Psychiatric Disorders Associated with the Onset and Persistence of Bulimia Nervosa and Binge Eating Disorder During Adolescence

Eating disorders and social media use among college students in Japan and China: a brief cross-sectional survey

BACKGROUND

In recent years, new forms of media-social networking services (SNS)-such as Facebook and Sina Weibo have spread rapidly. Greater SNS use has been associated with greater body dissatisfaction, which in turn, is related to greater eating disorder (ED) symptom severity. In this study, we (1) investigated the relationships between ED tendencies, SNS use intensity, and body esteem and (2) examined the mediating role of body esteem in the relationship between SNS use intensity and ED tendencies among Japanese and Chinese students.

METHODS

A total of 564 Japanese and Chinese college students aged 18-22 years were surveyed on their age and BMI, including self-filling questions from the Japanese and Chinese versions of the Eating Attitudes Test (EAT-26), SNS Intensity Scale, Body Esteem Scale for Adolescents and Adults (BESAA), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) scale.

RESULTS

The proportion of students with a score of ≥ 20 on the EAT-26 was 15.8% (Japanese, 14.7%; Chinese, 17.0%). The number of participants with scores ≥ 20 on the EAT-26 was significantly higher than ever before, both in Japan and China. Chinese students reported greater body esteem than Japanese students, as well as a stronger association of SNS use intensity with body esteem. Among Japanese students, EAT-26 scores were unrelated to SNS Intensity Scale scores but had a weak negative correlation with BESAA scores; therefore, body esteem did not mediate the relationship between SNS use intensity and ED tendencies. Among Chinese students, scores on the SNS Intensity Scale and BESAA had a weak correlation with EAT-26 scores, and SNS use intensity reduced ED tendencies through greater body esteem.

CONCLUSIONS

It is important to consider the way users engage with SNS, in addition to the SNS use intensity. Improving body esteem may reduce the risk of ED. Furthermore, it is necessary to include men in the discussion on ED in the future.

The multifaceted consequences and economic costs of child anxiety problems: A systematic review and meta-analysis

Background

Over a quarter of people have an anxiety disorder at some point in their life, with many first experiencing difficulties during childhood or adolescence. Despite this, gaps still exist in the current evidence base of the multiple consequences of childhood anxiety problems and their costs.

Methods

A systematic review of Medline, PsycINFO, EconLit and the National Health Service Economic Evaluation Database was conducted for longitudinal and economic studies reporting on the association between childhood anxiety problems and at least one individual-, family- or societal-level outcome or cost. All studies were synthesised narratively. For longitudinal studies, 'effect direction' was used as a common metric, with random effects meta-analysis undertaken where possible.

Results

Eighty-three studies met inclusion criteria and were synthesised narratively. We identified 788 separate analyses from the longitudinal studies, which we grouped into 15 overarching outcome domains. Thirteen of the studies were incorporated into 13 meta-analyses, which indicated that childhood anxiety disorders were associated with future anxiety, mood, behaviour and substance disorders. Narrative synthesis also suggested associations between anxiety problems and worse physical health, behaviour, self-harm, eating, relationship, educational, health care, employment, and financial outcomes. 'Effect direction' was conflicting in some domains due to a sparse evidence base. Higher economic costs were identified for the child, their families, healthcare providers and wider society, although evidence was limited and only covered short follow-up periods, up to a maximum of 2 years. Total annual societal costs per anxious child were up to £4040 (2021 GBP).

Conclusions

Childhood anxiety problems are associated with impaired outcomes in numerous domains, and considerable economic costs, which highlight the need for cost-effective interventions and policies to tackle them. More economic evidence is needed to inform models of the long-term, economic-related, consequences of childhood anxiety problems.

Prevalence and early risk factors for bulimia nervosa symptoms in inner-city youth: gender and ethnicity perspectives

BACKGROUND

Research on risk factors associated with bulimia nervosa symptoms (BN) in ethnic minorities has been limited. This study adds to the existing literature by providing the ethnicity- and gender-specific prevalence of BN in US inner-city youth and by exploring the longitudinal associations between a clinical level of BN and early risk factors assessed one year previously.

