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Carrino EA, Flatt RE, Pawar PS, Sanzari CM, Tregarthen JP, Argue S, Thornton LM, Bulik CM, Watson HJ. Sociodemographic and clinical characteristics of treated and untreated adults with bulimia nervosa or binge-eating disorder recruited for a large-scale research study. J Eat Disord 2023; 11:126. [PMID: 37525298 PMCID: PMC10391988 DOI: 10.1186/s40337-023-00846-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Eating disorders affect millions of people worldwide, but most never receive treatment. The majority of clinical research on eating disorders has focused on individuals recruited from treatment settings, which may not represent the broader population of people with eating disorders. This study aimed to identify potential differences in the characteristics of individuals with eating disorders based on whether they self-reported accessing treatment or not, in order to contribute to a better understanding of their diverse needs and experiences. METHODS The study population included 762 community-recruited individuals (85% female, M ± SD age = 30 ± 7 years) with bulimia nervosa or binge-eating disorder (BN/BED) enrolled in the Binge Eating Genetics Initiative (BEGIN) United States study arm. Participants completed self-report surveys on demographics, treatment history, past and current eating disorder symptoms, weight history, and their current mental health and gastrointestinal symptoms. Untreated participants (n = 291, 38%) were compared with treated participants (n = 471, 62%) who self-reported accessing BN/BED treatment at some point in their lives. RESULTS Untreated participants disproportionately self-identified as male and as a racial or ethnic minority compared with treated participants. Treated participants reported a more severe illness history, specifically, an earlier age at onset, more longstanding and frequent eating disorder symptoms over their lifetime, and greater body dissatisfaction and comorbid mental health symptoms (i.e., depression, anxiety, ADHD) at the time of the study. A history of anorexia nervosa was positively associated with treatment engagement. Individuals self-reporting a history of inpatient or residential treatment exhibited the most severe illness history, those with outpatient treatment had a less severe illness history, and untreated individuals had the mildest illness history. CONCLUSIONS Historically overlooked and marginalized populations self-reported lower treatment access rates, while those who accessed treatment reported more severe eating disorder and comorbid mental health symptoms, which may have motivated them to seek treatment. Clinic-based recruitment samples may not represent individuals with milder symptoms or racial and ethnic diversity, and males. Community-based recruitment is crucial for improving the ability to apply research findings to broader populations and reducing disparities in medical research. Trial Registration ClinicalTrials.gov NCT04162574 ( https://clinicaltrials.gov/ct2/show/NCT04162574 ).
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Affiliation(s)
- Emily A. Carrino
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Rachael E. Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Pratiksha S. Pawar
- Department of Biotechnology, Dr D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Christina M. Sanzari
- Department of Psychology, State University of New York at Albany, Albany, NY USA
| | | | | | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 171 65 Solna, Stockholm Sweden
| | - Hunna J. Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia
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Carrino E, Flatt R, Pawar P, Sanzari C, Tregarthen J, Argue S, Thornton L, Bulik C, Watson H. Sociodemographic and Clinical Characteristics of Treated and Untreated Adults with Bulimia Nervosa and/or Binge-eating Disorder Recruited for a Large-Scale Research Study. RESEARCH SQUARE 2023:rs.3.rs-2899349. [PMID: 37214840 PMCID: PMC10197743 DOI: 10.21203/rs.3.rs-2899349/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background: Eating disorders affect millions of people worldwide, but most never receive treatment. The majority of clinical research on eating disorders has focused on individuals recruited from treatment settings, which may not represent the broader population of people with eating disorders. This study compared the characteristics of individuals with eating disorders based on whether they self-reported accessing treatment or not, to identify potential differences and contribute to a better understanding of the diverse needs and experiences of individuals with eating disorders. Methods: The study population included 762 community-recruited individuals (85% female, M ± SD age = 30 ± 7 y) with bulimia nervosa and/or binge eating disorder (BN/BED) enrolled in the Binge-Eating Genetics Initiative (BEGIN) United States study arm. Participants completed self-report surveys on demographics, treatment history, past and current eating disorder symptoms, weight history, and current mental health and gastrointestinal comorbidity. Untreated participants ( n = 291, 38%) were compared with treated participants ( n = 471, 62%) who self-reported accessing BN/BED treatment at some point in their lives. Results: Untreated participants disproportionately self-identified as male and as a racial or ethnic minority compared with treated participants. Treated participants reported a more severe illness history, specifically, an earlier age at onset, more longstanding and frequent ED symptoms over their lifetime, and higher body dissatisfaction and comorbid mental health symptoms (i.e., depression, anxiety, ADHD) at the time of the study. Those who reported a history of inpatient or residential treatment displayed the most severe illness history, whereas those who reported outpatient treatment had a less severe illness history, and untreated individuals had the mildest illness history. Conclusions: Individuals from historically overlooked or marginalized populations were less likely to access treatment. Those who accessed treatment had more severe ED and comorbid symptoms, which may have motivated them to seek treatment. Clinic-based recruitment samples may not accurately represent all individuals with EDs, particularly those with milder symptoms and those with gender or racial/ethnic diversity. The results of this study indicate that community-based recruitment is crucial for improving the ability to apply research findings to broader populations and to reduce disparities in medical research. Trial Registration : ClinicalTrials.gov NCT04162574 (https://clinicaltrials.gov/ct2/show/NCT04162574).
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Thiebaut S, Godart N, Radon L, Courtet P, Guillaume S. Crossed prevalence results between subtypes of eating disorder and bipolar disorder: A systematic review of the literature. Encephale 2019; 45:60-73. [DOI: 10.1016/j.encep.2018.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 12/28/2017] [Accepted: 06/12/2018] [Indexed: 02/06/2023]
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Comorbid drug use disorders and eating disorders — a review of prevalence studies. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.2478/v10199-012-0024-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aims This study reviews literature on comorbidity of drug use disorders (DUD) and eating disorders (ED). The article updates knowledge on the occurrence of comorbidity of these diagnoses. Methods The databases Embase, Medline and PsycInfo were searched for studies published between 1990 and May 2011, with combinations of the terms ‘eating disorder’, ‘substance-related disorder’, ‘drug dependence’, ‘drug abuse’, ‘drug addiction’ and ‘substance abuse’. This generated altogether 596 studies. Studies in which diagnostic DUD and ED were not assessed in the same sample or the result was not given in percentages were excluded. Thirteen studies remained. Results In 11 of the 13 studies, the participants were initially diagnosed with an eating disorder. The prevalence of lifetime drug use disorders varies from 8–43 %. In two studies, DUD is the initial diagnosis, and the participants report 14 % concurrent and 27.3% lifetime ED. The most prevalent co-occurring diagnoses tend to be bulimia nervosa/bingeing-purging anorexia nervosa, and stimulants/cannabis disorders. Conclusions The lifetime prevalence percentages of eating disorders in people with drug use disorders (and vice versa) are higher than in the general population. The results indicate that the field of drug disorder treatment and research could benefit from paying closer attention to the risk of eating disorders.
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Burns M. Eating Like an Ox: Femininity and Dualistic Constructions of Bulimia and Anorexia. FEMINISM & PSYCHOLOGY 2016. [DOI: 10.1177/0959353504042182] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Using a feminist discursive analytic approach this article investigates descriptions of anorexia and bulimia for the purposes of deconstructing some of the hierarchies implicit in them. Data includes interview accounts of women who practise bulimia and of health professionals, and items from popular culture and psychological literature. Analysis demonstrates how a binary logic and discourses of femininity are involved in the inscription of value to the category of, and practices associated with, anorexia. The practices and category of bulimia are therefore often constituted as the eating disordered ‘other’ to anorexia. Potential implications for women who practise bulimia are examined, as is the destabilizing potential of other ways of describing eating disorders.
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Affiliation(s)
- Maree Burns
- Department of Psychology, The University of Auckland, Private Bag 92019, Auckland, New Zealand
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Álvarez Ruiz EM, Gutiérrez-Rojas L. Comorbilidad entre el trastorno bipolar y los trastornos de la conducta alimentaria. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2015; 8:232-41. [DOI: 10.1016/j.rpsm.2014.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 12/13/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
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Godart N, Radon L, Curt F, Duclos J, Perdereau F, Lang F, Venisse JL, Halfon O, Bizouard P, Loas G, Corcos M, Jeammet P, Flament MF. Mood disorders in eating disorder patients: Prevalence and chronology of ONSET. J Affect Disord 2015; 185:115-22. [PMID: 26162282 DOI: 10.1016/j.jad.2015.06.039] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/01/2015] [Accepted: 06/23/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES In a clinical population, we estimated the frequency of mood disorders among 271 patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in comparison to a control group matched for age and gender. METHOD The frequency of mood disorders was measured using the Mini International Neuropsychiatric Interview (MINI), DSM-IV version. RESULTS Mood disorders were more frequent among eating disorder (ED) patients than among controls, with a global prevalence of the order of 80% for each ED group. The majority of the mood disorders comorbid with ED were depressive disorders (MDD and dysthymia). The relative chronology of onset of these disorders was equivocal, because mood disorders in some cases preceded and in others followed the onset of the eating disorders. LIMITATIONS Our sample was characterized by patients with severe ED and high comorbidities, and thus do not represent the entire population of AN or BN. This also may have resulted in an overestimation of prevalence. CONCLUSION Mood disorders appear significantly more frequently in patients seeking care for ED than in controls. These results have implications for the assessment and treatment of ED patients, and for the aetio-pathogenesis of these disorders.
