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Epidemiology of Eating Disorders
Abstract
In the current chapter eating disorders are defined, with particular emphasis on the eating disorder not otherwise specified (EDNOS) category. Possible changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for eating disorders are discussed, along with the rationale for these changes. The major prevalence studies are reviewed, as are incidence studies. The mortality associated with eating disorders is described, followed by a review of the status of broad risk factors for eating disorders, including sociodemographic, sociocultural and genetic.
... Over 30 million Americans suffer from eating disorders [29,33,60,66]. Eating disorders "are characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning" [1]. ...
... The Diagnostic and Statistical Manual (DSM-5) recognizes eight types of eating disorders: anorexia nervosa, bulimia nervosa, binge-eating disorder, pica, rumination disorder, avoidant/restrictive food intake disorder, other specified feeding and eating disorders (OSFED), and unspecified feeding or eating disorder (UFED). The factors driving individuals into disorder are social, neuro-chemical, and psychological [60,66]. Most individuals who suffer from eating disorders hold a combination of these factors, none being necessary nor sufficient (ibid). ...
... Social-psychological pressures because of an unrealistic conception of an ideal feminine body have been routinely shown to have a significant influence for many in developing an eating disorder and to be major inhibitors of a full recovery from them. Furthermore, the normative pressures affecting women do not appear the same for the over 10 million men in the United States with eating disorders, many of whom hold highly masculine conceptions of ideal male bodies [66]. By performing a narrative analysis of original data from 200 accountholders on social media and eating disorder support forums, I examine how the experiences of eating disorders and recovery vary by gender. ...
Studies examining the social forces behind eating disorders have found that unrealistic conceptions of feminine beauty exert pressure on millions of women suffering from eating disorders. However, untenable feminine ideals do not explain the social factors affecting men. Utilizing narrative and content analyses of accounts of women and men on Tumblr and eating disorder recovery support groups, this paper finds that men experience eating disorders and recover differently from women. Gender salience, and not simply femininity, had a powerful effect on the recovery process for both women and men. Drawing from the sociologies of narrative, gender, and masculinity studies, this study provides a more nuanced and consequential way of understanding eating disorder recovery and how recovery trajectories vary by gender. Four categorical narrative types emerged from the sample: Ecological, Sickened, Abused, and Warrior. Language in the narratives relied on traditional gender roles, and each narrative lead to different proportions of recovery outcomes. Individuals in this study used one of four narrative types. The warrior narrative, which was the only one used by men, was associated with a higher rate of relapse. The propensity to relapse varied between the narrative types, suggesting some may be more conducive for recovery.
... Eating disorders are becoming more common in the United States and currently affect approximately 20 million women and 10 million men [1]. They are defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) as "a persistent disturbance of eating or eating-related behavior that results in altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning" [2]. ...
... The majority of studies regarding bone mineral density in the eating disorder population are limited by small study populations and narrow demographics, making clear recommendations challenging. For example, male subjects are rarely included in current studies but are an increasingly important presence in the eating disorder population [1]. Clear guidelines are urgently needed given the susceptibility of the typical, young eating disorder patient to lifelong debilitating fractures. ...
Aim
To review current medical literature regarding the causes and clinical management options for low bone mineral density (BMD) in adult patients with eating disorders.
Background
Low bone mineral density is a common complication of eating disorders with potentially lifelong debilitating consequences. Definitive, rigorous guidelines for screening, prevention and management are lacking. This article intends to provide a review of the literature to date and current options for prevention and treatment.
Methods
Current, peer-reviewed literature was reviewed, interpreted and summarized.
Conclusion
Any patient with lower than average BMD should weight restore and in premenopausal females, spontaneous menses should resume. Adequate vitamin D and calcium supplementation is important. Weight-bearing exercise should be avoided unless cautiously monitored by a treatment team in the setting of weight restoration. If a patient has a Z-score less than expected for age with a high fracture risk or likelihood of ongoing BMD loss, physiologic transdermal estrogen plus oral progesterone, bisphosphonates (alendronate or risedronate) or teriparatide could be considered. Other agents, such as denosumab and testosterone in men, have not been tested in eating-disordered populations and should only be trialed on an empiric basis if there is a high clinical concern for fractures or worsening bone mineral density. A rigorous peer-based approach to establish guidelines for evaluation and management of low bone mineral density is needed in this neglected subspecialty of eating disorders.