METHODS

The study was conducted on a representative sample of predominantly ethnic minority youth (N = 2794; 54.1% female; age 11-16 years old (M(SD) = 12.77(1.29)); 60.0% African-American, 26.1% Hispanic American, 13.9% White). Self-reported information was obtained on BN and early risk factors (e.g., depressive and anxiety symptoms, posttraumatic stress, somatic complaints). Multivariate analysis of covariance was used to examine the longitudinal associations.

RESULTS

The 3-month BN prevalence was higher in girls (5.1%) than in boys (2.3%) (ratio 2.22:1). Significant differences in BN rates were found between White and African American students (higher in Whites), whereas Hispanic-Americans did not differ significantly from either group. Individuals with BN had significantly higher levels of early risk factors one year prior.

CONCLUSIONS

Timely recognition of BN and associated early risk factors is important for early prevention and intervention strategies.

Bulimia symptoms in Czech youth: prevalence and association with internalizing problems

OBJECTIVE

Although clinical studies suggest that bulimia symptoms are common in youth, research on the prevalence of such symptoms and of their association with comorbid internalizing problems in the general population has been limited. This study aimed to evaluate the gender-specific prevalence of bulimia symptoms in Czech youth and explored the association between a clinical level of self-reported bulimia symptoms (CLBS) and internalizing problems by gender, controlling for age, socio-economic status and puberty status.

METHOD

The study was conducted on a representative national sample of Czech youth (N = 4430, 57.0% female) using self-report scales. Multivariate analysis of covariance (MANCOVA) was used to examine the associations.

RESULTS

The 3-month CLBS prevalence was higher in girls (11.4%) than in boys (3.8%) and in both genders a CLBS was associated with higher levels of comorbid internalizing problems.

DISCUSSION

Timely recognition of bulimia symptoms and associated risk factors is important for early prevention and intervention strategies.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study (according to Oxford (UK) CEBM Levels of Evidence, 2011).

Morbidity persistence and comorbidity of mood, anxiety, and eating disorders among preoperative bariatric patients

The current study investigates the patterns of disease persistence and comorbidity of psychiatric disorders among patients with class III obesity in pre-operative period. For 393 treatment-seeking patients with severe obesity recruited from a bariatric center, we ascertained their psychiatric diagnosis through Structured Clinical Interview for DSM-IV (SCID-I). Following, the frequency, persistence and comorbidity pattern of psychiatric disorders in this sample were determined. Current psychiatric disorders were observed in over half of patients during preoperative period, being anxiety disorders the most frequent diagnosis. For lifetime disorders, mood disorders were the most frequent diagnosis. Most of the sample presented 2 or more concurrent lifetime psychiatric disorders. While mood and eating disorders were frequent conditions, anxiety disorders were the most persistent conditions (the highest one month-to-lifetime prevalence ratio) and were significantly correlated with bipolar, depressive and eating disorders. Psychiatric disorders are frequent and enduring conditions among patients looking for bariatric surgery. Comorbid anxiety, mood, and eating disorders are remarkable features in treatment-seeking patients with obesity. Prognostic implications of preoperative psychiatric disorders on surgery outcome should be demonstrated prospectively in intervention studies.

Social phobia, depression and eating disorders during middle adolescence: longitudinal associations and treatment seeking

BACKGROUND

Longitudinal associations between social phobia (SP), depression and eating disorders (EDs), and the impact of antecedent SP and depression on subsequent treatment seeking for EDs have rarely been explored in prospective adolescent population studies.

AIM

We aimed to examine these associations in a large-scale follow-up study among middle adolescents.

METHOD

We surveyed 3278 Finnish adolescents with a mean age of 15 years for these disorders. Two years later, 2070 were reached and again surveyed for psychopathology and treatment seeking. Longitudinal associations between the self-reported disorders and treatment-seeking patterns for self-acknowledged ED symptoms were examined in multivariate analyses, controlling for SP/depression comorbidity and relevant socioeconomic covariates.

RESULTS

Self-reported anorexia nervosa (AN) at age 15 years predicted self-reported depression at age 17 years. Furthermore, self-reported SP at age 15 years predicted not seeking treatment for bulimia nervosa (BN) symptoms, while self-reported depression at age 15 years predicted not seeking treatment for AN symptoms during the follow-up period.

CONCLUSIONS

Adolescents with AN should be monitored for subsequent depression. Barriers caused by SP to help seeking for BN, and by depression for AN, should be acknowledged by healthcare professionals who encounter socially anxious and depressive adolescents, especially when they present with eating problems.