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Affiliation(s)
- N Godart
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France; Faculty of Medicine, Paris Descartes University, Paris, France; Inserm U669, Paris, France.
| | - L Radon
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France; Inserm U669, Paris, France
| | - F Curt
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France
| | - J Duclos
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France
| | - F Perdereau
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France
| | - F Lang
- University Hospital Centre of Saint Etienne, Psychiatric Services, Saint Etienne, France
| | - J L Venisse
- Saint Jacques Hospital, Addictions Unit, Nantes, France
| | - O Halfon
- University Child and Adolescent Psychiatric Services-SUPEA Department of Research, Lausanne, Switzerland
| | - P Bizouard
- University of Besançon Hospital Centre, Besançon, France
| | - G Loas
- University Hospital Sector, CHS P. Pinel, Amiens, France
| | - M Corcos
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France
| | - Ph Jeammet
- Psychiatry Department, Institut Mutualiste Montsouris (IMM), Paris, France
| | - M F Flament
- University of Ottawa Research Director, Youth Program, Institute of Mental Health Research Royal Ottawa Hospital, 1145 Carling Ave, Rm CB2111 Ottawa, ON, Canada K1Z 7K4
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Lupattelli A, Spigset O, Torgersen L, Zerwas S, Hatle M, Reichborn-Kjennerud T, Bulik CM, Nordeng H. Medication Use before, during, and after Pregnancy among Women with Eating Disorders: A Study from the Norwegian Mother and Child Cohort Study. PLoS One 2015. [PMID: 26200658 PMCID: PMC4511584 DOI: 10.1371/journal.pone.0133045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Little is known about medication use among women with eating disorders in relation to pregnancy. AIMS To explore patterns of and associations between use of psychotropic, gastrointestinal and analgesic medications and eating disorders in the period before, during and after pregnancy. METHOD This study is based on the Norwegian Mother and Child Cohort Study (MoBa). A total of 62,019 women, enrolled at approximately 17 weeks' gestation, had valid data from the Norwegian Medical Birth Registry and completed three MoBa questionnaires. The questionnaires provided diagnostic information on broadly defined anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and recurrent self-induced purging in the absence of binge eating (EDNOS-P), along with self-reported use of medication six months before, during, and 0-6 months after pregnancy. RESULTS The prevalence of eating disorder subtypes before and/or during pregnancy was: 0.09% AN (n = 54), 0.94% BN (n = 585), 0.10% EDNOS-P (n = 61) and 5.00% BED (n = 3104). The highest over-time prevalence of psychotropic use was within the AN (3.7-22.2%) and EDNOS-P (3.3-9.8%) groups. Compared to controls, BN was directly associated with incident use of psychotropics in pregnancy (adjusted RR: 2.25, 99% CI: 1.17-4.32). Having AN (adjusted RR: 5.11, 99% CI: 1.53-17.01) or EDNOS-P (adjusted RR: 6.77, 99% CI: 1.41-32.53) was directly associated with use of anxiolytics/sedatives postpartum. The estimates of use of analgesics (BED) and laxatives (all eating disorders subtypes) were high at all time periods investigated. CONCLUSIONS Use of psychotropic, gastrointestinal, and analgesic medications is extensive among women with eating disorders in the period around pregnancy. Female patients with eating disorders should receive evidence-based counseling about the risk of medication exposure versus the risk of untreated psychiatric illness during pregnancy and postpartum.
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Affiliation(s)
- Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- * E-mail:
| | - Olav Spigset
- Department of Clinical Pharmacology, St Olav’s University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Leila Torgersen
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Stephanie Zerwas
- UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Ted Reichborn-Kjennerud
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Psychiatry, University of Oslo, Oslo, Norway
| | - Cynthia M. Bulik
- UNC Center of Excellence for Eating Disorders, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
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Family Environment and Psychiatric History in Women with Binge-eating Disorder and Obese Controls. BEHAVIOUR CHANGE 2014. [DOI: 10.1017/s0813483900003569] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We examined the prevalence of comorbid psychopathology, family psychiatric history, and perceptions of family environment in 20 women with binge-eating disorder (BED) and 20 non-binge-eating obese controls. Women with BED were significantly more likely to report current or lifetime affective and anxiety disorders as well as family histories of BED. Family histories of substance abuse did not differ across groups. Significantly more women with BED rated their parents' parenting style as consistent with “affectionless control” on the Parental Bonding Instrument, and reported significantly lower cohesion, expressiveness, conflict, independence, intellectual-cultural orientation, and active-recreational orientation on the Family Environment Scale.
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Polnay A, James VAW, Hodges L, Murray GD, Munro C, Lawrie SM. Group therapy for people with bulimia nervosa: systematic review and meta-analysis. Psychol Med 2014; 44:2241-2254. [PMID: 24238470 DOI: 10.1017/s0033291713002791] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Approximately 25% of people with bulimia nervosa (BN) who undertake therapy are treated in groups. National guidelines do not discriminate between group and individual therapy, yet each has potential advantages and disadvantages and it is unclear how their effects compare. We therefore evaluated how group therapy for BN compares with individual therapy, no treatment, or other therapies, in terms of remission from binges and binge frequency. METHOD We performed a systematic review and meta-analysis of randomized controlled trials of group therapies for BN, following standard guidelines. RESULTS A total of 10 studies were included. Studies were generally small with unclear risk of bias. There was low-quality evidence of a clinically relevant advantage for group cognitive behavioural therapy (CBT) over no treatment at therapy end. Remission was more likely with group CBT versus no treatment [relative risk (RR) 0.77, 95% confidence interval (CI) 0.62-0.96]. Mean weekly binges were lower with group CBT versus no treatment (2.9 v. 6.9, standardized mean difference = -0.56, 95% CI -0.96 to -0.15). One study provided low-quality evidence that group CBT was inferior compared with individual CBT to a clinically relevant degree for remission at therapy end (RR 1.24, 95% CI 1.03-1.50); there was insufficient evidence regarding frequency of binges. CONCLUSIONS Conclusions could only be reached for CBT. Low-quality evidence suggests that group CBT is effective compared with no treatment, but there was insufficient or very limited evidence about how group and individual CBT compared. The risk of bias and imprecise estimates of effect invite further research to refine and increase confidence in these findings.
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Affiliation(s)
- A Polnay
- Edinburgh Psychotherapy Department, Royal Edinburgh Hospital, Edinburgh,UK
| | - V A W James
- Scottish Mental Health Research Network,Kennedy Tower, Royal Edinburgh Hospital, Edinburgh,UK
| | - L Hodges
- Division of Psychiatry,University of Edinburgh,Royal Edinburgh Hospital, Edinburgh,UK
| | - G D Murray
- Centre for Population Health Sciences,University of Edinburgh Medical School,Teviot Place, Edinburgh,UK
| | - C Munro
- Anorexia Nervosa Intensive Treatment Team, Royal Edinburgh Hospital, Edinburgh,UK
| | - S M Lawrie
- Division of Psychiatry,University of Edinburgh,Royal Edinburgh Hospital, Edinburgh,UK
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Kessler RC, Berglund PA, Chiu WT, Deitz AC, Hudson JI, Shahly V, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Benjet C, Bruffaerts R, de Girolamo G, de Graaf R, Maria Haro J, Kovess-Masfety V, O'Neill S, Posada-Villa J, Sasu C, Scott K, Viana MC, Xavier M. The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biol Psychiatry 2013; 73:904-14. [PMID: 23290497 PMCID: PMC3628997 DOI: 10.1016/j.biopsych.2012.11.020] [Citation(s) in RCA: 749] [Impact Index Per Article: 68.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 11/21/2012] [Accepted: 11/21/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Little population-based data exist outside the United States on the epidemiology of binge eating disorder (BED). Cross-national BED data are presented here and compared with bulimia nervosa (BN) data in the World Health Organization (WHO) World Mental Health Surveys. METHODS Community surveys with 24,124 respondents (ages 18+) across 14 mostly upper-middle and high-income countries assessed lifetime and 12-month DSM-IV mental disorders with the WHO Composite International Diagnostic Interview. Physical disorders were assessed with a chronic conditions checklist. RESULTS Country-specific lifetime prevalence estimates are consistently (median; interquartile range) higher for BED (1.4%; .8-1.9%) than BN (.8%; .4-1.0%). Median age of onset is in the late teens to early 20s for both disorders but slightly younger for BN. Persistence is slightly higher for BN (6.5 years; 2.2-15.4) than BED (4.3 years; 1.0-11.7). Lifetime risk of both disorders is elevated for women and recent cohorts. Retrospective reports suggest that comorbid DSM-IV disorders predict subsequent onset of BN somewhat more strongly than BED and that BN predicts subsequent comorbid disorders somewhat more strongly than does BED. Significant comorbidities with physical conditions are due almost entirely to BN and to a somewhat lesser degree BED predicting subsequent onset of these conditions. Role impairments are similar for BN and BED. Fewer than half of lifetime BN or BED cases receive treatment. CONCLUSIONS Binge eating disorder represents a public health problem at least equal to BN. Low treatment rates highlight the clinical importance of questioning patients about eating problems even when not included among presenting complaints.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
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Knoph C, Holle AV, Zerwas S, Torgersen L, Tambs K, Stoltenberg C, Bulik CM, Reichborn-Kjennerud T. Course and predictors of maternal eating disorders in the postpartum period. Int J Eat Disord 2013; 46:355-68. [PMID: 23307499 PMCID: PMC3622173 DOI: 10.1002/eat.22088] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate course and predictors of eating disorders in the postpartum period. METHOD A total of 77,807 women, participating in the Norwegian Mother and Child Cohort Study (MoBa), completed questionnaires during pregnancy including items covering DSM-IV criteria for prepregnancy anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS-P), and binge eating disorder (BED). Additional questionnaires were completed at 18 and 36 months postpartum. RESULTS Proportions of women remitting at 18 months and 36 months postpartum were 50% and 59% for AN, 39% and 30% for BN, 46% and 57% for EDNOS-P, and 45% and 42% for BED, respectively. However, disordered eating persisted in a substantial proportion of women meeting criteria for either full or subthreshold eating disorders. BN during pregnancy increased the risk for continuation of BN. BMI and psychological distress were significantly associated with course of BED. DISCUSSION This is the first large-scale population-based study on course of eating disorders in the postpartum period. The results indicated that disordered eating persists in a substantial proportion of women with prepregnancy eating disorders. Health care professionals working with women in this phase of life need to pay specific attention to eating disorder symptoms and behaviors.
