests all women require information and support regarding body image during the pregnancy and in the 12 months postpartum.

A comparison of eating disorder patients in India and Australia

BACKGROUND

Eating disorders (EDs) are an emerging concern in India. There are few studies comparing clinical samples in western and nonwestern settings.

AIM

The aim was to compare females aged 16-26 years being treated for an ED in India (outpatients n = 30) and Australia (outpatients n = 30, inpatients n = 30).

MATERIALS AND METHODS

Samples were matched by age and body mass index, and had similar diagnostic profiles. Demographic information and history of eating and exercise problems were assessed. All patients completed the quality-of-life for EDs (QOL EDs) questionnaire.

RESULTS

Indians felt they overate and binge ate more often than Australians; frequencies of food restriction, vomiting, and laxative use were similar. Indians were less aware of ED feelings, such as, "fear of losing control over food or eating" and "being preoccupied with food, eating or their body." Indians felt eating and exercise had less impact on their relationships and social life but more impact on their medical health. No differences were found in the global quality-of-life, body weight, eating behaviors, psychological feelings, and exercise subscores for the three groups.

CONCLUSION

Indian and Australian patients are similar but may differ in preoccupation and control of their ED-related feelings.

Body weight dissatisfaction: a comparison of women with and without eating disorders

OBJECTIVE

Body dissatisfaction is present in a majority of women without eating disorders (EDs), and almost all women with EDs. We compared body dissatisfaction in women with and without EDs to determine at which BMI women are content with their weight, and to determine if body dissatisfaction is affected by the presence of purging behaviours.

METHODS

We assessed women, age 18 to 55 with an ED (N=431) and without an ED (N=719) using the discrepancy between their current and desired BMI. This measure of body weight dissatisfaction (BWD) has been validated as being representative of overall body dissatisfaction. We also measured perceptions of (i) Body Appearance and (ii) Body Image to confirm our results.

RESULTS

Women with and without EDs wished to lose weight until very low weights were achieved (BMI 15-16 kg/m(2) and BMI 18-19 kg/m(2) respectively). BWD is higher in women with EDs (median 1.77, IQR 0-4.61) than women without EDs (median 0.85, IQR 0-1.80, p<0.001). Purging behaviours in women with EDs were associated with lower BMIs to achieve body satisfaction (BMI 15-16 kg/m(2)) than women who did not purge (16-17 kg/m(2)).

CONCLUSIONS

Body weight dissatisfaction is highly prevalent amongst women with and without EDs. Understanding body weight dissatisfaction in women with EDs and its association with purging may assist in the prevention, detection and treatment of these disorders. Women with EDs should be informed that body weight dissatisfaction will not resolve with the cessation of their disorder, as it is prevalent within the general population.

Personality factors and eating disorders: self-uncertainty

The International Personality Disorder Examination interview (IPDE) was used to examine common features of personality amongst eating disorder (ED) patients. Female inpatients (N=155), aged 18 to 45, BMI<30 kg/m(2), were interviewed. Items present in ≥ 25% of patients were analysed by factor analysis. Five factors emerged - 'interpersonal anxiety', 'instability', 'self-uncertainty', 'obsessionality' and 'perfectionism' accounting for 62% of the variance. Patients with BMI, <18.5 kg/m(2) had significantly greater 'interpersonal anxiety' factor scores. Patients who purged had higher 'interpersonal anxiety', 'instability', and 'perfectionism' factor scores. Differences between ED diagnostic groups were accounted for by body weight and purging. Increasing age was weakly associated with improvement in 'self-uncertainty' and 'instability' scores. This study separates obsessionality and perfectionism, possibly reflecting ED patients' 'need for control', and introduces a new factor 'self-uncertainty' which reflects their poor self-concept. The contribution of this factor structure to development and duration of illness should be studied.

Pelvic floor dysfunction predicts abdominal bloating and distension in eating disorder patients

OBJECTIVE

Little is known about the symptoms of abdominal bloating and distension in women with eating disorders (EDs). This study aimed to explore the prevalence and predictors of these symptoms in patients with EDs, by examining correlations with functional gastrointestinal disorders (FGIDs) including pelvic floor symptoms and other clinical features.

MATERIAL AND METHODS

184 ED inpatients, 16-55 years, completed on admission to hospital the ROME II symptom questionnaire, additional questions about abdominal bloating and distension, and psychological questionnaires. Prediction of abdominal bloating and distension was modeled using logistic regression analyses with individual FGIDs, psychological variables, ED type, and clinical features as the potential predictors.

RESULTS

Bloating (78%) was more common than distension (58%) in each ED type. In the final multivariate models, after controlling for BMI, the number of Rome II symptoms of pelvic floor dyssynergia (i.e., having to strain to pass a stool, feeling unable to empty the rectum, and having difficulty relaxing to evacuate the stool) was a significant predictor of both abdominal distension (p < 0.001) and bloating (p < 0.005). The presence of irritable bowel syndrome (IBS, 46%) was a significant predictor of bloating (p < 0.001) but not distension.

CONCLUSIONS

Symptoms of pelvic floor dysfunction, but not IBS, appear to be especially important in the genesis of abdominal distension in patients with ED.

