International Journal of Eating Disorders

To develop a scale for the assessment of multiple components of a media-based influence on body image. Seventy-five boys and 107 girls, ranging in age from 8 to 11, completed a measure designed to assess five facets of a media influence previously conceptualized by researchers. Three distinct scales emerged, which appeared to focus on concepts defined as internalization, awareness, and pressure. Correlations between subscales of the Multidimensional Media Influence Scale (MMIS) and the Eating Disorder Inventory-Body Dissatisfaction subscale were significant for both boys and girls. Girls had higher levels on all three subscales and regression analyses indicated that the MMIS scores predicted 30% of the variance associated with body dissatisfaction for girls, but an R(2) of only 0.10 emerged for boys. Internalization levels predicted significant variance beyond that explained by awareness and pressures, but only for the female sample. The findings are discussed with regard to the usefulness of the MMIS for future research and the role of internalization as a risk factor for the development of body image disturbances and eating disorders.

To evaluate bone mineral density (BMD) and body composition 11 years after the onset of anorexia nervosa (AN). Thirty-nine AN subjects (36 females, 3 males), selected from a population-based sample, and 46 matched controls (COMP; 43 females, 3 males) were examined by using double-energy X-ray absorptiometry (DXA). Only 2 women still had AN. None of the men had AN. The females in the AN and COMP groups did not differ regarding BMD, nor was there a difference across female groups concerning body mass index (BMI). The female AN group had a significantly lower percentage of body fat. BMD among females in the AN group was related to lowest BMI ever. There was an inverse relationship between lumbar BMD and AN duration. Low BMD is not overrepresented among weight-restored AN patients at long-term follow-up compared with healthy women. However, the inverse relationship between BMD and AN duration may be indicative of a risk for osteopenia in patients with subchronic and chronic AN.

This study sought to provide reference data for the Eating Disorder Inventory (EDI) with use of young adolescent black and white girls. Moreover, the study examined the relationship between race, age, socioeconomic status, and adiposity and each of the eight EDI scales. To achieve these aims, data were used that had been collected in Years 3, 5, and 7 as part of the National Heart, Lung, and Blood Institute Growth and Health Study, a longitudinal cohort study of risk factors for obesity in black and white girls. For the present report, data were available from 2,228 girls in Year 3, 2,056 girls in Year 5, and 1,902 girls in Year 7. EDI scores were found to vary by race, age, socioeonomic status, and body weight of respondents. Black girls scored different from white girls on all EDI subscales. Scores on all but two subscales (Body Dissatisfaction, Drive for Thinness) decreased significantly with increasing age. Significant inverse associations were found between maximum parental education and all EDI subscales except Body Dissatisfaction and Perfectionism. Elevated body weight was associated significantly with Body Dissatisfaction, Drive for Thinness, Bulimia, Interoceptive Awareness, and Ineffectiveness. Our results illustrate the importance of taking into consideration the potentially confounding role of demographic characteristics and body weight when comparing different race or ethnic groups on the EDI.

To study late-onset cases of eating disorders in order to (1) document the occurrence of these cases as truly new onset, even if postmenopausal; (2) to alert clinicians to the category of late-onset eating disorders, especially clinical features and treatment response; (3) to challenge some prevailing assumptions of etiology. Selection of cases of eating disorders with first onset after age 40 that met DSM-IV criteria, by review of eating disorders admissions to three university hospital programs. Eleven patients, approximately 1% of all cases of eating disorders, had first onset of an eating disorder after age 40 and as late as 77, with an average onset of 56 and clinical presentation at 60 years. They met DSM-IV criteria for all subtypes of eating disorders. In general, concurrent medical and comorbid psychiatric symptoms made recognition and treatment more complex. Truly late-onset cases do occur, challenging etiological theories requiring adolescent age of onset, premenopausal endocrine functioning, or adolescent psychodynamic conflicts. Late-occurring cases, after accurate diagnosis, require an appreciation of psychological themes pertinent to this age group, such as bereavement or unresolved body image issues. Age by itself is no barrier to onset of eating disorders, which may occur whenever self-starvation and/or binge-purge behaviors become entrenched as sustaining behaviors for amelioration of psychodynamic conflicts, mood disorders, or interpersonal distress.

Excessive weight or shape concerns and dieting are among the most important and well-established risk factors for the development of symptoms of disordered eating or full-syndrome eating disorders. Prevention programs should therefore target these factors in order to reduce the likelihood of developing an eating disorder. The aims of this study were to determine the short-term and maintenance effects of an internet-based prevention program for eating disorders. One hundred female students at two German universities were randomly assigned to either an 8-week intervention or a waiting-list control condition and assessed at preintervention, postintervention, and 3-month follow-up. Compared with the control group, the intervention produced significant and sustained effects for high-risk women. Internet-based prevention is effective and can be successfully adapted to a different culture.