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Affiliation(s)
- Cecilie Knoph
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Ann Von Holle
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Leila Torgersen
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristian Tambs
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Camilla Stoltenberg
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway,Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ted Reichborn-Kjennerud
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway,Department of Psychiatry, University of Oslo, Oslo, Norway
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Bulik CM, Marcus MD, Zerwas S, Levine MD, Hofmeier S, Trace SE, Hamer RM, Zimmer B, Moessner M, Kordy H. CBT4BN versus CBTF2F: comparison of online versus face-to-face treatment for bulimia nervosa. Contemp Clin Trials 2012; 33:1056-64. [PMID: 22659072 DOI: 10.1016/j.cct.2012.05.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/22/2012] [Accepted: 05/24/2012] [Indexed: 01/28/2023]
Abstract
Cognitive-behavioral therapy (CBT) is currently the "gold standard" for treatment of bulimia nervosa (BN), and is effective for approximately 40-60% of individuals receiving treatment; however, the majority of individuals in need of care do not have access to CBT. New strategies for service delivery of CBT and for maximizing maintenance of treatment benefits are critical for improving our ability to treat BN. This clinical trial is comparing an Internet-based version of CBT (CBT4BN) in which group intervention is conducted via therapeutic chat group with traditional group CBT (CBTF2F) for BN conducted via face-to-face therapy group. The purpose of the trial is to determine whether manualized CBT delivered via the Internet is not inferior to the gold standard of manualized group CBT. In this two-site randomized controlled trial, powered for non-inferiority analyses, 180 individuals with BN are being randomized to either CBT4BN or CBTF2F. We hypothesize that CBT4BN will not be inferior to CBTF2F and that participants will value the convenience of an online intervention. If not inferior, CBT4BN may be a cost-effective approach to service delivery for individuals requiring treatment for BN.
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Affiliation(s)
- Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599, USA.
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Puhl MD, Cason AM, Wojnicki FHE, Corwin RL, Grigson PS. A history of bingeing on fat enhances cocaine seeking and taking. Behav Neurosci 2011; 125:930-42. [PMID: 21988520 PMCID: PMC3226865 DOI: 10.1037/a0025759] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Binge eating and substance dependence are disorders characterized by a loss of control over consummatory behaviors. Given the common characteristics of these two types of disorders, it is not surprising that the comorbidity between eating disorders and substance abuse disorders is high (20-40%; Conason et al., 2006). It is unknown, however, whether loss of control in one disorder predisposes an individual to loss of control in the other. The present study, therefore, used a rodent model to test whether a history of binge eating would augment subsequent responding for cocaine. Using the limited access protocol described by Corwin et al. (1998), 45 adult male Sprague-Dawley rats were maintained on one of four dietary protocols for a period of six weeks: chow only (Chow; n = 9), continuous access to an optional source of dietary fat (Ad Lib; n = 12), 1-h access to an optional source of dietary fat daily (Daily; n = 12), or 1-h access to an optional source of dietary fat on Monday, Wednesday, and Friday (MWF; n = 12). All four groups also had unrestricted access to a nutritionally complete diet of chow and water. Fat-bingeing behaviors developed in the MWF rats, the group with the most restricted access to the optional fat. Thereafter, cocaine-seeking and -taking behaviors were assessed in all rats using a self-administration protocol modified from that described by Deroche-Gamonet et al. (2004), which focused on the motivation for and preoccupation with obtaining and consuming drug (assessed using a progressive ratio [PR] schedule of reinforcement) and persistence in responding for drug during periods of signaled drug non-availability (SNA). Rats with the MWF history tended to take more cocaine late in fixed ratio (FR) training, they persisted in their efforts to obtain cocaine in the face of signaled non-availability, worked harder for cocaine on a PR schedule of reinforcement, and exhibited more goal-directed behavior toward the cocaine-associated operandum. These results demonstrate a link between binge-type intake of fat and the development of drug-seeking and -taking behaviors, suggesting that a history of fat bingeing may predispose individuals to exhibit more robust "addiction-like" behaviors toward a substance of abuse. Thus, it appears that conditions promoting excessive behavior toward one substance (e.g., a palatable fatty food) beget excessive behavior toward another (e.g., cocaine).
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Affiliation(s)
- Matthew D. Puhl
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine
| | - Angie M. Cason
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine
| | | | - Rebecca L. Corwin
- Department of Nutritional Sciences, The Pennsylvania State University
| | - Patricia S. Grigson
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine
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15
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Mood-as-input hypothesis and perseverative psychopathologies. Clin Psychol Rev 2011; 31:1259-75. [PMID: 21963671 DOI: 10.1016/j.cpr.2011.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 08/01/2011] [Accepted: 08/24/2011] [Indexed: 12/17/2022]
Abstract
Mood-as-input hypothesis is a theory of task perseveration that has been applied to the understanding of perseveration across psychopathologies such as pathological worrying, compulsive checking, depressive rumination, and chronic pain. We review 10 years of published evidence from laboratory-based analogue studies and describe their relevance for perseveration in clinical populations. In particular, mood-as-input hypothesis predicts that perseveration at a task will be influenced by interactions between the individual's stop rules for the task and their concurrent mood, and that the valency of an individual's concurrent mood is used as information about whether the stop rule-defined goals for the task have been met. The majority of the published research is consistent with this hypothesis, and we provide evidence that clinical populations possess characteristics that would facilitate perseveration through mood-as-input processes. We argue that mood-as-input research on clinical populations is long overdue because (1) it has potential as a transdiagnostic mechanism helping to explain the development of perseveration and its comorbidity across a range of different psychopathologies, (2) it is potentially applicable to any psychopathology where perseveration is a defining feature of the symptoms, and (3) it has treatment implications for dealing with clinical perseveration.
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16
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Ferriter C, Ray LA. Binge eating and binge drinking: an integrative review. Eat Behav 2011; 12:99-107. [PMID: 21385638 DOI: 10.1016/j.eatbeh.2011.01.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 12/11/2010] [Accepted: 01/17/2011] [Indexed: 11/29/2022]
Abstract
The primary goal of this review is to provide a framework for understanding two highly overlapping behaviors: binge eating and binge drinking. Research is presented that suggests binge eating and drinking behaviors may share several important features, including personality correlates such as neuroticism and urgency, as well as affective characteristics, such as elevated levels of negative affect. Additionally, the review describes common explanatory models, which are helpful in terms of their potential to link these common features to the functions of, or reasons why individuals engage in, binge eating and drinking behaviors. Implications for understanding potentially common etiological pathways and development of interventions designed to target multiple behaviors are discussed.
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Affiliation(s)
- Caitlin Ferriter
- Department of Psychology, University of California, Los Angeles, CA 90095-1563, United States.
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17
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Piran N, Robinson SR. Patterns of associations between eating disordered behaviors and substance use in two non-clinical samples: a university and a community based sample. J Health Psychol 2011; 16:1027-37. [PMID: 21444727 DOI: 10.1177/1359105311398681] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined shared patterns of associations between disordered eating behaviors and substance use in two different non-clinical samples of young women. Participants were recruited from a university (526 women) and varied community (517 women) settings. Participants completed the Women's Health Survey, examining engagement in a wide range of licit and illicit substances and disordered eating patterns during the past 12 months. In both samples, the cluster of bingeing, dieting and purging was significantly associated with binge drinking, drinking associated with negative consequences, and with cocaine use. The cluster of dieting and purging was associated with the use of stimulants/amphetamines. Health services, including assessment and treatment, and health promotion activities, should consider these patterns of comorbidity.
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Affiliation(s)
- Niva Piran
- OISE/University of Toronto, 252 Bloor St W, Toronto, Ontario, Canada.