... Further, as the mortality rate for bulimia nervosa increases, the suicidal risk for bulimic inpatients also increases, with marked three-fold risk (Fichter & Quadflieg, 2016;Suokas et al., 2013). Correspondingly, the cause of death mentioned in death certificates is not mainly due to eating disorders, but the consequences of eating disorders, such as suicide (refusal to eat can also be a form of suicide) and cardiovascular diseases (Patel et al., 2015;Suokas et al., 2013;Wade, 2007). In 2004, the data for eating disorders marked that there are 1 out of 250 cases for females and 1 out of 2,000 cases for males are anorexic. ...
... Only the articles about help-seeking and online treatments considered outdated articles (2000 to 2008) due to limited researches. The study evaluated 10 reviews (Aardoom et al., 2013;Amichai-Hamburger et al., 2014;Beintner et al., 2014;Fjeldsoe et al., 2009;Martin et al., 2011;Pike & Dunne, 2015;Scaglioni et al., 2018;Schwartz et al., 2019; G. T. Wilson & Zandberg, 2012), 5 meta-analyses (Fogarty et al., 2016;Le, Barendregt, Hay, & Mihalopoulos, 2017;Loucas et al., 2014;Prefit et al., 2019;Sibeoni et al., 2017), 3 commentaries (Agras et al., 2017;Schulte et al., 2017;Wade, 2007), 2 unspecified (Chavez & Insel, 2007;Lewis & Nicholls, 2016), and 1 critical evaluation (Sysko & Walsh, 2008). ...
Eating disorder has been comprehensively reported in different contexts. Assuming it can also exist in the Philippine context, the exponential in data, from another context, suggests that if eating disorders are not addressed, this can be alarming to the society that an illness could lead to its fatality. Online treatments are widely accepted as a first step in treating eating disorders. This study included four non-sequential phases divided into two aspects: (1a) descriptive; (2a) qualitative; (3b) design; and (4b) evaluation. The study was guided by the Self-Affirmation Theory and Theory of Planned Behavior. The baseline in developing a mobile-based prevention program was explored and enriched for future development. Results indicated that the mobile-based application would be highly feasible and acceptable to both symptomatic individuals and clinicians; and the suggested improvements were noted. The study aims to increase awareness of eating disorders in the Philippines. Recommendations concerning the methodology, psychological program, and technical improvements, and program compliance were discussed.
... Eating disorders typically treated in DP settings include anorexia nervosa, where patients are underweight and may or may not exhibit other disordered eating behaviours such as purging or binge eating, and bulimia nervosa, non-underweight patients where binge eating occurs in conjunction with behaviours designed to offset weight gain, such as purging, exercise or fasting. Lifetime prevalence of these two disorders in females has been estimated at 3.0% to 4.6% and 4% to 6.7% [2]. ...
... This research was a pragmatic evaluation, i.e., evaluation of the effectiveness of an intervention in the real world setting where the intervention was adjusted in response to evidence, clinical expertise, and patient preference. Sequential adjustments to the DP format included: (1) reducing costs associated with service provision (staffing and meals) and (2) improving the opportunity to develop autonomy in the recovery process through providing pre-determined admission lengths, prohibiting socialisation with other patients outside of program, and limiting crisis support. Both adjustments transferred greater responsibility to the patient for change. ...
The use of a Day Program (DP) format (i.e., intensive daily treatment with no overnight admission) has been shown to be an effective treatment for eating disorders (EDs). The disadvantages, however, include higher cost than outpatient treatment (including costs of meals and staff), greater disruption to patients’ lives, and the use of a highly structured and strict schedule that may interrupt the development of patients’ autonomy in taking responsibility for their recovery. This study investigated whether reducing costs of a DP and the disruption to patients’ lives, and increasing opportunity to develop autonomy, impacted clinical outcomes. Three sequential DP formats were compared in the current study: Format 1 was the most expensive (provision of supported dinners three times/week and extended staff hours); Format 2 included only one dinner/week and provision of a take-home meal. Both formats gave greater support to patients who were not progressing well (i.e., extended admission and extensive support from staff when experiencing feelings of suicidality or self-harm). Format 3 did not provide this greater support but established pre-determined admission lengths and required the patient to step out of the program temporarily when feeling suicidal. Fifty-six patients were included in the analyses: 45% were underweight (body mass index (BMI) < 18.5), 96.4% were female, 63% were given a primary diagnosis of anorexia nervosa (or atypical anorexia nervosa), and mean age was 25.57 years. Clinical outcomes were assessed using self-reported measures of disordered eating, psychosocial impairment, and negative mood, but BMI was recorded by staff. Over admission, 4- and 8-week post-admission, and discharge there were no significant differences between any of the clinical outcomes across the three formats. We can tentatively conclude that decreasing costs and increasing the opportunities for autonomy did not negatively impact patient outcomes, but future research should seek to replicate these results in other and larger populations that allow conclusions to be drawn for different eating disorder diagnostic groups.