We report a 28-year-old woman with a 4-year history of anorexia nervosa who abruptly developed massive ascites and moderate pedal edema associated with marked elevation of carbohydrate antigen (CA) 125, a serum tumor marker. She gained 8 kg over 2 weeks after having maintained a body mass index (BMI) of 12.2 kg/m2. The upper body was none-dematous, appearing dehydrated. The serum CA125 concentration was 688 U/ml (normal, <35U/ml). These findings initially suggested malignant disease within the abdominal cavity, particularly ovarian carcinoma. However, none was found and ascites disappeared completely with medical treatment alone. Her CA125 level normalized in parallel with the decrease in ascites. Marked ascites with an elevated CA125 level thus can result from anorexia nervosa.

The authors sought to describe a sample of adolescent males who reported disordered eating, to explore whether males with disordered eating are overweight or obese, and to determine if patterns displayed by females would be replicated with a male sample. Three school-based adolescent samples were selected. (1) 27 males reporting disordered eating (2) 27 physically matched controls, and (3) 27 randomly selected controls. Findings indicated that boys reporting disordered eating expressed greater body dissatisfaction, depression, restraint, and poorer interoceptive awareness compared to matched and randomly selected controls. Negative Emotionality and poor Interoceptive Awareness scores showed the strongest associations with eating pathology. Body mass index and Negative Emotionality scores showed the strongest relationships to restrained eating. Previous results for female adolescents were replicated, suggesting that findings for females can be generalized to males. Disordered eating appears to exist in the absence of significant weight problems in adolescent males.

This study reviews the published research on energy expenditure in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Individual studies are reviewed and their results summarized. The most consistent finding is a reduction in resting energy expenditure (REE) in patients with AN, which increases with increased energy intake and body weight. Data regarding BN are inconsistent. Three available studies in subjects with BED have not found evidence of changes in energy expenditure corrected for lean body mass compared with obese non-binge eaters. The ability to measure REE reliably and cost-effectively may aid in the refeeding of patients with AN in whom REE is reduced. Changes in individuals with BN and BED have yet to be consistently identified.

This study analyzes whether obese children have a higher risk of attention deficit/hyperactivity "characteristics" (AD/HD) than do children with other nutritional states. This study included 35,403 participants from 486 community schools. They completed the AD/HD scale of the Strengths and Difficulties Questionnaire (SDQ) and were weighed and measured. 2879 of the participants were obese and 78 were morbidly obese (BMI>40). A discrete, nonsignificant, increment was found in the AD/HD characteristics of male participants with morbid obesity, as compared with the other nutritional states. Among morbidly obese females, the prevalence of AD/HD characteristics was slightly superior, although not significantly, to that found in participants with normal weight, overweight or obese (BMI<40). Among nonclinical populations with a communitarian origin, previous findings reporting high rates of AD/HD in obese children are not replicated. This increment in the prevalence of AD/HD among hospitalized obese children could be the result of selection bias.

This study describes the rates of eating disorders in patients who present to the emergency department (ED) for any reason and examines the relationship between eating disorders, depression, and substance use in these patients. ED patients aged 14-20 years (n = 942) completed a computerized questionnaire. Analyses were conducted comparing individuals who screened positive for an eating disorder with those who did not based on demographics (gender, age, race, and public assistance), body mass index, substance use, and depression. Sixteen percent of patients screened positive for an eating disorder. These patients were more likely to also screen positive for depression and substance use. Males accounted for 26.6% of all eating disorders, and no difference was seen in rates across ethnic or income groups. Eating disorders are common amongst all patients aged 14-20 years presenting to the ED and are associated with high rates of psychiatric comorbidity. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012;45:883-890).

Objective: Among overweight and obese youths, rates of depression, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) are elevated. We analyze whether these emotional and behavioral problems are associated with specifically disordered eating pattern. Method: Participants in the study were 128 overweight and obese children/adolescents (BMI: m = 29.3, s = 4.5; BMI-SDS: m = 2.5, s = 0.4) between 8 and 15 years. Structured psychiatric assessments were conducted adopting a multimethod, multiinformant approach. Results: Children/adolescents with ODD symptoms showed increased eating in response to external cues and binge eating. ADHD symptoms were not associated with disordered eating behaviors. Children/adolescents with symptoms of depression and anxiety showed emotional and binge eating. In particular, overweight girls with symptoms of depression showed restrained eating. Discussion: Our results point to specific eating problems in overweight/obese children with ODD and depression/anxiety symptoms. The findings could help to tailor interventions to optimally meet the specific needs of overweight children with emotional and behavioral problems.

This study aimed to investigate the extent of eating problems and their association with self-esteem in girls aged 15-16. Six hundred and nine schoolgirls aged 15-16 completed a questionnaire examining eating behavior, self-esteem, and general psychological well-being. A subsample of 31 girls was subsequently interviewed in terms of eating behavior and self-esteem. The questionnaire findings revealed that 56% of girls felt too fat and had used some form of weight control strategy. In addition, 32% scored above the Hospital Anxiety and Depression Scale (HADS) threshold for anxiety and 43% reached the Rosenberg Self-Esteem Scale criterion for low self-esteem. Interviews confirmed that those showing abnormal eating behavior in the questionnaires did indeed show greater eating pathology as well as lower self-esteem. Interviews also revealed that those with high levels of eating concern showed greater levels of global self-dissatisfaction and higher dissatisfaction with their physical appearance and family relationships. The results suggest that preventative interventions targeted at girls with low self-esteem may be appropriate.