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18
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Feldman MB, Meyer IH. Comorbidity and age of onset of eating disorders in gay men, lesbians, and bisexuals. Psychiatry Res 2010; 180:126-31. [PMID: 20483473 PMCID: PMC3726047 DOI: 10.1016/j.psychres.2009.10.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 10/19/2009] [Accepted: 10/20/2009] [Indexed: 11/19/2022]
Abstract
This study examines the prevalence of psychiatric disorders among lesbian, gay, and bisexual (LGB) men with eating disorders. A total of 388 white, black, and Latino LGB men and women were sampled from community venues. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of anorexia, bulimia, and binge eating disorder were assessed using the World Health Organization's Composite International Diagnostic Interview. Gay and bisexual men with eating disorders were more likely to have an anxiety or substance abuse disorder than gay and bisexual men without eating disorders, whereas lesbian and bisexual women with eating disorders were more likely to have a mood disorder than lesbian and bisexual women without an eating disorder. For individuals diagnosed with an eating and anxiety or major depressive disorder, the onset of the psychiatric disorder was more likely to precede the onset of the eating disorder. Researchers should study potential explanations of the relationship between eating and psychiatric disorders among LGB men and women.
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19
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Wilson GT. Eating disorders, obesity and addiction. EUROPEAN EATING DISORDERS REVIEW 2010; 18:341-51. [PMID: 20821736 DOI: 10.1002/erv.1048] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
An addiction model of both eating disorders and obesity has received increasing attention in the popular and scientific literature. The addiction is viewed as a brain disease that must be directly targeted if treatment is to succeed. Evidence from laboratory feeding studies, epidemiology, genetic and familial research, psychopathological mechanisms, and treatment outcome research on cognitive behaviour therapy (CBT) is inconsistent with the clinical validity or utility of the addiction model of eating disorders. Neurobiological research has shown commonalities in brain reward processes between obesity and substance abuse disorders. Yet emphasis on apparent similarities overlooks important differences between obesity and drug addiction. Interest in obesity as a brain disease should not detract from a public health focus on the 'toxic food environment' that is arguably responsible for the obesity epidemic and related nutrition-based chronic disease.
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Affiliation(s)
- G Terence Wilson
- Graduate School of Applied and Professional Psychology, Rutgers-the State University of New Jersey, USA.
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20
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Buckner JD, Silgado J, Lewinsohn PM. Delineation of differential temporal relations between specific eating and anxiety disorders. J Psychiatr Res 2010; 44:781-7. [PMID: 20185151 PMCID: PMC2895008 DOI: 10.1016/j.jpsychires.2010.01.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 01/18/2010] [Accepted: 01/26/2010] [Indexed: 10/19/2022]
Abstract
This study examined the temporal sequencing of eating and anxiety disorders to delineate which anxiety disorders increase eating disorder risk and whether individuals with eating disorders are at greater risk for particular anxiety disorders. The sample was drawn from the Oregon Adolescent Depression Project. Temporal relations between specific eating and anxiety disorders were examined after controlling for relevant variables (e.g., mood disorders, other anxiety disorders) over 14 years. After excluding those with anorexia nervosa (AN) in adolescence (T1), OCD was the only T1 anxiety disorder to predict AN by age 30 (T4). No T1 anxiety disorder was associated with T4 bulimia nervosa (BN). Although T1 AN did not increase risk of any T4 anxiety disorder, T1 BN appeared to increase risk for social anxiety and panic disorders. Evidence that eating disorders may have differential relations to particular anxiety disorders could inform prevention and treatment efforts.
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Affiliation(s)
- Julia D. Buckner
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA,Corresponding Author: Telephone: 1-225-578-4096, Fax: 1-225-578-4125,
| | - Jose Silgado
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA
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21
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Pinheiro AP, Raney TJ, Thornton LM, Fichter MM, Berrettini WH, Goldman D, Halmi KA, Kaplan AS, Strober M, Treasure J, Woodside DB, Kaye WH, Bulik CM. Sexual functioning in women with eating disorders. Int J Eat Disord 2010; 43:123-9. [PMID: 19260036 PMCID: PMC2820601 DOI: 10.1002/eat.20671] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe sexual functioning in women with eating disorders. METHOD We assessed physical intimacy, libido, sexual anxiety, partner status, and sexual relationships in 242 women from the International Price Foundation Genetic Studies relative to normative data. RESULTS Intercourse (55.3%), having a partner (52.7%), decreased sexual desire (66.9%), and increased sexual anxiety (59.2%) were common. Women with restricting and purging anorexia nervosa had a higher prevalence of loss of libido than women with bulimia nervosa and eating disorder not otherwise specified (75%, 74.6%, 39%, and 45.4%, respectively). Absence of sexual relationships was associated with lower minimum lifetime body mass index (BMI) and earlier age of onset; loss of libido with lower lifetime BMI, higher interoceptive awareness and trait anxiety; and sexual anxiety with lower lifetime BMI, higher harm avoidance and ineffectiveness. Sexual dysfunction in eating disorders was higher than in the normative sample. DISCUSSION Sexual dysfunction is common across eating disorders subtypes. Low BMI is associated with loss of libido, sexual anxiety, and avoidance of sexual relationships.
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Affiliation(s)
| | - TJ Raney
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC
| | - Manfred M. Fichter
- Department of Psychiatry, University of Munich (LMU), Munich, Germany, and Roseneck Hospital for Behavioral Medicine, Prien, Germany
| | - Wade H. Berrettini
- Center of Neurobiology and Behavior, University of Pennsylvania, Philadelphia, PA
| | - David Goldman
- National Institute of Alcohol Abuse and Alcoholism, Rockville, MD
| | - Katherine A. Halmi
- New York Presbyterian Hospital-Westchester Division, Weill Medical College of Cornell University, White Plains, NY
| | - Allan S. Kaplan
- Department of Psychiatry, The Toronto Hospital, Toronto, Canada
| | - Michael Strober
- Semel Institute for Neuroscience, University of California at Los Angeles, Los Angeles, CA
| | | | | | - Walter H. Kaye
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, Department of Psychiatry, University of California at San Diego, San Diego, CA
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC
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22
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Calero-Elvira A, Krug I, Davis K, López C, Fernández-Aranda F, Treasure J. Meta-analysis on drugs in people with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2009; 17:243-59. [DOI: 10.1002/erv.936] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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23
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Harrell ZA, Slane JD, Klump KL. Predictors of alcohol problems in college women: the role of depressive symptoms, disordered eating, and family history of alcoholism. Addict Behav 2009; 34:252-7. [PMID: 19027241 DOI: 10.1016/j.addbeh.2008.10.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 09/15/2008] [Accepted: 10/15/2008] [Indexed: 12/13/2022]
Abstract
Disordered eating and depressive symptoms are established correlates of alcohol use in college women. Family history of alcoholism (FHA) is also related to problematic alcohol use, but there have been limited studies of how it relates to other established cofactors in women. Predictive associations between disordered eating (i.e., overall levels as well as binge eating), depressive symptoms, and alcohol problems were examined in a sample of 295 female twins. The direct and moderating effects of FHA on the relationships between alcohol problems, disordered eating, and depressive symptoms were investigated. Using hierarchical linear modeling depressive symptoms, but not disordered eating or FHA, significantly predicted alcohol problems. However, there was a significant interaction between disordered eating and FHA; disordered eating was associated with alcohol problems in those with a positive FHA. The implications for high-risk subgroups of college women are discussed.
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24
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Klump KL, Bulik CM, Kaye WH, Treasure J, Tyson E. Academy for eating disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord 2009; 42:97-103. [PMID: 18951455 DOI: 10.1002/eat.20589] [Citation(s) in RCA: 267] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan 48824-1116, USA.
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25
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Bulik CM, Von Holle A, Siega-Riz AM, Torgersen L, Lie KK, Hamer RM, Berg CK, Sullivan P, Reichborn-Kjennerud T. Birth outcomes in women with eating disorders in the Norwegian Mother and Child cohort study (MoBa). Int J Eat Disord 2009; 42:9-18. [PMID: 18720472 PMCID: PMC3586575 DOI: 10.1002/eat.20578] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We explored the impact of eating disorders on birth outcomes in the Norwegian Mother and Child Cohort Study. METHOD Of 35,929 pregnant women, 35 reported broad anorexia nervosa (AN), 304 bulimia nervosa (BN), 1,812 binge eating disorder (BED), and 36 EDNOS-purging type (EDNOS-P) in the six months before or during pregnancy. The referent comprised 33,742 women with no eating disorder. RESULTS Pre-pregnancy body mass index (BMI) was lower in AN and higher in BED than the referent. AN, BN, and BED mothers reported greater gestational weight gain, and smoking was elevated in all eating disorder groups. BED mothers had higher birth weight babies, lower risk of small for gestational age, and higher risk of large for gestational age and cesarean section than the referent. Pre-pregnancy BMI and gestational weight gain attenuated the effects. CONCLUSION BED influences birth outcomes either directly or via higher maternal weight and gestational weight gain. The absence of differences in AN and EDNOS-P may reflect small numbers and lesser severity in population samples. Adequate gestational weight gain in AN may mitigate against adverse birth outcomes. Detecting eating disorders in pregnancy could identify modifiable factors (e.g., high gestational weight gain, binge eating, and smoking) that influence birth outcomes.
