Prevalence of eating disorders and minor psychiatric morbidity in central Europe before the political changes in 1989: a cross-cultural study

Eating disorder characteristics among Hungarian medical students: Changes between 1989 and 2011

BACKGROUND AND AIMS

There are contradictory findings on time changes in the prevalence of eating disorders (EDs). The first epidemiological studies in Hungary were carried out in the late 1980s. The objective of the present study was to follow the changes in the prevalence of EDs in medical students after a period of 22 years.

METHODS

A questionnaire survey was conducted in 1989 and in 2010. The sample comprised medical students: 538 subjects (248 males and 290 females) in 1989 and 969 subjects (261 males and 708 females) in 2010. The questionnaire contained sociodemographic and anthropometric items, the Eating Behaviour Severity Scale, the General Health Questionnaire, the Anorexia Nervosa Inventory for Self-Rating, and the Eating Disorder Inventory (EDI). In the second wave, three subscales of the EDI-2 and the SCOFF questionnaire were added.

RESULTS

Current and desired body mass index were significantly higher in the second study. Binge eating at least once a week was reported less frequently (2.7% vs 6.8% in males, 6.1% vs 13% in females) in 2010. The proportion of subclinical anorexia nervosa was higher among females in 2011 (2.5% vs 0.3%, P < 0.01). Among males, the proportion of counterregulatory behaviours increased significantly (from 8.9 to 14.6%).

DISCUSSION AND CONCLUSIONS

The increase of the proportion of subclinical anorexia nervosa and that of male EDs may relate to the importance of the changes in the sociocultural background. Further representative studies are proposed in other countries of Central and Eastern Europe among medical students and in the general population.

Eating pathology in medical students in Eastern Germany: comparison with general population and a sample at the time of the German reunification

PURPOSE

Medical students have been found to be vulnerable to mental health problems due to the high pressures of medical school. Countries developing into industrial nations tend to adopt Western beauty ideals which might increase eating disorder risk.

METHODS

This cross-sectional study compared eating (Eating Disorder Inventory 2 EDI-2) and general psychopathology (General Health Questionnaire-28) in medical students from the newly formed German states with a historical sample of East German medical students examined at the time of the German reunification. Current medical students were also compared to population-based samples assessed before the German Reunification as well as recently to consider time trends in EDI scores.

RESULTS

The current sample comprised 316 medical students (232 female) from the newly formed German states (mean age = 21.7 years, SD = 2.6). Significantly higher levels of drive for thinness as well as body dissatisfaction and higher levels of general psychopathology were displayed in female medical students 20 years after the German reunification. In male medical students, no significant changes of eating pathology were observable. However, male medical students expressed significantly more anxiety and insomnia and a higher GHQ-28 total score than their counterparts examined in 1989.

CONCLUSIONS

Twenty years after the Reunification, an acculturation to Western beauty ideals seems to be more pronounced in female than in male medical students. Still, as a group, medical students from the newly formed German states did not appear to display a particular risk to develop eating disorders. However, due to the low response rate, results of this study should be interpreted cautiously.

Psychosocial wellbeing in the Central and Eastern European transition: an overview and systematic bibliographic review

This paper presents the results of a systematic review of literature on the psychosocial wellbeing of populations in Central and Eastern Europe during the transition period subsequent to the fall of the SovietBloc. A revision of research addressing emotional wellbeing trends in this period and theoretical models was carried in order to verify their validity in the analysis of empirical studies. Hence, a systematic bibliographic review was conducted, aiming to find possible subjective mediators between social variables derived from change sand emotional wellbeing. The results of the review show that subjective mediators such as locus of control,perceived control, self-efficacy beliefs, perceived familial support, and the subjective evaluation of social change explain part of the relationship between macrosocial changes and emotional wellbeing. Results appear coherent with proposed multidimensional models of social change and mental health, although further research should be conducted to determine the specific weight of these phenomena in individual emotional wellbeing.

Muscle dysmorphia in Hungarian non-competitive male bodybuilders

BACKGROUND

Muscle dysmorphia (MD) has been described as a male body image disorder, characterized by a pathological preoccupation with muscle size.

OBJECTIVE

The aim of the study was to examine the MD features, eating disorder characteristics and body attitudes in non-competitive male bodybuilders in a Hungarian sample.