Prospective Relations between Overeating, Loss of Control Eating, Binge Eating, and Depressive Symptoms in a School-Based Sample of Adolescents

A sample of 353 community adolescents (grades 9 to 12, 57.6 % female) participated in a 2-wave longitudinal study of eating behaviors (overeating, loss of control eating [LOC], and binge eating) and depression. The study addresses 4 hypotheses. (1) The prospective relations between eating behaviors and depressive symptoms will be reciprocal, with each predicting the other over time. (2) These relations will be stronger for girls than for boys. (3) These relations will be stronger for adolescents with high (not low) body mass index (BMI). (4) LOC will show incremental predictive utility in relation to depressive symptoms over and above overeating. Evidence supported reciprocal relations between binge eating and depressive symptoms and between overeating and depressive symptoms, but not between LOC and depressive symptoms. Sex and BMI did not substantially moderate these relations. Taken separately, overeating but not LOC predicted depressive symptoms. Taken together, neither predictor was significant controlling for the other. Results raise questions about the importance of LOC alone in predicting depressive symptoms in adolescence.

Longitudinal Bi-directional Effects of Disordered Eating, Depression and Anxiety

OBJECTIVE

The present study aims to explore the potentially longitudinal bi-directional effects of disordered eating (DE) symptoms with depression and anxiety.

METHOD

Participants were 189 (49.5% male) adolescents from Melbourne, Australia. DE, depressive and anxiety symptoms were assessed at approximately 15, 16.5 and 18.5 years of age.

RESULTS

Analysis of longitudinal bi-directional effects assessed via cross-lagged models indicated that DE symptoms of eating and shape/weight concerns were risk factors for anxiety. Results also showed that depression was a risk factor for eating concerns.

CONCLUSION

Our findings provide preliminary evidence that preventative measures designed to target concerns about eating and shape/weight might be most efficacious in reducing the transmission of effects between symptoms of DE, depression and anxiety. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

The longitudinal relationship between worry and disordered eating: Is worry a precursor or consequence of disordered eating?

Worry, the core component of generalized anxiety disorder, is associated with disordered eating. However, it is unclear whether worry is a precursor to disordered eating or whether worry is a consequence of disordered eating (or both). The current study tested if worry prospectively predicted disordered eating symptoms and vice-versa across six months. Young adult women (n=300) completed a measure of worry and disordered eating at Time 1, and two months and six months later. A prospective path model utilizing structural equation modeling investigated if worry predicted disordered eating (and vice-versa). Worry prospectively predicted drive for thinness across both two and six months while controlling for previous levels of worry. In the opposite direction, drive for thinness did not predict worry over time. There were no prospective relationships between worry and bulimia or body dissatisfaction. Therefore, interventions focusing on decreasing worry could be effective in preventing and treating excessive concerns about thinness and their associated impairment.

A systematic review and meta-analysis on the longitudinal relationship between eating pathology and depression

OBJECTIVE

Undertake a meta-analysis to provide a quantitative synthesis of longitudinal studies that assessed the direction of effects between eating pathology and depression. A second aim was to use meta-regression to account for heterogeneity in terms of study-level effect modifiers.

METHOD

A systematic review was conducted on 42 studies that assessed the longitudinal relationship between eating pathology and depression. Of these 42 studies, multilevel random-effects meta-analyses were conducted on 30 eligible studies.

RESULTS

Meta-analysis results showed that eating pathology was a risk factor for depression (rm  = 0.13) and that depression was a risk factor for eating pathology (rm  = 0.16). Meta-regression analyses showed that these effects were significantly stronger for studies that operationalized eating pathology as an eating disorder diagnosis versus eating pathology symptoms, and for studies that operationalized the respective outcome measure as a categorical variable (e.g., a diagnosis of a disorder or where symptoms were "present"/"absent") versus a continuous measure. Results also showed that in relation to eating pathology type, the effect of an eating disorder diagnosis and bulimic symptoms on depression was significantly stronger for younger participants.

DISCUSSION

Eating pathology and depression are concurrent risk factors for each other, suggesting that future research would benefit from identifying factors that are etiological to the development of both constructs.