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Affiliation(s)
- Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina 27599-7160, USA.
| | - Ann Von Holle
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Anna Maria Siega-Riz
- Department of Nutrition, University of North Carolina at Chapel Hill,Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Leila Torgersen
- Division of Mental Health, Norwegian Institute of Public Health
| | - Kari Kveim Lie
- Division of Epidemiology, Norwegian Institute of Public Health
| | - Robert M. Hamer
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | | | - Patrick Sullivan
- Department of Psychiatry, University of North Carolina at Chapel Hill,Department of Genetics, University of North Carolina at Chapel Hill
| | - Ted Reichborn-Kjennerud
- Division of Mental Health, Norwegian Institute of Public Health,Department of Psychiatry, University of Oslo, Norway,Columbia University, Department of Epidemiology, New York, New York
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26
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Herpertz-Dahlmann B. Adolescent eating disorders: definitions, symptomatology, epidemiology and comorbidity. Child Adolesc Psychiatr Clin N Am 2009; 18:31-47. [PMID: 19014856 DOI: 10.1016/j.chc.2008.07.005] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Eating disorders have morbidity and mortality rates that are among the highest of any mental disorders and are associated with significant functional impairment. This article provides an up-to-date review on recent developments and expanding knowledge in adolescent anorexia nervosa, bulimia nervosa, and related disorders. It covers diagnoses and assessment, recognition of typical symptoms, medical and psychiatric comorbidities, and current trends in epidemiology.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany
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27
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28
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Kumpfer KL, Smith P, Summerhays JF. A wakeup call to the prevention field: are prevention programs for substance use effective for girls? Subst Use Misuse 2008; 43:978-1001. [PMID: 18649225 DOI: 10.1080/10826080801914261] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Substance misuse in adolescent girls has increased dramatically since 1992. This article reviews trends in use rates and etiological theories tested by gender that suggest that family protective factors have more influence on girls. Next, a literature review reveals that few prevention programs have published their outcomes by gender or developed gender-specific programs. Nationwide community coalition results found positive effects on boys but increased drug use in young girls. The most effective programs are family focused targeting family bonding, supervision, and communication. Recent gender-specific prevention programs with positive results address stress, depression, social assertiveness, and body image. The authors recommend additional research testing programs by gender and also gender-specific versus generic versions of evidence-based programs to determine how to improve prevention program effectiveness for girls.
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Affiliation(s)
- Karol L Kumpfer
- Department of Health Promotion and Education, University of Utah, Salt Lake City, Utah 84112, USA.
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29
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Perdereau F, Faucher S, Wallier J, Vibert S, Godart N. Family history of anxiety and mood disorders in anorexia nervosa: review of the literature. Eat Weight Disord 2008; 13:1-13. [PMID: 18319632 DOI: 10.1007/bf03327779] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To provide a critical review of the research on mood and anxiety disorders in relatives of individuals with anorexia nervosa (AN). In the first section, we explore methodological issues with these studies. In the second section, we present results. METHOD A Medline search identified studies published on family history of mood and anxiety disorders in AN, and was complemented by a manual search. Only studies from 1980 to 2006 using strict diagnostic criteria for the disorders were included [Feighner and Halmi criteria for AN, Reasearch Diagnostic Criteria (RDC), Diagnostic and Statistical Manual of Mental Disorders - Third Edition - Revised (DSM-III-R) or DSM - Fourth Edition (DSM-IV) for anorexia and other disorders]. RESULTS A review of the research methods used in the studies revealed a number of methodological problems. Therefore, we provide only a description of the prevalence of mood and anxiety disorders in relatives of individuals with AN. CONCLUSIONS In the light of the methodological issues uncovered, the value of the results of these studies and their implications for further study are considered.
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Affiliation(s)
- F Perdereau
- Department of Psychiatry for Adolescents and Young Adults, Université Paris-Descartes, Faculté de Médecine, Site Institut Mutualiste Montsouris (IMM), Paris, France
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30
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Von Holle A, Pinheiro AP, Thornton LM, Klump KL, Berrettini WH, Brandt H, Crawford S, Crow S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, Keel P, La Via M, Mitchell J, Strober M, Woodside DB, Kaye WH, Bulik CM. Temporal patterns of recovery across eating disorder subtypes. Aust N Z J Psychiatry 2008; 42:108-17. [PMID: 18197505 DOI: 10.1080/00048670701787610] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To compare patterns of recovery in individuals with index episodes of anorexia nervosa (AN) and bulimia nervosa (BN). METHOD Using Kaplan-Meier methods and Cox proportional hazards models, comparisons were conducted that were conditional on duration of eating disorder from onset and included a conservative recovery criterion of 3 asymptomatic years. Data collection was retrospective and from two of the international Price Foundation genetic studies on 901 individuals with eating disorders. RESULTS Using Kaplan-Meier methods, 11% of those with index AN and 10% of those with index BN met recovery criteria at 10 years. At 15 years, 16% of those with index AN and 25% of those with index BN met recovery criteria. In a Cox proportional hazards model the index BN group had three times the rate of recovery at 10-14 years (p=0.01) than the index AN group. CONCLUSIONS Initially the probability of recovery was greater for those with index AN, but as the duration of the eating disorder lengthened those with BN had higher probabilities of recovery. Replication of these results with prospective data using similarly stringent recovery criteria and methods is required to confirm trends.
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Affiliation(s)
- Ann Von Holle
- Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina 27599-7160, USA
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31
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Jordan J, Joyce PR, Carter FA, Horn J, McIntosh VVW, Luty SE, McKenzie JM, Frampton CMA, Mulder RT, Bulik CM. Specific and nonspecific comorbidity in anorexia nervosa. Int J Eat Disord 2008; 41:47-56. [PMID: 17868127 DOI: 10.1002/eat.20463] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This article reports lifetime Axis I and II comorbidity in women with anorexia nervosa (AN), and ascertains specific and nonspecific comorbidity in AN compared to clinical samples of women with bulimia nervosa (BN) or major depression (DEP). METHOD Outpatient AN (n = 56), BN (n = 132), and DEP (n = 100) samples were assessed using Structured Clinical Interviews I and II for DSM-III-R. Baseline data were compared using univariate statistics and logistic regression. RESULTS In the AN sample as a whole, specific elevations were found for prevalences of obsessive compulsive disorder. The AN-binge eating purging subtype (AN-BP) and the BN sample had elevated prevalences of Cluster B personality disorders. Cluster C prevalences were elevated across samples. CONCLUSION Evidence of AN-specific, eating disorder-specific, and nonspecific comorbidity illustrates the heterogeneity in AN. Further research is need to examine the relative impact of specific and nonspecific comorbidity in AN subtypes and AN as a whole.
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Affiliation(s)
- Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand.
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32
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Fletcher BC, Kupshik GA, Uprichard S, Shah S, Nash AS. Eating disorders and concurrent psychopathology: a reconceptualisation of clinical need through Rasch analysis. EUROPEAN EATING DISORDERS REVIEW 2008; 16:191-8. [PMID: 17910033 DOI: 10.1002/erv.833] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Therapies for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS) take as their focus, perhaps of necessity, the eating disorder symptomatology. However, there is increasing evidence of comorbidity of psychopathological mechanisms (e.g. perfectionism, depression) with eating disorders which, left untreated, may diminish any therapeutic effects. Thus identifying the extent of comorbidity in an eating disorder population and assessing the relationship between psychopathological mechanisms and the eating disorder is important. Rasch analysis was applied to the findings from questionnaires (EDI-2; SCL90-R) completed by 105 female patients referred to an eating disorder unit. General psychopathology was found to be more indicative of 'caseness' than eating disorder psychopathology. In particular, interpersonal sensitivity, depression and mild interpersonal aspects of psychoticism emerged as important factors across eating disorders. The comorbidity of psychopathological mechanisms needs to be given consideration in the successful treatment of eating disorders.
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33
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Perdereau F, Faucher S, Jeammet P, Godart NT. [Mood and anxiety disorders in relatives of anorexia nervosa patients: a review]. Encephale 2007; 33:144-55. [PMID: 17675909 DOI: 10.1016/s0013-7006(07)91544-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED In the literature, no review concerning the family comorbidity of mood and anxiety disorders of anorexic subjects exists. However, this data can be important for the comprehension of this disorder and for the assumption of responsibility. OBJECTIVE We conducted a critical literature review on studies assessing the prevalence of anxiety disorders (AD) and mood disorders in relatives of anorexia nervosa (AN) subjects. In the first part, we discuss methodological issues relevant to these comorbidity studies. In the second part, taking into account the methodological considerations raised, we summarise the findings of these studies. METHOD We performed a manual and computerised search (Medline) for all published studies on the frequency of MD and AD in AN relatives and MD or AD, limiting our search to the 1980-2002 period, in order to get sufficiently homogeneous diagnostic criteria for both categories of disorders (most often RDC, DSM III, DSM III-R, or DSM IV criteria). RESULTS We review methodological issues regarding population sources, general methodological procedures, diagnostic criteria for AN, MD and AD, diagnostic instruments, age of subjects and course of the eating disorder. DISCUSSION We discuss the results taking into account the methodological problems observed. We give implications for reviewing the results of published studies and planning future research.