METHOD

Sixty male bodybuilders and 60 undergraduate university students completed the self-report questionnaires of the Muscle Appearance Satisfaction Scale, the Body Attitude Test and the Eating Disorders Inventory.

RESULTS

MD was associated with current bodybuilding activity, higher ideal body weight and eating disorder characteristics. Moreover, current selfreported steroid users displayed higher tendency for MD symptoms than self-reported steroid non-users.

DISCUSSION

Results emphasize the relationship between MD symptoms, eating disorder characteristics and steroid use. MD and body image related concerns among men could be a wide-spread phenomena also in the Central-Eastern European region.

Psychometric properties and construct validity of the Muscle Appearance Satisfaction Scale among Hungarian men

Limited studies have evaluated the psychometric properties of the Muscle Appearance Satisfaction Scale (MASS), a measure of muscle dysmorphia, in different cultures and languages. The aims were to examine the psychometric properties of the Hungarian version of the MASS (MASS-HU), and to investigate its relationship with self-esteem and exercise-related variables. Two independent samples of male weight lifters (ns=289 and 43), and a sample of undergraduates (n=240) completed the MASS, Eating Disorder Inventory, and Rosenberg Self-esteem Scale. Exploratory factor analysis supported the original five-factor structure of the MASS only in the weight lifter sample. The MASS-HU had excellent scale score reliability and good test-retest reliability. The construct validity of the MASS-HU was tested with multivariate regression analyses which indicated an inverse relationship between self-esteem and muscle dysmorphia. The 18-item MASS-HU was found to be a useful measure for the assessment of muscle dysmorphia among male weight lifters.

The prevalence of eating disorders in a Hungarian secondary school population over a period of 10 years

Az evészavarok sokféle, időnként irreverzíbilis és veszélyes szövődményekkel és jelentős pszichiátriai komorbiditással járó betegségek, amelyek elsősorban a fiatal nőket érintik. Ellentmondásos eredményeket közölnek azzal kapcsolatban, időben hogyan változik az evészavarok gyakorisága. Célkitűzés: annak meghatározása, hogyan változott az evészavarok és tüneteinek gyakorisága 10 év alatt. Módszerek: Az 1989-ben végzett vizsgálatot (Túry és mtsai, 1991; Szabó és Túry, 1991) ismételtük meg az 1998/1999-es tanévben. Mindkét vizsgálatban ugyanazokat a kérdőíveket alkalmaztuk az evészavarok vizsgálatára: az Evési attitűdök tesztjét, a Bulimia kognitív disztorziós skálát és az Evészavar-súlyossági skálát. A kérdőívet 6 város 9 középiskolájának tanulói töltötték ki. Eredmények: Összesen 2731 tanuló vett részt a vizsgálatban (2138 lány és 593 fiú, az 1. vizsgálatban 932, a másodikban 1799). A testsúly csökkentésére használt módszerek és az evészavar-patológiát jelző kérdőíves pontszám szerint a kóros jelenségek lényegesen gyakoribbak a lányok körében, emellett 10 év távlatában gyakoribbá is váltak. A klinikai és szubklinikai anorexia és bulimia gyakorisága is lényegesen nőtt a lányoknál a vizsgált időszakban (összesen 0,12%-ról 0,68%-ra). Következtetések: Eredményeink alapján az evészavarok tünetei és az evészavar-szindrómák gyakorisága lényegesen nőtt 10 év alatt a hazai középiskolás lányok csoportjában. Ebben nagy jelentőséget tulajdonítunk a külső megjelenés fontosságának és a karcsúságideál térnyerésének.

Comparison of the eating disorder inventory (EDI) in the Netherlands, Austria and Italy

OBJECTIVE

Comparison of scores of the Eating Disorder Inventory (EDI) in non-clinical females aged 15-35 years (total n = 2402) in three European countries with North-South variation.

METHODS

Participants were high school girls from the Netherlands (n = 642), Austria (n = 544) and Italy (n = 359), and college students from the Netherlands (n = 348), Austria (n = 114) and Italy (n = 395).

RESULTS

Age-dependent differences of EDI subscale scores were observed. Whereas in Dutch females weight and body shape concerns had a peak between 16 and 19 years, these concerns remained relatively constant in Italy and Austria. The Italian scores were significantly higher than the Dutch scores on almost all EDI subscales whereby effects were small or medium.