A detailed comparison was made of two methods for assessing the features of eating disorders. An investigator-based interview was compared with a self-report questionnaire based directly on that interview. A number of important discrepancies emerged. Although the two measures performed similarly with respect to the assessment of unambiguous behavioral features such as self-induced vomiting and dieting, the self-report questionnaire generated higher scores than the interview when assessing more complex features such as binge eating and concerns about shape. Both methods underestimated body weight.

To examine the extent to which the prevalence of self-reported dieting and the wish to be thinner changed in 7-15-year-old girls over a 3-year period, and to explore potential differences between cohorts recruited in 1995 and 1999. In addition, changes in eating attitudes (Children's Eating Attitudes Test [ChEAT]) were compared between 1995 and 1999. A three-wave longitudinal study including girls (n = 1,076-1,279) in five age groups (7, 9, 11, 13, 15, the Main Cohort) and an age-matched cross-sectional sample consisting of 1,759 girls (the Societal Cohort). A marked increase of the wish to be thinner was evident in the 10-14-year-old age range and significant increases in dieting attempts occurred mainly among 9-13-year-old girls. ChEAT scores were significantly higher among 11-year-olds in 1999 than in 1995. However, more 7-year-olds scored above the ChEAT cutoff (</=15) in 1995 compared with 1999. There was an increasing trend in the wish to be thinner and in dieting attempts among 9-14-year-olds. Attitudes and behaviors associated with disturbed eating had increased between 1995 and 1999 only among the 11-year- olds.

The authors studied the prevalence rates of eating disorders (ED) and their risk factors in a Spanish population aged 12-18 years. A two-stage epidemiologic study was conducted in the province of Valencia. Educational centers, classrooms, and individuals were selected randomly. The initial sample comprised 544 subjects. During Stage 1, subjects were screened with the 40-item Eating Attitude Test and a sociodemographic questionnaire that evaluates risk factors. During Stage 2, a semistandardized clinical interview was conducted with each participant. A random control group was paired by class, age, and sex. Comorbid psychiatric disorders and partial and subclinical forms were detected using criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Using DSM-IV criteria, the morbidity rate was 2.91%, women comprised 5.17% of the sample, men comprised 0.77% of the sample, and the sex ratio was 6.71. Using DSM-IV criteria, including subclinical forms, the morbidity rate was 5.56%, women comprised 10.3% of the sample, men comprised 1.07% of the sample, and the sex ratio was 9.63. Six risk factors were isolated: psychiatric comorbidity, friend on a diet in the last year, desire to lose weight, desire to be less corpulent, sentimental problems, and diet in the last year. This is the first Spanish two-stage epidemiologic study to include a control group and to investigate risk factors.

To study reproduction in a representative group of anorexia nervosa (AN) cases. Fifty-one adolescent-onset AN cases (48 women; three men), originally recruited after community screening, and 51 matched comparison cases (COMP) were interviewed 18 years after AN onset at a mean age of 32 years, regarding pregnancies and early development of the children. The results of the 48 AN and 48 COMP group women are reported in the present study. Six women still had an eating disorder (ED), none of whom had become a mother. Twenty-seven women in the AN group and 31 women in the COMP group had children. Three women had an ED during pregnancy. Mean age at birth of the first child was lower in the AN group. Five AN women reported postpartum depression. Children in the AN group had significantly lower birth weight than the children in the COMP group. No other complications during pregnancy and the neonatal period differed across groups. Feeding difficulties were not overrepresented among the children of the AN group. Adults who had recovered from teenage-onset AN did not differ in most aspects from matched controls with respect to pregnancies and development of their offspring.

The print media's depiction of the ideal of feminine beauty as presented to American women was examined for the years 1959-1999. Trends were investigated through an analysis of cover models appearing on the four most popular American fashion magazines. Body size for fashion models decreased significantly during the 1980s and 1990s. There was also a dramatic increase in the frequency with which the media depicted the entire bodies of the models from the 1960s to the 1990s. Both the increasingly thin images and the striking increase in full-body portrayals suggest an increase in the value placed by American society on a thin ideal for women, a change that is concurrent with the increase in disturbed eating patterns among American women.

With Russell's description of bulimia nervosa in 1979, followed by the DSM-III diagnosis of bulimia, a "new" eating syndrome found its official acceptance in the scientific world. In the two preceding decades clinicians and researchers gradually payed more attention to special forms of overeating. In the 1970s the nosographic conceptualizations of binge eating, bulimia, compulsive eating, or hyperorexia clearly shifted from a symptom level--closely connected to anorexia nervosa and/or obesity--to a syndrome level. Around the same time and independently from one another, clinicians from different countries proposed various descriptive labels for this new diagnostic entity, which, finally, became accepted as bulimia nervosa.