RESUMEN OBJETIVO

Llevar a cabo un meta-análisis para proporcionar una síntesis cuantitativa de los estudios longitudinales que evaluaron la dirección de los efectos entre la alimentación patológica y la depresión. Un segundo objetivo fue utilizar la meta-regresión para dar cuenta de la heterogeneidad en términos de modificadores del efecto a nivel de estudio. MÉTODO: Una revisión sistemática se llevó a cabo en 42 estudios que evaluaron la relación longitudinal entre la alimentación patológica y la depresión. De estos 42 estudios, se realizaron meta-análisis de multinivel de efectos aleatorios en 30 estudios elegibles.

RESULTADOS

Los resultados del meta-análisis mostraron que la alimentación patológica era un factor de riesgo para depresión (rm=0.13) y que la depresión era un factor de riesgo para la alimentación patológica (rm=0.16). Los análisis de meta-regresión mostraron que estos efectos eran significativamente más fuertes para estudios que operacionalizaban la alimentación patológica como un diagnóstico de trastorno de la conducta alimentaria versus síntomas de alimentación patológica, y para los estudios que operacionalizaban la medida respectiva de resultado como una variable categórica (e.g., un diagnóstico de trastorno o cuando los síntomas estaban "presentes"/"ausentes") versus una medida continua. Los resultados mostraron que en relación al tipo de alimentación patológica, el efecto de un diagnóstico de trastorno de la conducta alimentaria y síntomas bulímicos en la depresión era significativamente más fuerte para participantes más jóvenes. DISCUSIÓN: La alimentación patológica y la depresión son factores de riesgo concurrentes uno para el otro, lo que sugiere que la investigación futura se beneficiaría de identificar factores que son etiológicos al desarrollo de ambos constructos. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016;49:439-454).

A Primer on the Genetics of Comorbid Eating Disorders and Substance Use Disorders

Eating disorders (EDs) and substance use disorders (SUDs) frequently co-occur; however, the reasons for this are unclear. We review the current literature on genetic risk for EDs and SUDs, as well as preliminary findings exploring whether these classes of disorders have overlapping genetic risk. Overall, genetic factors contribute to individual differences in liability to multiple EDs and SUDs. Although initial family studies concluded that no shared familial (which includes genetic) risk between EDs and SUDs exists, twin studies suggest a moderate proportion of shared variance is attributable to overlapping genetic factors, particularly for those EDs characterized by binge eating and/or inappropriate compensatory behaviours. No adoption or molecular genetic studies have examined shared genetic risk between these classes of disorders. Research investigating binge eating and inappropriate compensatory behaviours using emerging statistical genetic methods, as well as examining gene-environment interplay, will provide important clues into the aetiology of comorbid EDs and SUDs.

Bulimic Behaviors and Early Substance Use: Findings from a Cotwin-Control Study

BACKGROUND

Bulimic behaviors (i.e., binge eating and compensatory behaviors) and substance use frequently co-occur. However, the etiology underlying this association is poorly understood. This study evaluated the association between bulimic behaviors and early substance use, controlling for genetic and shared environmental factors.

METHODS

Participants were 3,540 young adult women from the Missouri Adolescent Female Twin Study. A telephone adaptation of the Semi-Structured Assessment for the Genetics of Alcoholism interview assessed DSM-IV bulimic behaviors, substance use, and other psychological characteristics. Lifetime bulimic behaviors were examined in twin pairs concordant and discordant for early substance use. Logistic regressions were adjusted for the nonindependence of twin data, zygosity, age, body mass index, early menarche (onset before age 12), and early sex (first consensual sexual intercourse before age 15).

RESULTS

In the entire study population, women who reported early use of alcohol or nicotine were more likely to engage in bulimic behaviors after adjusting for covariates. In 53 pairs of monozygotic twins discordant for alcohol experimentation before age 15, the twin who reported early alcohol experimentation had 3.21 (95% confidence interval = 1.54 to 6.67) times higher odds of reporting bulimic behaviors than the cotwin who did not report early alcohol experimentation, even after adjustment for covariates.

CONCLUSIONS

Findings suggest that early alcohol experimentation may contribute to the development of bulimic behaviors via mechanisms extending beyond shared vulnerability, including individual-specific environmental experiences or causal pathways.