CONCLUSIONS

The scores may be influenced by socio-cultural factors, cultural traits, culture-specific social demands on young adults and differences in maturation between North and South Europe. National norms are necessary for different age, weight and sex groups.

Cultural correlates of eating attitudes: a comparison between native-born and immigrant university students in Israel

OBJECTIVE

This study explores the association between gender and exposure to Western culture and attitudes toward eating.

METHOD

Four hundred and ninety-nine university students participated in the study: 216 Israeli natives, 153 new immigrants (3 years or less since immigration) from the Former Soviet Union (FSU), and 130 veteran immigrants from FSU (4-15 years since immigration). Attitudes toward eating were measured using the Eating Attitude Test - EAT-26.

RESULTS

Israeli born women had higher weight and body mass index (BMI) than did new immigrant women. Higher scores on the EAT-26 were found among women than among men. Among women only, native-born Israelis and veteran immigrants were more likely to have positive EAT-26 scores (19.6%, 18.8%) than were new immigrant women (7.9%), indicating disordered eating attitudes. Part of the differences in EAT-26 scores was explained by differences between the groups on age and BMI; however, even after adjustment the differences remained significant on the bulimia subscale.

CONCLUSION

The results suggest a rapid cultural effect in attitudes toward eating that may reflect a tendency toward eating disorders as well as a difference in the proportion of obesity. It seems that the veteran immigrants have adopted Western cultural norms and eating patterns in a way that has erased the differences in tendency toward eating disorders between them and the Israeli born women.

Eating attitudes and behaviours in South african adolescents and young adults

We examined the presence and severity of disordered eating attitudes and behaviours in a group of 895 South Africans. The Eating Attitude Test-26 (EAT-26), the Bulimic Investigatory Test, Edinburgh (BITE) and the Rosenberg Self-esteem Scale (RSE), were administered to high-school and college students (515 White, 126 Black, and 254 'Coloured'). There were few differences between these three groups on measures of eating disorder pathology and self-esteem. A small number of participants (3.5%) were identified as at 'high risk' for an eating disorder as shown by scores in the clinical range for both the EAT-26 and BITE. Weight, self-esteem and age were predictors for this subgroup. This study suggests that ethnicity per se may not 'protect' against the development of disordered eating attitudes and behaviours in nonwestern black populations. These findings remain tentative until future survey studies employ interviews to confirm eating disorder diagnosis.

Eating behavior differences and the perception of gender roles in Czech and German nonclinical samples

This study compares non clinical subjects from the Czech Republic and Germany regarding their eating behavior and attributes they associate with female role models. We assessed Czech and German students and their mothers, 328 subjects in total, by having them complete 2 questionnaires related to weight, eating behavior, as well as different role models (a professionally successful woman, a good mother, etc.). The female Czech students had a lower ideal BMI than the German female students, and were more dissatisfied with their bodies. Thus, the higher drive for thinness in the Czech students could be an indicator for an increased risk regarding eating disorders. Regarding role models, the Czech results were very different from those of the Germans. The Czech women characterized female roles more with items like following own goals, competent in job, competing. The more professional female role description in the Czech Republic reflects the tradition of working women in former socialist states. But the relationship between eating behavior and gender roles remains unclear.

Epidemiological studies on adverse dieting behaviours and eating disorders among young people in Hungary

BACKGROUND

Most results on the prevalence rates of eating disorders and related adverse dieting attitudes have been published in North America and Western Europe and there have been only a few pioneering surveys conducted in Central and Eastern Europe in this domain. The authors investigated the prevalence rates for anorexia nervosa, bulimia nervosa and related adverse dieting attitudes and eating behaviours among secondary school and college students in Budapest and Pécs in the second half of the 1990s.

METHODS

In the process of a two-stage study, a series of internationally approved tests were carried out as a screening examination and a semi-structured diagnostic interview was conducted. These techniques were also applied in a comparative study of a class of secondary school ballet students.

RESULTS

Of the overall female sample, 3% revealed an anorexic disposition, but no actual cases of anorexia were detected; 25% of the ballet students corresponded to the criteria of simulated anorexia. In addition, 4.5% of the females and 0.8% of the males were classified as subclinical bulimics, whereas 3.6% of the females and 0.4% of the males could be listed in the category of simulated bulimia nervosa. The prevalence rate of bulimia nervosa defined by DSM-IV, which could be proved by the diagnostic interview, was 0.6%.