Rates of anorexia nervosa among females presenting to specialist services in northeast Scotland had increased significantly between 1965 and 1991. We sought to elucidate possible causes of this change. Hospital and primary care records were searched. Age, weight, and body mass index (BMI) were determined for 196 patients and duration of symptoms from onset to presentation was established in 190 cases. Changes in these parameters were investigated over the 27-year period of the study. There was no significant change in duration of illness or in age at presentation. BMIs increased significantly, but this arose because patients decreased in height, not because they increased in weight. There was no increase in seriously underweight patients with BMIs of < or =15. Anorexic females were not referred at an earlier stage of their illness, but primary care teams may be identifying and referring milder cases. Alternatively, the findings may reflect an increasing incidence of eating disorders coupled with changes in their presenting symptomatology.

In the recent literature on eating disorders, little attention is usually given to the possible role played by heightened death fears and anxieties and failed death transcendence in the dynamics of patients who suffer from anorexia and bulimia nervosa. For reasons that remain unclear, early texts and articles in the literature do address death themes, particularly as they are discernible from patients' dreams and nightmares. Thomä's 1967 text Anorexia Nervosa may be interpreted as giving further illustration to this thesis.

The aim of this study is to describe mortality rates and causes of death for patients with eating disorders. By means of record-linkage, the study includes all patients admitted and diagnosed as suffering from an eating disorder according to the ICD-8 classification system during the period 1970-1993 at any Danish psychiatric (since 1970) or somatic department (since 1977). The study includes 2,763 cases, of which 237 are males. Maximum follow-up time is 23 years and mean follow-up time is 10.3 years. Crude mortality at follow-up is 8.4%. A significant excess mortality is demonstrated since the standardized mortality ratio (SMR) of the total patient population is 6.69 (CI 5.68-7.83) and the highest rate ratio (RR) of 14.92 (CI 9.66-22.03) relates to women aged 25-29. The study documents a significant excess mortality among eating-disordered patients.

We present a case (from a series) of a young woman suffering from a particular abnormality in her behavior with regards to food: She ingests large quantities of food to immediately vomit it. This behavior becomes progressively the central activity and concern of the patients. Both the desire of eating food and of vomiting it are imperious, but they are not experienced as foreign to the self, are considered as an 'irresistible temptation.' Among the secondary symptoms we find pertinacious constipation and dysthymic states each time more intense and prolonged. (2) The clinical picture evolves toward a narrowing of existence and a greater limitation of social and work abilities. (3) A phenomenological analysis of the major symptom is attempted, in order to establish essential differences with regards to hysteric, obsessive, and delusional phenomena. A special place is granted to the differential diagnosis with regards to anorexia nervosa and psychogenic obesity. (4) The clinical picture presented by these patients is considered as constituting an independent syndrome. This syndrome can be subordinated to the broader group of addictions.

To study excess mortality, causes of death, and co-morbidity in patients with eating disorder (ED), treated in a Swedish specialist facility. A retrospective cohort study of 201 patients with ED followed from 1974 to year 2001 in the Swedish Causes of Death Register (SCODR). Standardized mortality ratio (SMR) was calculated with respect to the Swedish population, by gender, age, and calendar time. In the complete follow-up of 201 patients, 23 had died. At a mean follow-up of 14.3 years the overall SMR was 10. Patients with body mass index (BMI) over 11.5 had an average SMR of about 7 and for those with BMI lower than 11.5 had SMR above 30. Six patients died from AN/starvation, nine due to suicide, and eight from other causes. SMR in anorexia nervosa (AN) is high but not in bulimia nervosa. A risk stratification of AN, based on BMI is suggested.

The current study compared the eating disorder and anxiety disorder literature in terms of research design and methodologic features in 1980, 1990, and 2000. Computer literature searches were conducted using PubMed and PsychInfo databases to identify relevant eating disorder and anxiety disorder articles published at each of the three time points. A total of 456 articles were randomly selected, including 228 articles from the eating disorder literature and the anxiety disorder literature. Within each specific literature, one third (76) of the articles were selected from each of the three time points (1980, 1990, 2000). Two raters, from a team of eight trained raters, were randomly assigned to independently rate each article in terms of 75 separate methodologic features. Disagreements in ratings were resolved via consensus. Ratings were tabulated separately for eating disorders and anxiety disorders across the three time points. Although there were some differences between anxiety disorders and eating disorders, most of the variables did not substantially differ between these two fields. There was a consistent trend for both fields to show increases in more rigorous methodologies over time. However, both the eating disorder literature and the anxiety disorder literature were characterized by a pervasive absence of many recommended methodologic procedures across the past two decades. Although the eating disorder literature and the anxiety disorder literature are increasingly characterized by improved reporting of rigorous methodologic procedures, there is still a pervasive absence of such procedures in both literatures, which limits the strength of inference in these studies.

The current study compared the eating disorder literature and the anxiety disorder literature in terms of statistical hypothesis testing features in 1980, 1990, and 2000. Computer literature searches were conducted using PubMed and PsychInfo databases to identify relevant eating disorder and anxiety disorder articles published at each of the three time points. A total of 456 articles were randomly selected, including 228 articles each from the fields of eating disorders and anxiety disorders. Within each field, one third (76) of the articles were selected from each of the three time points. Two raters, from a team of eight trained raters, were randomly assigned to independently rate each article in terms of 75 separate methodologic features. In the current article, we will emphasize the findings about hypothesis testing and statistical analysis. Disagreements in ratings were resolved via consensus. Ratings were tabulated separately by field across the three time points. Few differences were observed between eating disorder and anxiety disorder publications in terms of statistical hypothesis testing features. Although increases were observed in both fields in a number of areas from 1980 to 2000, there remains a pervasive absence of many of the statistical hypothesis testing features recommended by the American Psychological Association Task Force on Statistical Inference. These results are discussed in terms of their implications for the fields of eating disorders and anxiety disorders, for researchers, for reviewers, and for professional journals and editorial boards.