Weight loss and related behavior changes among lesbians

Overweight and obesity are known risk factors for several modifiable, if not preventable diseases. Growing evidence suggests that lesbians may have higher rates of obesity than other women. This study was designed to describe weight loss and behavior changes related to food choices and exercise habits among lesbians who participated in a predominantly lesbian, mainstream, commercial weight loss program. Behavioral changes were recorded in exercise, quality of food choices, and number of times dining out. Although there were several limitations based on sample size and heterogeneity, the impact of a lesbian-supportive environment for behavior change was upheld.

Exploring eating disorder quality of life and functional gastrointestinal disorders among eating disorder patients

BACKGROUND

Functional gastrointestinal-like disorders (FGIDs) are prevalent among eating disorder (ED) patients. The aims are to explore the relationship between quality of life related to eating disorders (QOL ED) and FGIDs.

METHODS

Consecutive ED patients, 18-45 years old, completed the Rome II, QOL ED, Irritable Bowel Syndrome QOL (IBS-QOL) and Bowel Symptom Severity Index (BSSI) questionnaires on admission to hospital for treatment of their ED.

RESULTS

Despite the high prevalence of FGIDs (93%), only IBS is clearly correlated with QOL ED scores. The QOL ED subscores significantly related are ED feelings, psychological feelings and effect on daily living. These subscores contain items such as fearing loss of control over your body and feelings, being preoccupied with thoughts of body weight and shape, feeling confused and that eating and exercise have a negative effect on work/study. There were no relationships between QOL ED behavior and individual FGIDs or categories of FGIDs. The QOL ED and IBS-QOL are highly correlated, and there is a positive linear relationship between the QOL ED global and IBS-QOL total and BSSI scores.

CONCLUSION

The presence of IBS (but not other FGIDs) in ED patients is strongly related to eating disordered and psychological feelings. The poorer the QOL ED is, the poorer the IBS-QOL is and the more severe the IBS symptoms are.

Fear- and disgust-related covariation bias and eating disorders symptoms in healthy young women

Covariation bias refers to the phenomenon of overestimating the contingency between certain stimuli and negative outcomes, which is considered as a heuristic playing a role in the maintenance of certain types of psychopathology. In the present study, an attempt was made to investigate covariation bias within the context of eating pathology. In a sample of 61 female undergraduates, a priori and a posteriori contingencies were measured between pictures of obese and slim bodies, on the one hand, and fear- or disgust-relevant outcomes, on the other hand. Results indicated that participants in general displayed an a priori and an a posteriori covariation bias reflecting an overestimation of the link between obese bodies and disgust-relevant outcomes. However, this bias was not related to eating disorder symptomatology. Meanwhile, eating pathology was positively associated with a priori covariation biases referring to the associations between obese bodies and fear-relevant outcomes, and between slim bodies and disgust-relevant outcomes. All in all, these findings suggest that covariation bias plays a role in eating pathology.

Translation of the Quality of Life for Eating Disorders questionnaire into Hindi

OBJECTIVE

The Quality of Life for Eating Disorders questionnaire was translated into Hindi (QOL ED-H) using the forward-backward translation procedure for use with Indian females.

METHOD

A total of ninety-five females were recruited from two secondary schools and one tertiary college from Delhi, India. They were aged between 14 and 37 years, ranging from low to high socioeconomic status communities. A psychologist and teacher produced a preliminary Hindi version, which was back-translated by the psychologist and a journalist and any disparity was checked. The Hindi and English versions were administered one week apart to the same participants, the order being randomised.

RESULTS

Repeated measures analysis revealed no significant differences in QOL ED scores (global and subscores) between the Hindi and English versions, when controlled for age.

CONCLUSION

The QOL ED-H can be used to assess eating and exercise disordered thinking, feeling, behaviours, psychological feelings and daily living in Indian females of all SES groups.

The role of the right parietal lobe in anorexia nervosa

BACKGROUND

Patients with anorexia nervosa (AN) overestimate their size despite being severely underweight. Whether this misperception echoes an underlying emotional disturbance or also reflects a genuine body-representation deficit is debatable. Current measures inquire directly about subjective perception of body image, thus distinguishing poorly between top-down effects of emotions/attitudes towards the body and disturbances due to proprioceptive disorders/distorted body schema. Disorders of body representation also emerge following damage to the right parietal lobe. The possibility that parietal dysfunction might contribute to AN is suspected, based on the demonstrated association of spatial impairments, comparable to those found after parietal lesion, with this syndrome.

METHOD

We used a behavioral task to compare body knowledge in severe anorexics (n=8), healthy volunteers (n=11) and stroke patients with focal damage to the left/right parietal lobe (n=4). We applied a psychophysical procedure based on the perception, in the dark, of an approaching visual stimulus that was turned off before reaching the observer. Participants had to predict whether the stimulus would have hit/missed their body, had it continued its linear motion.

RESULTS

Healthy volunteers and left parietal patients estimated body boundaries very close to the real ones. Conversely, anorexics and right parietal patients underestimated eccentricity of their left body boundary.

CONCLUSIONS

These findings are in line with the role the parietal cortex plays in developing and maintaining body representation, and support the possibility for a neuropsychological component in the pathogenesis of anorexia, offering alternative approaches to treatment of the disorder.