CONCLUSIONS

Body ideal of thinness in young women has a significant effect on their self-esteem. The prevalence rate of adverse eating behaviours and bulimia nervosa in Hungary has been found to be similar to the scores published in the Western countries.

The Eating Disorder Inventory-2 in Japanese clinical and non-clinical samples: psychometric properties and cross-cultural implications

OBJECTIVE

To determine the usefulness of and cross-cultural differences in the Japanese version of the eating disorder inventory-2 (EDI-2).

METHOD

A Japanese version of the EDI-2 was administered to a consecutive series (1995-2001) of 91 Japanese eating disordered inpatients and 119 matched non-clinical controls. Scores were compared with each other and with those of Canadian data previously reported. Internal consistencies were also examined.

RESULTS

All subscales (except Ascetism) reached sufficient internal consistencies. The patients' mean scores were significantly higher than controls on most subscales. Restricting anorexics (AN-R) scored higher than controls on body dissatisfaction (BD) and Social Insecurity (SI) subscales. Purging bulimics (BN-P) scored higher than controls on most subscales, except for maturity fears (MF) and SI subscales. Scores of binge-eating/purging type anorexics (AN-B/P) were higher than controls on all subscales. AN-B/P and BN-P scored higher than AN-R on bulimia (B) subscale. Comparison with Canadian subjects showed that Japanese control subjects scored significantly higher on the MF, ineffectiveness (I), impulse regulation (IR), SI subscales, and lower on the perfectionism (P) subscale.

DISCUSSION

The EDI-2 is useful and reliable in understanding Japanese clinical and non-clinical samples. High MF and low P subscales in our samples confirm previous findings in Chinese samples suggesting meaningful cultural differences in the emphasis placed on family bonds and individual accomplishments. In addition, high I, IR, and SI scores in Japanese non-clinical samples may reflect recent problems in Japanese culture.

An exploration of eating disorders in a Georgian sample

BACKGROUND

There is debate as to whether eating disorders may be culture-bound. However, accumulating evidence suggests that eating disorders may be found outside of the West, although the precise form of the eating disorder may differ.

AIMS

There were two aims of this study: (1) to translate and establish the psychometric properties of standard questionnaires to measure eating pathology in a Georgian sample; (2) to use these measures to determine whether cases of eating disorders exist in Georgia.

METHODS

We held focus groups of various health professionals to establish how eating disorders present in Georgia and to identify groups perceived to be at high risk of having an eating disorder. We obtained translated versions of a number of standardized questionnaires (measuring eating and general psychopathology) from 245 women from these identified high risk groups and a subsample were given a structured clinical interview.

RESULTS

We estimated from the responses to the questionnaires, that as many as 5% may have clinically significant bulimia nervosa, 7% fell in the weight range for anorexia nervosa with a further 7% in the weight range for obesity. We interviewed a sample of the high scoring group which confirmed the presence of clinically significant eating pathology in the majority of those identified as possible cases.

CONCLUSIONS

The results of this study suggest there may be women in Georgia with significant eating problems.

Epidemiology and mortality of eating disorders

Although considerable progress has been made over the past 2 decades in the field of eating-disorder epidemiology, there is room for improvement. Eating disorder diagnoses for children, need assessment, prospective longitudinal studies, studies of natural cause, treatment dose-effect studies, and bias are all areas that need careful consideration. Clinicians should consider establishing a Cochrane database for eating disorders. The mortality studies reviewed in this article are dominated by small, sparse, unbalanced data sets, and publication bias and bias caused by loss to follow-up limits the validity of the reported findings. Some methodologic advice is given in the hope that some of the more obvious pitfalls can be avoided in future research.

[Prevalence of eating disorders in a representative sample of female adolescents from Navarra (Spain)]

BACKGROUND

In spite of the social concern about eating disorders (ED), information of its prevalence in Spain is limited. Further studies in communities are needed to estimate the frequency of this problem in representative samples of the population.