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Affiliation(s)
- F Perdereau
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France
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Abstract
The objective of this study was to examine the co-morbidity between eating disorders and substance use in a large nationally representative sample of Canadian women and men while including varied measures of substance consumption and a wide range of substance classes. The research was based on secondary analyses of data collected, using multistage stratified probability sampling, by Statistics Canada in the Mental Health and Well-being cycle 1.2 of the Canadian Community Health Survey (CCHS). Data were collected mostly in face to face interviews using the Computer Assisted Personal Interviewing method. Data included the Eating Attitude Test (EAT-26), and modules of the short form of the Composite International Diagnostic Interview (CIDI-SF) to assess alcohol and drug use, dependence and interference. Alcohol interference and amphetamine use were associated with the risk for an eating disorder in both women and men. In the women sample only, risk for an eating disorder was associated with illicit drug use, dependence and interference, as well as with the number of substance classes used. The study findings support the importance of developing assessment instruments and treatment strategies that address the co-occurrence of eating disorders and substance use for both women and men.
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Affiliation(s)
- Tahany Gadalla
- Faculty of Social Work, University of Toronto, 246 Bloor Street W., Toronto, Ontario, Canada.
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Luce KH, Engler PA, Crowther JH. Eating disorders and alcohol use: group differences in consumption rates and drinking motives. Eat Behav 2007; 8:177-84. [PMID: 17336788 DOI: 10.1016/j.eatbeh.2006.04.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 04/24/2006] [Indexed: 11/28/2022]
Abstract
Alcohol use and drinking motives were investigated among college women divided into four probable eating disorder groups: Bulimia Nervosa, purging subtype (BN n=16) Binge Eating Disorder (BED n=30) Eating Disorder, Not Otherwise Specified (EDNOS n=85) and Non-Eating Disordered Controls (NEDC n=252). Participants completed questionnaires that assessed eating behaviors and attitudes, motives for drinking alcohol, quantity and frequency of alcohol use, and binge drinking. The BED group reported greater weekend alcohol consumption and binge drinking than the EDNOS and NEDC groups. The BN and BED groups were significantly more likely to endorse Coping as a drinking motive than the EDNOS and NEDC groups. The NEDC group was more likely to endorse Mood Enhancement than the EDNOS group. These results offer one explanation for the relationship between eating and alcohol use disorders. Women with eating disorders may use alcohol to cope with negative affect, analogous to findings that women with eating disorders report binge eating to regulate negative affect [Mizes, J. S. (1985). Bulimia: A review of its symptomatology and treatment. Advances in Behavior Research and Therapy, 7, 91-142].
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Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007; 61:348-58. [PMID: 16815322 PMCID: PMC1892232 DOI: 10.1016/j.biopsych.2006.03.040] [Citation(s) in RCA: 2887] [Impact Index Per Article: 169.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Revised: 02/10/2006] [Accepted: 03/29/2006] [Indexed: 01/27/2023]
Abstract
BACKGROUND Little population-based data exist on the prevalence or correlates of eating disorders. METHODS Prevalence and correlates of eating disorders from the National Comorbidity Replication, a nationally representative face-to-face household survey (n = 9282), conducted in 2001-2003, were assessed using the WHO Composite International Diagnostic Interview. RESULTS Lifetime prevalence estimates of DSM-IV anorexia nervosa, bulimia nervosa, and binge eating disorder are .9%, 1.5%, and 3.5% among women, and .3% .5%, and 2.0% among men. Survival analysis based on retrospective age-of-onset reports suggests that risk of bulimia nervosa and binge eating disorder increased with successive birth cohorts. All 3 disorders are significantly comorbid with many other DSM-IV disorders. Lifetime anorexia nervosa is significantly associated with low current weight (body-mass index <18.5), whereas lifetime binge eating disorder is associated with current severe obesity (body-mass index > or =40). Although most respondents with 12-month bulimia nervosa and binge eating disorder report some role impairment (data unavailable for anorexia nervosa since no respondents met criteria for 12-month prevalence), only a minority of cases ever sought treatment. CONCLUSIONS Eating disorders, although relatively uncommon, represent a public health concern because they are frequently associated with other psychopathology and role impairment, and are frequently under-treated.
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Affiliation(s)
- James I Hudson
- Department of Psychiatry, Harvard Medical School and Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts 02478, USA.
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Faravelli C, Ravaldi C, Truglia E, Zucchi T, Cosci F, Ricca V. Clinical epidemiology of eating disorders: results from the Sesto Fiorentino study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2007; 75:376-83. [PMID: 17053339 DOI: 10.1159/000095444] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is speculated that clinical samples do not fully reflect the characteristics of eating disorders (EDs) as they are in the general population, especially in their lowest range of severity. The present article reports the prevalence of EDs in a community sample aged >14 years, their clinical and psychopathological features, and their course and outcome on naturalistic grounds. METHODS The Sesto Fiorentino Study is a three-phase community-based survey where 2,355 out of 2,500 people representative of the population aged >14 years living in Sesto Fiorentino were evaluated by their own general practitioner using the Mini International Neuropsychiatric Interview plus six additional questions. All those who had positive results plus a probability sample of the non-cases were re-interviewed by psychiatrists using the Florence Psychiatric Interview. The subjects who reported ED symptoms were subsequently administered the Eating Disorder Examination (12th edition). RESULTS Overall, the lifetime prevalence of EDs was 1.21%. More precisely, 0.42% had anorexia nervosa, 0.32% bulimia nervosa, 0.32% binge eating disorder and 0.32% eating disorder not otherwise specified. All the subjects suffering from an ED fulfilled diagnostic criteria for at least another DSM-IV axis I psychiatric disorder. At the moment of the interview, conducted a few years (average 7 years) after the onset of the disorder, 50% had fully recovered from EDs, 26.9% were currently affected by an ED, 23.1% showed a persistent body image disturbance and/or the presence of compensatory behaviours. CONCLUSIONS Community surveys conducted by clinicians may provide useful additional information on the psychopathological features, natural course and outcome of these disorders on naturalistic grounds.
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Affiliation(s)
- C Faravelli
- Psychiatric Unit, Department of Neurological and Psychiatric Sciences, Florence University School of Medicine, Florence, Italy.
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Fernandez-Aranda F, Pinheiro AP, Tozzi F, Thornton LM, Fichter MM, Halmi KA, Kaplan AS, Klump KL, Strober M, Woodside DB, Crow S, Mitchell J, Rotondo A, Keel P, Plotnicov KH, Berrettini WH, Kaye WH, Crawford SF, Johnson C, Brandt H, La Via M, Bulik CM. Symptom profile of major depressive disorder in women with eating disorders. Aust N Z J Psychiatry 2007; 41:24-31. [PMID: 17464678 DOI: 10.1080/00048670601057718] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Based on the well-documented association between eating disorders (EDs) and affective disorders, the patterns of comorbidity of EDs and major depressive disorder (MDD) were investigated. The temporal relation between EDs and MDD onset was analyzed to determine differences in the course and nature of MDD when experienced prior to versus after the onset of the ED. METHOD Lifetime MDD and depressive symptoms were assessed in 1371 women with a history of ED. The prevalence of MDD was first explored across ED subtypes, and ages of onset of MDD and EDs were compared. Depressive symptoms were examined in individuals who developed MDD before and after ED onset. RESULTS The lifetime prevalence of MDD was 72.9%. Among those with lifetime MDD (n =963), 34.5% reported MDD onset before the onset of ED. Those who experienced MDD first reported greater psychomotor agitation (OR =1.53; 95%CI =1.14-2.06), and thoughts of own death (but not suicide attempts or ideation; OR =1.73; 95%CI =1.31-2.30). Among individuals who had MDD before ED, 26.5% had the MDD onset during the year before the onset of ED; 67% of individuals had the onset of both disorders within the same 3 year window. CONCLUSION Clinicians treating individuals with new-onset ED or MDD should remain vigilant for the emergence of additional psychopathology, especially during the initial 3 year window following the onset of the first disorder.
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Godart NT, Perdereau F, Rein Z, Berthoz S, Wallier J, Jeammet P, Flament MF. Comorbidity studies of eating disorders and mood disorders. Critical review of the literature. J Affect Disord 2007; 97:37-49. [PMID: 16926052 DOI: 10.1016/j.jad.2006.06.023] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 06/27/2006] [Accepted: 06/27/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We conducted a critical literature review of studies assessing the prevalence of mood disorders (MD) in subjects with eating disorders (ED; anorexia nervosa and bulimia nervosa). In the first part of this article, we discuss methodological issues relevant to comorbidity studies between ED and MD. In the second part, we summarize the findings of these studies in light of the methodological considerations raised. METHOD A manual computerised search (Medline) was performed for all published studies on comorbidity between ED and MD. In order to have sufficiently homogeneous diagnostic criteria for both categories of disorders, this search was limited to articles published between 1985 and 2006. RESULTS Too few studies include control groups, few studies compared diagnostic subgroups of ED subjects, and results are scarce or conflicting. DISCUSSION The results are discussed in the light of the methodological problems observed. The implications when reviewing the results of published studies and planning future research are set out.