To examine the clinical profile of Chinese eating disorder patients at a tertiary psychiatric clinic in Hong Kong from 1987 to 2007. Data on 195 consecutive patients were retrieved from a standardized intake interview by an eating disorder specialist. Patients seen between 1987-1997 (n = 67) and 1998-2007 (n = 128) and fat-phobic (n = 76) and nonfat-phobic (n = 39) anorexic patients were compared. Patients were predominantly single (91.8%), female (99.0%), in their early-20s and suffered from anorexia (n = 115; 59.0%) or bulimia (n = 78; 40.0%) nervosa. The number of patients increased twofold across the two periods. Bulimia nervosa became more common while anorexia nervosa exhibited an increasingly fat-phobic pattern. Nonfat-phobic anorexic patients exhibited significantly lower premorbid body weight, less body dissatisfaction, less weight control behavior, and lower EAT-26 scores than fat-phobic anorexic patients. The clinical profile of eating disorders in Hong Kong has increasingly conformed to that of Western countries.

To investigate whether the prevalence of bulimic behaviors and weight control practices changed between 1990 and 1997. In November 1997, we surveyed a representative sample of 2,130 adult subjects in West Germany and 2,155 subjects in East Germany. We asked subjects about binge eating, vomiting, use of laxatives, appetite suppressants and diuretics, and about dieting, weighing, and exercise. As the same questions had been used in a representative survey (N = 1,773) in autumn 1990 in West Germany, trend comparisons for prevalence between 1990 and 1997 are possible. The prevalence of severe eating binges twice a week dropped nonsignificantly between 1997 and 1990 from 3.1% to 2.4% in men and from 2.3% to 1.3% in women. In men, the prevalence of binge eating disorder dropped nonsignificantly from 2.4% to 1.5%, the prevalence of bulimia nervosa from 2.1% to 1.1%. In women, the prevalence of binge eating disorder dropped nonsignificantly from 1.5% to 0.7% and that of bulimia nervosa from 2.4% to 1.1%. The prevalence of bulimic behaviors decreased slightly during 1990 and 1997 in the West German population.

To study the occurrence of eating disorders in patients admitted to somatic hospitals. For all, approximately 3.3 million, admissions to Norwegian general hospitals in the period 1990-1994, admissions with the primary diagnoses for the eating disorders anorexia nervosa (AN) and bulimia nervosa (BN) were selected. Data on gender, age groups, emergency admission, different hospital types, length of stay, seasonal differences, and differences along the latitudes were related to the primary diagnosis. A small number of men with eating disorders were admitted; 9-17 times more women were admitted (140-183 female and 11-15 male admissions per year). The male/female ratio was on the mean 8% for the period. About two thirds to three fourths were emergency admissions. The mean length of stay was 12-19 days, and the median stay was 6-8 days. A significant (p = .03) season of admission was found. A significant number of admissions occurred in the beginning of March and a minimum in June. The best model was two harmonics without trend. There are few reports on eating disorders in somatic inpatients in the literature, but our results indicate that it is important to consider the general hospital in this connection. Bulimia nervosa was rather unusual in the present study, while anorexia nervosa was prevalent, specifically for women. Seasonality has rarely been reported in relation to hospitalization.

This study investigated the point prevalence of probable cases of bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS), and specific eating disorder symptomatology among 6,844 undergraduate women at a single site, examining changes across five 3-year time periods and on a yearly basis from 1990 to 2004. Participants completed a self-report checklist that assessed the diagnostic criteria for BN (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 1994) and the Bulimia Test (Smith and Thelen, J Consult Clin Psychol, 52, 863-872, 1984) (BULIT) or Bulimia Test-Revised (Thelen et al., Psychol Assess, 3, 119-124, 1991) (BULIT-R). Chi-square analyses comparing the percentages of probable cases of BN and EDNOS and the percentages of women who reported frequent binge eating and most compensatory weight control strategies were nonsignificant. Only the percentages of women who endorsed overconcern with weight and shape and diuretic use and excessive exercise as compensatory weight control strategies changed over time. Consistent with Keel et al.'s (Keel et al., Psychol Med, 36, 119-127, 2006) findings regarding the point prevalence rates of BN from 1992 to 2002, results indicated that probable cases of eating disorders remained relatively stable. Methodologically, this research illustrates the importance of examining multiple data points when investigating stability or change in behavior.