Toward understanding the role of body dissatisfaction in the gender differences in depressive symptoms and disordered eating: a longitudinal study during adolescence

This study was aimed at examining whether body dissatisfaction in early adolescence contributes to the development of gender differences in depressive symptoms and disordered eating across early to mid-adolescence, testing both a mediation hypothesis (higher levels of body dissatisfaction in girls, provided body dissatisfaction is a predictor of psychopathology beyond the effect of gender) and a moderation hypothesis (more detrimental effect of body dissatisfaction in girls). A community-based sample initially comprising 882 (49.55% female) adolescents (M(age) = 12.85) was followed-up after 2 and 4 years. Multilevel models were used to analyze the data. Results supported the mediation hypothesis for depressive symptoms and disordered eating, and the moderation hypothesis for disordered eating. Whereas gender differences in depressive symptoms may be simply linked to dissimilar levels of body dissatisfaction in girls and boys, gender differences in disordered eating may arise from both dissimilar levels and effects of body dissatisfaction for each gender.

Screening cluster A and cluster B personality disorders in Chinese high school students

BACKGROUND

Personality disorders (PDs) during adolescence may, in addition to increasing risk for violent behaviors and suicide, also increase risk for elevated PD traits in adulthood. The aim of this study was to explore the prevalence of Cluster A and Cluster B PD traits and their relationships to demographic variables in Chinese high school students.

METHODS

A cohort of 3,552 students from eight high schools completed the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and MacArthur Scale of Subjective Social Status-youth version (SSSy) questionnaires.

RESULTS

Boys scored higher than girls on the paranoid, schizotypal, antisocial, and narcissistic PDs. Freshmen and sophomores scored higher than juniors on schizoid, borderline, and antisocial PDs. Children in single-child families scored higher than nonsingletons on the paranoid and antisocial PDs. Students from single-parent households scored higher than students from double-parent households on the schizotypal and antisocial PDs, and students with remarried parents scored higher than students from double-parent households on the borderline and antisocial PDs. Students who had low perception of social status in the society ladder scored higher than those with a high perceived status on the schizoid and borderline PDs, but scored lower on the histrionic PD; students with a low subjective social status in the school community ladder scored higher scores than those with a high perceived status on the paranoid, schizoid, borderline, and antisocial PDs, but scored lower on the histrionic PD.

CONCLUSIONS

Gender, grade, family structure, and subjective social status may affect the development of PDs. Longitudinal studies and studies of the full scope of PDs are needed to fully elucidate the impact of demographic variables on PD prevalence rates in adolescence and adulthood.

Dietary intake in population-based adolescents: support for a relationship between eating disorder symptoms, low fatty acid intake and depressive symptoms

BACKGROUND

Relatively little is known about the dietary intake and nutritional status of community-based individuals with eating disorders. This research aimed to: (i) describe the dietary intake of population-based adolescents with an eating disorder and (ii) examine associations between eating disorder symptoms, fatty acid intake and depressive symptoms in adolescents with and without an eating disorder.

METHODS

Data were drawn from the Western Australian Pregnancy Cohort (Raine) Study, a population-based cohort study that has followed participants from birth to young adulthood. This research utilised self-report data from the 17-year Raine Study assessment. Participants comprised 429 female adolescents who completed comprehensive questionnaire measures on dietary intake, eating disorder symptoms and depressive symptoms.

RESULTS

Adolescents with an eating disorder (n = 66) reported a significantly lower intake of total fat, saturated fat, omega-6 fatty acid, starch, vitamin A and vitamin E compared to adolescents without an eating disorder (n = 363). Adolescents with an eating disorder and pronounced depressive symptoms (n = 23) also reported a significantly lower intake of polyunsaturated fat and omega-3 and omega-6 fatty acid than adolescents with an eating disorder but no marked depression (n = 43). In the eating disorder sample but not the control sample, omega-3 and omega-6 fatty acid correlated significantly and negatively with eating disorder symptoms and with depressive symptoms.

CONCLUSIONS

Support is provided for a relationship between low omega-3 and omega-6 fatty acid intake and depressive symptoms in adolescents with eating disorders. Research is needed to examine the feasibility and effectiveness of fatty acid supplementation in this high-risk group.