SUBJECTS AND METHODS

To estimate the prevalence of anorexia nervosa (AN), bulimia nervosa (BN), and partial syndromes of the "non specified eating disorders" (NOSED) type, a representative sample of the female population of Navarre was selected using a random multistage sampling scheme. A sample of 2862 participants aged 12 to 21 was studied. The screening procedure was performed using the Eating Attitudes Test (EAT) (values over 30 as the cutoff point) and each diagnosis was confirmed using a semi-structured interview performed by a psychiatry according to DSM-IV criteria.

RESULTS

The overall prevalence of ED in this female population was 4.1% (95% CI: 3.45-4.95). The disorder specific prevalences being NOSED 3.1% (95% CI: 2.5-3.8), BN 0.8 (95% CI: 0.5-1.2) and AN 0.3 (95% CI: 0.1-0.6).

CONCLUSIONS

Our results show a slight lower prevalence than what other Spanish authors have reported, although we found higher prevalences of incomplete syndromes and suggest that a high social burden does exist and primary prevention strategies are needed.

Eating Attitudes Test and culture: a study in northern and southern Italy

The EAT (Eating Attitudes Test) has been widely used to compare eating morbidity in cultural groups and variations in it have been taken as indicative of cultural differences. This study assumed the existence of cultural differences between the north and the south of Italy. The EAT scores of female students from a northern and a southern Italian high school were compared. They were both higher than in other European studies, though there were no significant differences between the two groups. The result could be due to sampling limitations, but could also indicate that the EAT is not a reliable yardstick of cultural differences.

Eating attitudes and behaviors in 1,435 South African Caucasian and non-Caucasian college students

OBJECTIVE

The purpose of this study was to examine the presence and severity of eating disorder pathology in students representing South Africa's ethnically and culturally diverse population.

METHOD

A questionnaire survey, which involved the Eating Attitude Test and the Bulimic Investigatory Test, was administered to 1,435 South African college students (739 Caucasian and 696 non-Caucasian) from six universities in two urban centers.

RESULTS

Black students scored significantly higher than the other ethnic groups on these measures. In addition, a comparable percentage of black and Caucasian female students had scores within the clinical range on these scales. Male students scored consistently lower than female students.

CONCLUSIONS

This study's findings challenge the notion that eating disorders are primarily a Western, Caucasian phenomenon and raise the possibility that the risk of eating disorders may increase in developing societies.

The EAT speaks many languages: review of the use of the EAT in eating disorders research

The Eating Attitudes Test questionnaire (EAT) has been a major instrument for detecting eating morbidity in a great number of studies across the world. The instrument was devised by two Canadian research workers and was initially validated on a Canadian population. Since then it has been used with reasonable success in eating disorders research emanating from English speaking countries, particularly the UK. This paper attempts to focus on the application of the EAT in non-English speaking countries where it was essential to translate it into the language of these countries. Comparative analysis of the results is assessed and the degree of success of the instrument in these studies is evaluated. The outcome of this review could have significant implications for the future use of the EAT in eating disorders research.

A two-stage epidemiological study of abnormal eating attitudes and their prospective risk factors in Polish schoolgirls

In this longitudinal two-stage screening study of abnormal eating attitudes and behaviours in Polish schoolgirls self-report questionnaires (EAT-26) were completed by 747 schoolgirls aged between 14 and 16 years. On the basis of their EAT-26 scores 167 girls were selected for a clinical interview conducted blind to questionnaire scores. No clinical cases of DSM-III-R anorexia or bulimia nervosa were identified, however, there was a point prevalence of 2.34% for subclinical eating disorder and of 28.6% for dieting. Natural history was investigated, repeating the screening and interviews after 10 months. Both the group mean EAT-26 score and the proportion of subclinical cases remained the same at follow-up however, individual girls showed substantial fluctuations over time. On re-screening 11.5% of the sample had moved EAT category (based on scoring below or above the clinical cut-off point). Follow-up interviews showed that 58% (7) of the original subclinical cases were no longer cases while seven girls were "new' subclinical cases. This second stage of the study also aimed to investigate the risk factors for the development of eating disorders. Several family factors distinguished the dieters from non-dieters at the initial stage. Subjects who began dieting between the initial and follow-up interviews had higher Body Mass Index, felt more overweight and had greater discrepancy between their current and ideal weights than the non-dieters. However, analysis of regression revealed no specific risk factors for development of a subclinical syndrome.