This study investigated demographic and diagnostic characteristics of individuals whose medical record or death certificate indicated the presence of anorexia nervosa at the time of death. Two national registers, the National Patient Register (NPR) and the Causes of Death Register (CODR), were examined in Norway for anorexia nervosa-related deaths occurring across a 9-year period (1992-2000). The medical record or death certificate listed anorexia nervosa as a diagnosis or cause of death for 66 individuals. Rates of death were 6.46 and 9.93 per 100,000 deaths for the NPR and the CODR, respectively. A substantial percentage of deaths (43.9%) in both registers occurred at or above the age of 65 years. For the NPR, the mean age at the time of death was 61 years and 31% of deaths occurred among men. For the CODR, the mean age at the time of death was 49 years and 18% of deaths occurred among men. Potential merits and shortcomings of assessing mortality rates using register-based data without linkage to a previously identified clinical sample are discussed.

This study examines secular trends in eating problems among adolescents between 1992 and 2010. The study aims further to investigate whether such trends can be accounted for by secular changes in putative risk factors. Three nationwide surveys of Norwegian senior high-school students were conducted in 1992, 2002, and 2010 (response rates 97.0, 91.0, and 83.2%). At each time point, approximately 3,000 adolescents participated. Eating problems were assessed by means of the Dieting and the Bulimia and Food Preoccupation subscales of the Eating Attitude Test-12. Moreover, a variety of potential risk factors that might account for time trends in such problems were measured. Dieting scores increased almost linearly for both genders during the research period. No differences over time in Bulimia and Food Preoccupation scores were seen among boys, whereas these symptoms peaked in 2002 for girls with considerably lower levels in both 1992 and 2010. The increase in Dieting from 1992 to 2010 for both genders could be attributed in part to increasing body mass index levels and, to a lesser degree, to depressive symptoms among females. The girls' time trend in Bulimia and Food Preoccupation was to some extent related to changes in appearance satisfaction, alcohol intoxication, and global self-worth. This study is one of few to statistically examine how secular trends in eating problems are related to changes in putative risk factors. The study does not however provide conclusive information on the causal direction between putative risk factors and eating problems. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014).

This study investigated changes in symptom severity and the psychopathology of patients with bulimia nervosa between 1993 and 2003. Pretreatment data of patients diagnosed with bulimia nervosa, collected between 1993 and 1997 from two multisite studies (N = 263), and from 2001 to 2003 from a third multisite study (N = 233) were compared for differences in psychopathology, eating disorder symptoms, and demographic characteristics. There was a significant increase in baseline age between the cohorts (1993M = 28.7 +/- 7.9, 2001M = 30.3 +/- 8.7, p = 0.036) together with a decrease in personality disorders and in several aspects of eating disorder psychopathology. After controlling for age however, significant pretreatment differences were found only in the restraint subscale on the EDE. Results suggest that the presentation of individuals with bulimia nervosa has changed between 1993 and 2003, in that participants were older and demonstrated less dietary restraint. Hence, comparisons between samples and treatment trials over time must be made with caution.

To examine trends in weight control practices from 1995 to 2005. The Youth Risk Behavior Surveillance System biennially assesses five weight control behaviors among nationally representative samples of United States high school students. Across time, more females than males dieted (53.8% vs. 23.8%), used diet products (10% vs. 4.3%), purged (7.5% vs. 2.7%), exercised (66.5% vs. 46.9%), or vigorously exercised (42.8% vs. 36.8%). All weight control behaviors among males increased during the decade. Black females were less likely than Hispanic females, who were less likely than White females, to practice weight control. White males were less likely than Black males, who were less likely than Hispanic males, to practice weight control. The ethnic difference in weight control practices is consistent across time. All male adolescents are at increasing risk for developing eating disorder symptomatology, and Black females appear to continue to resist pressure to pursue thinness.

To measure the cooccurrence of obesity and eating disorder (ED) behaviors in the South Australian population and assess the change in level from 1995 to 2005. Two independent cross-sectional single stage interview based population surveys were conducted a decade apart. Self-reported height, weight, ED behaviors, and sociodemographics were assessed. Changes between the two time points were analyzed. From 1995 to 2005 the population prevalence of comorbid obesity and ED behaviors increased from 1 to 3.5%. Comorbid obesity and ED behaviors increased more (prevalence odds ratio (POR) = 4.5; 95% confidence interval (CI) = 95% CI = [2.8, 7.4]; p < .001) than either obesity (POR = 1.6; 95% CI = [1.3, 2.0]; p < .001) or ED behaviors (POR = 3.1; 95% CI = [2.3, 4.1]; p < .001) alone. Comorbid obesity and ED behaviors are an increasing problem in our society. Prevention and treatments efforts for obesity and EDs must consider and address this increasing comorbidity.