The role of gender, affectivity and parenting in the course of disordered eating: a 4-year prospective case-control study among adolescents

BACKGROUND

Prolonged eating disturbances increase the risk for a full-blown eating disorder and lifelong health impairment. Screening will improve early detection of eating pathology, but the major question still remains: who will benefit from early treatment and who needs little or no intervention. To answer this question, information about the factors that predict the course of disordered eating is valuable.

OBJECTIVES

To investigate the course of eating disturbance from middle to late adolescence, to test certain individual and parental factors potentially explaining the differences in the course of eating disturbance, and to estimate the predictive power of these factors in terms of the recurrence of eating disturbance and the onset of new presentations of eating pathology after mid-adolescence.

DESIGN

A four-year follow-up study with a case-control design.

SETTINGS

School health care and community settings in south-western Finland.

PARTICIPANTS

Students who had reported eating disturbance at baseline (n=208, response rate 69%) and a group of non-symptomatic controls (n=514, response rate 81%) were enrolled and matched by school, grade, and gender.

METHODS

At baseline assessment, mid-adolescent students (mean age 14.9 years) self-administered the SCOFF eating disorder questionnaire as part of their regular health examination. Background information, including self-reported mood questionnaire RBDI, was obtained from the students' health care records. Four years later, the participants (mean age 19.0 years) responded to the questionnaire by mail. Logistic regression analyses were used to assess the recurrence and onset of eating disturbance and the associated factors.

RESULTS

Altogether 52% of girls and 17% of boys who reported eating disorder symptoms in the baseline assessment remained symptomatic at follow-up. Depressiveness--even transient--in mid-adolescence predicted recurrence of eating disturbance in late adolescence. Prolonged dissatisfaction with appearance predicted the onset of eating disturbance in previously symptom-free girls. In general, experience of average parenting was good enough for the girls in terms of recovering from eating disturbance and avoiding the onset of eating problems after mid-adolescence.

CONCLUSIONS

Adolescent girls who report both eating disturbance and negative affectivity may benefit from extra support. The beneficial role that parents may have in helping these girls must not be forgotten.

Subclinical eating disorders and their comorbidity with mood and anxiety disorders in adolescent girls

The present study assesses the prevalence of subclinical eating disorders and examines their comorbidity with mood and anxiety disorders in a sample of adolescent girls. A DSM-III-R computerized self-reported interview was administered to 833 adolescent girls (mean age=15.7±0.5 years) from a population sample to assess the prevalence of subclinical eating disorders, major depression, dysthymia, separation anxiety, and generalized anxiety disorders. The prevalence of subclinical anorexia nervosa (restricting subtype) was 3.5%, 13.3% for weight concerns (restricting subtype), 3.8% for subclinical bulimia nervosa, and 10.8% for subclinical binge eating disorder. Girls with subclinical anorexia nervosa had a higher prevalence of separation anxiety diagnosis, and they reported significantly more major depressive and generalized anxiety symptoms compared with girls reporting no eating disorders. Girls with weight concerns reported significantly more major depressive, separation, and generalized anxiety symptoms compared with girls reporting no eating disorders. Girls with subclinical bulimia nervosa or binge eating disorder had a higher prevalence of mood disorders (major depression and dysthymia) compared with girls reporting no eating disorders. Furthermore, girls with subclinical bulimia nervosa or binge eating disorder also reported significantly more anxiety symptoms (separation anxiety and generalized anxiety) compared with girls reporting no eating disorders. In summary, adolescent girls suffering from subclinical eating disorders should be investigated concomitantly for mood and anxiety disorders while those suffering from mood and anxiety disorders should be investigated simultaneously for subclinical eating disorders.

Comorbidity and age of onset of eating disorders in gay men, lesbians, and bisexuals

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.

Delineation of differential temporal relations between specific eating and anxiety disorders

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.

Depression and eating pathology: prospective reciprocal relations in adolescents

The association between disordered eating and depression has been established, but less is known about the temporal relations between these two disturbances. Accordingly, the current study examined the reciprocal relations between depressive and bulimic symptoms over an 8-year period, with longitudinal data from a community sample of 496 female adolescents. Depressive symptoms predicted future increases in bulimic symptoms, and bulimic symptoms likewise predicted increases in depressive symptoms, controlling for earlier levels of symptoms for each outcome. These results provide evidence consistent with the hypothesis that the two disorders contribute reciprocally to each other, and indicate that successful prevention or treatment of one disorder may yield effects for the other. However, the relatively small predictive effect sizes imply that some third variable may contribute to both conditions (e.g., temperamental negative affectivity).