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Affiliation(s)
- N T Godart
- Department of Psychiatry, Institut Mutualiste Montsouris (IMM), University, René Descartes-Paris V, France.
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Abstract
AIMS This study aimed to examine the comorbidity between eating disorders and substance use in a large nationally representative sample of Canadian adult women. Recent as well as life-time measures of substance use were used. DESIGN The research was based on secondary analyses of data collected, using multi-stage stratified probability sampling, by Statistics Canada in the Mental Health and Well-being cycle 1.2 of the Canadian Community Health Survey (CCHS). MEASUREMENTS The Eating Attitude Test (EAT-26) was used to measure risk of eating disorders. Alcohol use, dependence and interference, and illicit drug use, dependence and interference were measured using relevant modules from the short form of the Composite International Diagnostic Interview (CIDI-SF). PARTICIPANTS Data on a nationally representative sample of Canadian adult women, grouped into three age groups, were used for this research. FINDINGS Alcohol dependence and alcohol interference were associated significantly with the risk for an eating disorder in the three adult age groups. Significant associations were also found in the three age groups between risk for an eating disorder and the life-time abuse of and dependence on illicit drugs. Significant associations were found in the 15-24 and 25-44-year age groups when the 12-month time-frame was used. CONCLUSIONS The study findings support the call for the development of short screening instruments for adult women with eating disorders and substance abuse, as well as for the development of treatment strategies that address the co-occurrence of eating disorders and substance use
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Affiliation(s)
- Niva Piran
- Ontario Institute for Studies in Education at the University of Toronto, Canada.
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Swinbourne JM, Touyz SW. The co-morbidity of eating disorders and anxiety disorders: a review. EUROPEAN EATING DISORDERS REVIEW 2007; 15:253-74. [PMID: 17676696 DOI: 10.1002/erv.784] [Citation(s) in RCA: 246] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To critically review the literature examining the co-morbidity between eating disorders and anxiety disorders. METHOD A review of the literature on the co-morbidity between anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified and the anxiety disorders of OCD, PTSD, social anxiety, GAD, panic and agoraphobia. RESULTS Of the empirical studies undertaken, it is clear that anxiety disorders are significantly more frequent in subjects with eating disorders than the general community. Researchers have shown that often anxiety disorders pre-date eating disorders, leading to a suggestion that early onset anxiety may predispose individuals to developing an eating disorder. To date however, the research presents strikingly inconsistent findings, thus complicating our understanding of eating disorder and anxiety co-morbidity. Furthermore, despite indications that eating disorder prevalence amongst individuals presenting for anxiety treatment may be high, there is a distinct lack of research in this area. DISCUSSION This review critically examines the available research to date on the co-morbidity of eating disorders and anxiety disorders. Some of the methodological limitations of previous research are presented, in order to highlight the issues which warrant further scientific investigation in this area.
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Abstract
OBJECTIVES To review the scientific evidence examining the comorbidity among eating disorders and bipolar disorder (BD). METHODS We reviewed all published English-language studies addressing the comorbidity of anorexia nervosa, bulimia, bulimia nervosa, and binge eating disorder in patients with BD and studies of comorbidity of BD in patients with eating disorders. In addition, we discuss the pharmacologic treatment implications from reviewed studies of agents used in BD and eating disorders. RESULTS Community and clinical population studies of the lifetime prevalence rates of eating disorders in patients with BD, and of BD in patients with eating disorders, particularly when subthreshold and spectrum manifestations of these disorders are included, indicate high rates of comorbidity among these illnesses. CONCLUSIONS Pharmacologic treatment approaches to patients with BD and a co-occurring eating disorder require examination of the possible adverse effects of the treatment of each syndrome on the other and attempts to manage both syndromes with agents that might be beneficial to both.
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Affiliation(s)
- Susan L McElroy
- Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
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Piran N, Robinson SR. Associations between disordered eating behaviors and licit and illicit substance use and abuse in a university sample. Addict Behav 2006; 31:1761-75. [PMID: 16448780 DOI: 10.1016/j.addbeh.2005.12.021] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Revised: 11/04/2005] [Accepted: 12/19/2005] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine associations between discrete eating disordered behaviors as well as clusters of eating disordered behaviors in relation to the use and abuse of a wide spectrum of substance classes, both licit and illicit, in a female university sample. METHODS Women with particular types of eating disordered behaviors were selected from a pool of 526 students who completed the Women's Health Survey. Analyses compared the frequencies of lifetime engagement in a wide range of licit and illicit substances between each of the eating disorder groups and the normal control group. RESULTS Associations were found between severe levels of alcohol consumption and binge eating, dieting with purging and the use of central nervous stimulants, and bingeing with dieting and tobacco use and the abuse of prescription medications. CONCLUSION Examining a broad range of substance classes, with differing physiological properties and effects, in relation to specific disordered eating behaviors, could contribute to theory development regarding the functions of the specific co-occurring behaviors.
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Affiliation(s)
- Niva Piran
- AECP (7-225), Ontario Institute for Studies in Education at the University of Toronto, 252 Bloor St. W, Toronto, Ont., Canada, M5S 1V6.
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Abstract
OBJECTIVE Drug abuse in women with eating disorders has received relatively little attention. The frequency of drug use disorder (DUD) by specific drug type was examined in the current longitudinal study. METHOD In a prospective study, women diagnosed with either anorexia nervosa (AN; n = 136) or bulimia nervosa (BN; n = 110), were interviewed and assessed for research diagnostic criteria (RDC) DUD every 6-12 months over 8.6 years. RESULTS Forty-two (17%) women in the current longitudinal study had a lifetime history of DUD, with 19 prospective onsets over the course of the study (9 AN and 10 BN). The most commonly abused illicit drugs were amphetamines, cocaine, and marijuana, and rates of DUD did not differ between intake diagnoses of AN and BN. CONCLUSION Drug abuse in women with eating disorders is an area of clinical concern and should be monitored routinely throughout the treatment process.
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Affiliation(s)
- David B Herzog
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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Godart NT, Perdereau F, Jeammet P, Flament MF. [Comorbidity between eating disorders and mood disorders: review]. Encephale 2006; 31:575-87. [PMID: 16598962 DOI: 10.1016/s0013-7006(05)82417-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Comorbidity between eating disorders (ED) and mood disorders is a major issue when evaluating and treating patients with anorexia nervosa (AN) or bulimia nervosa (BN). In the literature, estimated comorbidity rates of mood disorders in subjects with ED differ widely across studies. Obviously, it is difficult to compare results from various sources because of differences in methods of assessment of depressive symptoms and in diagnostic criteria for both ED and mood disorders. Furthermore, few studies have included control groups, and, since mood disorders are among the most frequent psychiatric disorders in women--with an average estimated lifetime prevalence of 23.9 % (Kessleret al., 1994)--, it is not clear, yet, whether mood disorders are more common among women with an ED (AN or BN) than among women from the community. The only review articles we found on the relationships between ED and mood disorders survey different types of arguments in favour of a link between both categories of disorders, including symptoms, personal and family comorbidity, overlap in biological findings, and treatment results, but do not review in detail available comorbidity data. The aim of this paper is to conduct a critical literature review on studies assessing the prevalence of mood disorders in subjects with an ED (AN or BN). In the first part, we will discuss methodological issues relevant to comorbidity studies between ED and mood disorders, and select the most reliable studies. In the second part, taking into account these methodological considerations raised, we summarize the findings of these studies. METHOD We performed a manual and computerized search (Medline) for all published studies on comorbidity between ED and AD, limiting our search to the 1985-2002 period, in order to get sufficiently homogeneous diagnostic criteria for both categories of disorders. RESULTS Too few studies include control groups and few studies have compared diagnostic subgroups of ED subjects, with scarce or conflicting results. DISCUSSION We reviewed numerous studies here and conclude simply that there are many arguments in favor of elevated rates of MD in ED subjects, but there is no convincing evidence yet. Many questions are left unanswered or have conflicting responses. Our review highlights the need for further studies, which should address several requisites: comorbidity studies should be designed with this as a specific goal, rather than as a secondary aim within other types of studies (such as treatment studies, follow-up studies, etc.). Kendler et al. (1991) state that individuals with two disorders are more likely to present for treatment than individuals with one, therefore, comorbidity rates (which are not in agreement with a special etiologic relationship between BN and depression) may be exaggerated in clinical population results. New studies should include control subjects, matched (at least) for sex and age with ED subjects. Studies should evaluate prevalence of all types of MD in order to yield comparable estimates of MD in general. Comorbidity studies should be conducted on both current and recovered patients, compared to subjects from the community. It is still necessary to demonstrate specificity of findings, i.e. that early onset MD are of specific etiological importance to ED and do not simply increase the risk of later psychopathology in general. Studies should be conducted on larger samples, and all diagnostic subgroups should be considered (restrictive and bulimic anorexics, bulimics with and without history of AN, with or without purging). Multivariate comparisons should be performed, taking into account subject age, sex (if men are included), in- and outpatient status, course of illness, and other possibly relevant variables. Thus, more reliable estimates of the frequency of MD in subjects with ED could provide us with valuable etiologic, therapeutic and prognostic information.