Despite a lack of data demonstrating benefit, psychotropic medications are frequently prescribed for patients with anorexia nervosa. We studied 525 women (18–54 years of age) with anorexia nervosa who presented to the Clinical Research Center at the Massachusetts General Hospital between January 1997 and December 2009. For this analysis, participants were a priori divided into two groups based on date of presentation (Group I: participants presenting between 1997 and 2002; Group II: participants presenting between 2003 and 2009). Overall, 53% of participants reported current use of any psychotropic medication; 48.4% reported use of an antidepressant and 13% reported use of an antipsychotic. Twice as many participants in Group II (18.5%) reported using atypical antipsychotics as compared to Group I (8.9%) (p = 0.002). A majority of participants with anorexia nervosa report using psychotropic medications despite lack of data supporting their efficacy. These data are concerning given the known adverse effects of these medications. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)

In this research study, we examine how both overweight and nonoverweight adolescent girls and boys fared from 1999 to 2010 in terms of disordered eating behaviors and psychosocial well-being. A repeated cross-sectional design was used. Participants were recruited from public schools in 1999 (n = 3072, mean age = 14.6 ± 1.8) and 2010 (n = 2793, mean age = 14.4 ± 2.0). Secular trends were examined by weight status and gender using inverse probability weighting to control for changes in socio-demographics. In general, the prevalence of disordered eating behaviors and markers of psychosocial well-being among overweight girls and boys remained the same from 1999 to 2010. In contrast, among nonoverweight girls, chronic dieting, unhealthy weight control behaviors, and extreme weight control behaviors decreased, and body satisfaction improved during this time period. Further, among non-overweight boys, the prevalence of unhealthy and extreme weight control behaviors decreased, as did mean depression scores. Overall, findings indicate a strong need to ensure that messages about the dangers of disordered eating behaviors are reaching overweight youth. Obesity prevention interventions should not overlook the comorbid nature of obesity, disordered eating and poor psychosocial health; prevention programming should address shared risk factors, including dieting, media use, body dissatisfaction, and weight-related teasing. © 2014 Wiley Periodicals, (Inc. Int J Eat Disord 2015). © 2015 Wiley Periodicals, Inc.

The purpose of this paper is to explore the relationship between binge eating disorder (BED) and obesity. Recent literature relating to the etiology, risk factors, pathophysiology, and treatment of binge eating disorder was reviewed. The data suggest that binge eating may be a contributor to the development of obesity in susceptible individuals. Although eating disorders treatment in the absence of obesity treatment does not result in large weight losses, amelioration of binge eating does result in small weight losses and decreased weight regain over time. Our challenge in the future is to understand better the ways in which BED and obesity co-exist, and to find treatment strategies that will relieve the distress and dysfunction due to this disordered eating while enhancing appropriate weight loss or preventing further weight gain.

To update new evidence for psychotherapies in eating disorders (EDs) since 2005-September 2012. Completed and published in the English language randomized controlled trials (RCTs) were identified by SCOPUS search using terms "bulimia" or "binge eating disorder" (BED) or "anorexia nervosa" (AN) or "eating disorder" and "treatment," and 36 new RCTs met inclusion criteria. There has been progress in the evidence for family based treatment in adolescents with AN, for cognitive behavior therapy (CBT) in full and guided forms, and new modes of delivery for bulimia nervosa (BN), BED, and eating disorder not otherwise specified with binge eating. Risk of bias was low to moderate in 22 (61%) of RCTs. The evidence base for AN has improved and CBT has retained and extended its status as first-line therapy for BN. However, further research is needed, in particular noninferiority trials of active therapies and the best approach to addressing ED features and weight management in co-morbid BED and obesity. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:462-469).

To prospectively explore the relationship between exposure to potentially distressing news content and disordered eating. Within 2 weeks of the March 3, 2011 Japan earthquake, an online survey was conducted among non-Japanese adults in distant countries (N = 698) assessing time spent on TV and the internet watching the news as well as peritraumatic reactions to the news and sleep disturbance. Participants were invited to complete a followup survey two months later [n = 113, mean age (SD) = 38.8 (11.91), 73% female] reporting on eating disorder symptoms. Exposure to TV and, to a lesser extent, internet coverage of the Japan disaster were associated with disordered eating, in particular dieting and oral control, as measured by the eating attitudes test. Peritraumatic reactions and sleep disturbance displayed specific patterns of association with disordered eating. Exposure to media coverage of distant disasters may be associated with increased disordered eating. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012;45:845-849).

This study evaluated an eating disorder intervention multimedia program modeled after self-help eating disorder treatment programs. It was hypothesized that women who completed the program would increase their body satisfaction and decrease their preoccupation with weight and frequency of disordered eating behaviors. Participants were 57 undergraduate females randomly assigned to either the intervention or control group. Psychological functioning was assessed at baseline, at 3 months postintervention, and at 3 months follow-up. Intervention group subjects significantly improved their scores on all psychological measures over time. When compared to the control group, however, only the intervention group's improvements on the Body Shape Questionnaire were statistically significant. This study has demonstrated that minimally effective eating disorder intervention programs can be delivered. A revised program that eliminates interface problems and increases the structure of the intervention is likely to be even better received and more effective.

As part of a larger prognostic study of anorexia nervosa, clinical features at presentation of 24 males with anorexia are described, and compared with a female group matched for date of admission. Data were extracted from the original case records and follow-up interview. The study confirms the view that males display the classical syndrome of anorexia nervosa, but differs from previous studies in several respects. Age at onset (mean 18.6 years) and at presentation (mean 20.2 years) is later, with a mean duration of illness at presentation of only 1.6 years. A premorbid tendency to obesity is confirmed; maximum weight loss during the illness amounted to 42% matched population mean weight (MPMW), and weight at presentation was 78.5% MPMW, somewhat higher than the female group. In keeping with earlier studies, binging and vomiting were noted commonly, in around half of sufferers, but laxative abuse was less frequent and excessive exercising more frequent in males. Depressive and obsessional symptoms are common in both groups, and a strong family history of affective disorders and alcohol abuse was noted in over one third.