Anxiety, Alexithymia, and Depression as Mediators of the Association between Childhood Abuse and Eating Disordered Behavior in African American and European American Women

This study evaluated structural equation models of the associations among family functioning, childhood abuse, depression, anxiety, alexithymia, and eating disorder symptomatology in a sample of 412 European American and 192 African American female undergraduates. Additionally, the specific roles of anxiety, depression, and alexithymia as mediators were assessed. Each of these variables was a significant mediator of the association between childhood abuse and disordered eating. Finally, a test of invariance between the African American and European American subsamples was significant, highlighting the need for additional cross-cultural eating disorder research.

Pediatric obesity: parallels with addiction and treatment recommendations

Rates of pediatric obesity have increased dramatically over the past decade. This trend is especially alarming because obesity is associated with significant medical and psychosocial consequences. It may contribute to cardiovascular, metabolic, and hepatic complications, as well as to psychiatric difficulties. The development of obesity appears to be influenced by a complex array of genetic, metabolic, and neural frameworks, along with behavior, eating habits, and physical activity. Numerous parallels exist between obesity and addictive behaviors, including genetic predisposition, personality, environmental risk factors, and common neurobiological pathways in the brain. Typical treatments for pediatric obesity include behavioral interventions targeting diet or exercise. These treatments have yielded mixed results and typically have been examined in specialty clinic populations, limiting their generalizability. There are limited medication options for overweight children and adolescents, and no approved medical intervention in children younger than 16 years old. Bariatric surgery may be an option for some adolescents, but due to the risks of surgery, it is often seen as a last resort. The parallels between addiction and obesity aid in developing novel interventions for pediatric obesity. Motivational enhancement and cognitive-behavioral strategies used in addiction treatment may prove to be beneficial.

Genetic epidemiology, endophenotypes, and eating disorder classification

OBJECTIVE

To explore how genetic epidemiology has informed the identification of endophenotypes and how endophenotypes may inform future classification of eating disorders.

METHOD

Literature review and synthesis.

RESULTS

Although a number of endo- and subphenotypes have been suggested for eating disorders, few reach the rigorous definitions developed for candidate endophenotypes.

CONCLUSION

Further study of endophenotypes and subphenotypes for eating disorders may assist with developing a more homogenous classification system that more closely reflects underlying biological mechanisms, and provides a clearer focus for the development of coherent models and treatments.

Anxiety of young female athletes with disordered eating behaviors

The aim of this study was to investigate the prevalence rate of disordered eating behaviors in young female athletes and to compare the anxiety levels of the athletes with or without disordered eating behaviors. Female athletes (n=243) of 15 to 25 years old from the city, Edirne, in Turkey participated our study. Disordered eating behaviors and anxiety levels of participants were evaluated by the Eating Attitudes Test (EAT-40) and State-Trait Anxiety Inventory. Disordered eating behaviors was reported as 40 (16.7%) among all athletes. Both state and trait anxiety scores were higher in athletes with disordered eating behaviors than the athletes without disordered eating behaviors (p=0.01). The athletes who engage in leanness and non leanness sports were reported as having similar EAT-40 scores and anxiety scores. In conclusion, athletes with disordered eating behaviors have higher state and trait anxiety scores.

Personality disorder traits evident by early adulthood and risk for eating and weight problems during middle adulthood

OBJECTIVE

The current article investigates the association of personality disorder (PD) with the subsequent development of eating and weight problems.

METHOD

Psychiatric interviews were administered to a community-based sample of 658 individuals at mean ages 14, 16, 22, and 33 years.

RESULTS

Individuals with PD by age 22 were at an elevated risk for eating disorders at mean age 33 years. PDs were associated with risk for onset of binge eating, purging, daily dietary restriction, and obesity among individuals without a history of these problems. Borderline and histrionic PD symptoms were associated with recurrent binging and purging at mean age 33 years. Antisocial and schizotypal symptoms were associated with recurrent binging and obesity at mean age 33 years. Depressive PD symptoms were associated with recurrent binging and dietary restriction at mean age 33 years.

CONCLUSION

PD symptoms, evident by early adulthood, may be associated with the risk for the development of eating and weight problems by middle adulthood.