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Affiliation(s)
- N T Godart
- Département de Psychiatrie, Institut Mutualiste Montsouris, Paris, France
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Abstract
OBJECTIVE We analyze 27 point-prevalent DSM-IV Axis I comorbidities for eating disorder inpatients. METHODS The sample included 2436 female inpatients treated between January 1, 1995, and December 31, 2000, for primary DSM-IV diagnoses of anorexia, bulimia, and eating disorder not otherwise specified. Analyses were multivariate analysis of variance and multinomial logistic regression; sociodemographics and severity-of-illness measures were controlled. RESULTS Ninety-seven percent of patients evidenced > or = 1 comorbid diagnoses; 94% evidenced comorbid mood disorders, largely unipolar depression, with no differences across eating disorders; 56% evidenced anxiety disorders, with no differences across eating disorders; and 22% evidenced substance use disorders, with significant differences across eating disorders (p < .0001). Five specific diagnoses differed across eating disorders. Alcohol abuse/dependence was twice as likely with bulimia (p < .0001); polysubstance abuse/dependence three times as likely with bulimia (p < .0001); obsessive-compulsive disorder twice as likely with restricting and binge/purge anorexia (p < .01); posttraumatic stress disorder twice as likely with binge-purge anorexia (p < .05); schizophrenia/other psychoses three times more likely with restricting anorexia (p < .05) and two times with binge-purge anorexia (p < .05). CONCLUSIONS New findings emerged: extremely high comorbidity regardless of eating disorder, ubiquitous depression across all eating disorders, no difference in overall rate of anxiety disorders across eating disorders, greater posttraumatic stress disorder in binge-purge anorexia, more psychotic diagnoses in anorexia. Certain previous findings were confirmed: more obsessive-compulsive disorder in anorexia; more substance use in bulimia; and a replicated comorbidity rank-ordering for eating disorder patients: mood, anxiety, and substance use disorders, respectively.
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Affiliation(s)
- Barton J Blinder
- Department of Psychiatry and Human Behavior, University of California, Irvine, 400 Newport Center Drive, Newport Beach, California 92660, USA.
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Mazzeo SE, Slof-Op't Landt MCT, Jones I, Mitchell K, Kendler KS, Neale MC, Aggen SH, Bulik CM. Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women. Int J Eat Disord 2006; 39:202-11. [PMID: 16498586 DOI: 10.1002/eat.20243] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The current study investigated associations among eating disorders, depressive symptoms during pregnancy and postpartum, and perfectionism in a population-based sample of women. METHOD Females who reported > or = 1 pregnancy (N = 1,119) completed questionnaires assessing perfectionism, eating disorder symptomatology, and depression during pregnancy and postpartum. Information regarding participants' history of major depressive disorder (MDD) was also available from structured psychiatric interviews completed during a previous wave of data collection. RESULTS Depressive symptoms during pregnancy and postpartum were high among women with a history of eating disorders. Both binge eating disorder (BED) and bulimia nervosa (BN) were positively associated with symptoms of postpartum depression (PPD), even when lifetime MDD was controlled. However, logistic regression indicated that women with a history of BN and BED are at particular risk of developing PPD symptomatology. Linear regression analyses conducted with the subset of the sample who endorsed a PPD screening item suggested that the severity of PPD symptomatology may be attributable to Concern Over Mistakes, a specific aspect of perfectionism. CONCLUSION These results highlight the importance of assessing specific features of perfectionism. In addition, they suggest that women with BN, BED, or high Concern over Mistakes may be at particular risk of developing PPD symptoms, and could benefit from prenatal screening.
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Affiliation(s)
- Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia 23284-2018, USA.
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Corwin RL. Bingeing rats: a model of intermittent excessive behavior? Appetite 2006; 46:11-5. [PMID: 16188345 PMCID: PMC1769467 DOI: 10.1016/j.appet.2004.09.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Revised: 09/08/2004] [Accepted: 09/27/2004] [Indexed: 01/27/2023]
Abstract
Intermittent excessive behaviors (IEB) characterize a variety human disorders including binge eating, drug abuse, alcoholism, aberrant sexual conduct, and compulsive gambling. Clinical co-morbidity exists among IEB, and limited treatment options are available. The use of behavioral models of bingeing and other feeding protocols is beginning to clarify neural similarities and differences that exist between IEB directed toward obtaining and consuming food and IEB directed toward obtaining and consuming drugs of abuse. Research from this laboratory using a limited access binge-type eating protocol may provide new insight into IEB.
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Affiliation(s)
- Rebecca L Corwin
- Department of Nutritional Sciences, The Pennsylvania State University, 126 S. Henderson, University Park, PA 16802, USA.
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Buda-Levin A, Wojnicki FH, Corwin RL. Baclofen reduces fat intake under binge-type conditions. Physiol Behav 2005; 86:176-84. [PMID: 16140347 PMCID: PMC1769468 DOI: 10.1016/j.physbeh.2005.07.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Accepted: 07/06/2005] [Indexed: 12/22/2022]
Abstract
The GABA-B agonist baclofen reduces drug self-administration in rats and has shown promise clinically in the treatment of substance abuse. Baclofen generally does not reduce food intake in non-binge feeding protocols. In this study, baclofen was tested in a fat-binge protocol. Thirty male rats were divided into three groups (B: binge; FM: fat-matched; C: chow). B received a bowl of vegetable shortening for 2 h on Monday, Wednesday, and Friday (MWF) and continuous access to powdered chow (regular chow) in all phases. FM had continuous access to a regular chow+shortening mixture (FM chow) that provided the same proportion of shortening and regular chow that the B rats consumed in all phases. In addition, FM had the following: phase 1: no separate bowl of shortening; phase 2: 2-h MWF access to a separate bowl of shortening; phase 3, daily 2-h access to a separate bowl of shortening; C rats had continuous access to the regular chow in all phases. In addition, C had the following: phase 1: no separate bowl of shortening; phase 2: 2-h MWF access to a separate bowl of shortening; in phase 3, daily 2-h access to a separate bowl of shortening. Baclofen (1.0, 1.8 mg/kg, i.p.) reduced shortening intake regardless of access condition. Baclofen had no effect on, or stimulated, FM and regular chow intake. These results demonstrate that baclofen can reduce fat intake in rats under binge-type conditions. Furthermore, these results indicate that bingeing, as modeled in our protocol, is different from other forms of food intake and may share similarities with substance abuse.
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Affiliation(s)
| | | | - Rebecca L. Corwin
- * Corresponding author. Tel.: +1 814 865 6519; fax: +1 814 863 6103. E-mail address: (R.L. Corwin)
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Silberg JL, Bulik CM. The developmental association between eating disorders symptoms and symptoms of depression and anxiety in juvenile twin girls. J Child Psychol Psychiatry 2005; 46:1317-26. [PMID: 16313432 DOI: 10.1111/j.1469-7610.2005.01427.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We investigated the role of genetic and environmental factors in the developmental association among symptoms of eating disorders, depression, and anxiety syndromes in 8-13-year-old and 14-17-year-old twin girls. METHODS Multivariate genetic models were fitted to child-reported longitudinal symptom data gathered from clinical interview on 408 MZ and 198 DZ female twin pairs from the Virginia Twin Study of Adolescent Behavioural Development (VTSABD). RESULTS Model-fitting revealed distinct etiological patterns underlying the association among symptoms of eating disorders, depression, overanxious disorder (OAD), and separation anxiety disorder (SAD) during the course of development: 1) a common genetic factor influencing liability to all symptoms - of early and later OAD, depression, SAD, and eating symptoms; 2) a distinct genetic factor specifically indexing liability to early eating disorders symptoms; 3) a shared environmental factor specifically influencing early depression and early eating disorders symptoms; and 4) a common environmental factor affecting liability to symptoms of later eating disorders and both early and later separation anxiety. CONCLUSIONS These results suggest a pervasive genetic effect that influences liability to symptoms of over-anxiety, separation anxiety, depression, and eating disorder throughout development, a shared environmental influence on later adolescent eating problems and persistent separation anxiety, genetic influences specific to early eating disorders symptoms, and a shared environmental factor influencing symptoms of early eating and depression.
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MESH Headings
- Adolescent
- Anorexia Nervosa/diagnosis
- Anorexia Nervosa/genetics
- Anorexia Nervosa/psychology
- Anxiety Disorders/diagnosis
- Anxiety Disorders/genetics
- Anxiety Disorders/psychology
- Anxiety, Separation/diagnosis
- Anxiety, Separation/genetics
- Anxiety, Separation/psychology
- Bulimia/diagnosis
- Bulimia/genetics
- Bulimia/psychology
- Child
- Depressive Disorder, Major/diagnosis
- Depressive Disorder, Major/genetics
- Depressive Disorder, Major/psychology
- Diseases in Twins/genetics
- Diseases in Twins/psychology
- Female
- Humans
- Male
- Models, Genetic
- Personality Assessment
- Phenotype
- Risk Factors
- Social Environment
- Statistics as Topic
- Twins, Dizygotic/genetics
- Twins, Dizygotic/psychology
- Twins, Monozygotic/genetics
- Twins, Monozygotic/psychology
- Virginia
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Affiliation(s)
- Judy L Silberg
- Department of Human Genetics and Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA
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