This study examined the relationship between perfectionism and outcome in anorexia nervosa (AN). Seventy-three patients received inpatient treatment for AN. Participants completed the Eating Disorder Inventory (EDI) at admission to (n = 55), at discharge (n = 27), and at a median of 15.9 months (n = 49) after inpatient treatment. At follow-up, participants also completed the Multidimensional Perfectionism Scale (MPS) and their scores were compared with those of healthy controls. EDI Perfectionism was associated with illness status. A lower EDI Perfectionism score at admission was associated with a better response to treatment, which was subsequently associated with better outcome at follow-up. Both the good and poor outcome groups had significantly higher MPS total perfectionism scores than healthy controls. The EDI measures an aspect of perfectionism that is sensitive to illness status, whereas the MPS is less dependent on clinical state and may reflect a common personality trait that persists with remission of disease.

Objective We examined how parental characteristics and other aspects of family background were associated with the development of eating disorders (ED) in males and females. Method We used register data and record linkage to create the prospective, total-population study the Stockholm Youth Cohort. This cohort comprises all children and adolescents who were ever residents in Stockholm County between 2001 and 2007, plus their parents and siblings. Individuals born between 1984 and 1995 (N = 249, 884) were followed up for ED from age 12 to end of 2007. We used Cox regression modeling to investigate how ED incidence was associated with family socioeconomic position, parental age, and family composition. ResultsIn total, 3,251 cases of ED (2,971 females; 280 males) were recorded. Higher parental education independently predicted a higher rate of ED in females [e.g., adjusted hazard ratio (HR) 1.69 (95% CI: 1.42, 2.02) for degree-level vs. elementary-level maternal education], but not in males [HR 0.73 (95% CI: 0.42, 1.28), p < 0.001 for gender interaction]. In females, an increasing number of full-siblings was associated with lower rate of ED [e.g., fully adjusted HR 0.92 (95% CI: 0.88, 0.97) per sibling], whereas an increasing number of half-siblings was associated with a higher rate [HR 1.05 (95% CI: 1.01, 1.09) per sibling]. DiscussionThe effect of parental education on ED rate varies between males and females, whereas the effect of number of siblings varies according to whether they are full or half-siblings. A deeper understanding of these associations and their underlying mechanisms may provide etiological insights and inform the design of preventive interventions. (c) 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:693-700)

We conducted a critical literature review on studies assessing the prevalence of anxiety disorders (AD) in subjects with eating disorders (ED) (anorexia nervosa and bulimia nervosa). In the first part, we discuss methodological issues relevant to comorbidity studies between ED and AD. In the second part, taking into account these methodological considerations raised, we summarize the findings of these studies. We performed a manual and computerized search (Medline) for all published studies on comorbidity between ED and AD, limiting our search from 1985-2001 to get sufficiently homogeneous diagnostic criteria for both categories of disorders. Too few studies include control groups and few studies have compared diagnostic subgroups of ED subjects, with scarce or conflicting results. We discuss the results taking into account the methodological problems observed. We give guidelines for reviewing the results of published studies and planing future research.

This paper reports part of the data from a comparative trial of two forms of family intervention for the management of eating disorders in adolescents. Measures of family process at the beginning of treatment included Expressed Emotion (EE) and the Family Adaptability and Cohesion Evaluation Scales (FACES). EE in the families of both anorexic and bulimic patients were, on the whole, at low levels. The low levels of parental Critical Comments might be taken to represent the conflict avoiding character of the families of psychosomatic patients. However, the families showed low levels of Emotional Overinvolvement, which contradicts the clinical descriptions. The FACES scores revealed patterns that were superficially contradictory to the accepted clinical descriptions in that the patients appeared to have perceived their families as not close and as highly structured. The parents experienced their family structure as more similar to the clinical descriptions, scoring their families as more flexible and cohesive than do the patients. The FACES ideals for family organization scored by patients and parents more nearly equate with the clinical descriptions of enmeshment and lack of boundary structure. The relationship between the research findings and the clinical evaluation will be discussed.

To analyze whether caregiver and family characteristics predict success in a family-based lifestyle intervention program for children and adolescents. Participants were 111 overweight and obese children (7-15 years) who attended a family-based weight-reduction program. Body mass index (BMI) and BMI standard deviation scores (BMI-SDS) of index child, and BMI of family members, family adversity characteristics, depression, and attachment attitudes of the primary caregiver were assessed. Risk of nonresponse (<or=5% reduction of BMI-SDS or dropout) was elevated in older children, cases with obese sibling(s), maternal depression, and avoidant attachment attitude. In a logistic regression analysis, maternal depression, attachment attitude, and age of index child explained common variance whereas the presence of obese siblings explained unique variance in nonresponding. To meet the specific needs of all participating families and to prevent the discouraging experience of failure in weight-control interventions, our data suggest that special support should be provided to adolescents with obese siblings, and cases of maternal depression, and avoidant attachment attitude.