... Although eating disorders are increasing among boys and men 4 , girls and women are more likely to develop eating disorders 5 . While approximately 20 million girls and women in the United States have an eating disorder, many more have undiagnosed eating disorders, subclinical or subthreshold eating disorders, or disordered eating behaviors 6,7 . College women in particular are at an increased risk for developing eating disorders, and the number of college women who exhibit disordered eating behaviors is high [8][9][10][11][12] . ...
... This could be because they are unaware (i.e., symptoms have not yet emerged or they are unaware that these may be eating disorder symptoms) or because they are simply not thinking about their eating disorder history (i.e., they view this motivation [weight loss and/or awareness] as separate or more important than their health history). Then they use heuristics, such as recommendation, popularity and name recognition, top of search results, high ratings and reviews, and features and usability in order to navigate the search results and select a specific app among the search results 6 . It is important to note that while for instance, recommendations and popularity and name recognition play a role during their navigation behavior, these existed prior to navigation. ...
There is a myriad of mobile health applications designed to address a variety of health conditions. While these apps hold significant promise for the management of these conditions, users sometimes turn to general health apps, rather than those designed with their specific condition in mind, which can lead to unmet needs and worsened conditions. We outline one example by focusing on college women with disordered eating behaviors and their use of general food diary apps, rather than eating disorder-specific apps. We investigate the types of health apps they use and how they choose them, focusing on the role of motivations and search behavior. We found their initial motivation informs their search process, which results in their selection of general food diary apps. Researchers should consider app adoption as influenced by user motivations and navigation behavior, particularly when determining how and why general apps are used and how clinicians can help.
... It is estimated that 20 million women and 10 million men in the United States have experienced an ED at some point in their lives. 2 One research-based questionnaire on ED that was administered among Iranian school girls estimated the prevalence of BN at 3.2%. 3 Another study on an Australian population reported a doubling of incidence over a decade, and the socio-demographic characteristics strayed from comprehensively young white upper-class females to an upward trend in males and those of lower financial status as well as those in older age groups. 1 ED affects nearly 1.6% of women and 0.8% of men each year in the developed countries although it appears to be lower in developing countries. ...
... 4 Although the main reason for EDs is not yet clear, there may be both biological and environmental factors that put some persons at higher risk of developing ED. 2 Bulimia nervosa is a psychological ED and mental health condition described by consuming a large quantity of food in one sitting, followed by an attempt to avoid gaining weight by purging what was consumed. 5 BN has a series of sign and symptoms such as swollen salivary glands in the jaw and neck regions, sore and chronic inflammation in throat, worn tooth enamel, progressively decaying and sensitive tooth (mainly because of stomach acid), severe dehydration due to purging of fluids, electrolyte imbalance (such as calcium, potassium, sodium, and various minerals), acid reflux and other gastrointestinal disorder and intestinal distress as well as irritation. ...
Background:
Eating disorders (EDs) are widely known by abnormal eating behaviors associated with significant medical complications. Bulimia nervosa (BN) is an eating disorder characterized by uncontrolled episodes of overeating typically followed by some form of compensatory behaviors. We aimed to determine the relationships between socio-demographic characteristics, biochemical markers, and cytokine levels in BN candidates for laparoscopic sleeve gastrectomy (LSG).
Methods:
A case-control study was designed among 76 BN participants of Iranian descent who were candidates for LSG based on defined criteria for Bulimia by Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The healthy control subjects (n = 42) were selected at random from academic staff in the college. Moreover, levels of biochemical parameters and serum cytokines were measured in serum samples.
Results:
Routine consumption of caffeine (odds ratio [OR] = 3.1, 95% CI: 1.23-6.41, P = 0.013), tobacco (OR = 1.8, 95% CI: 0.67-3.57, P = 0.03), and alcohol (OR = 3.6, 95% CI: 0.84-7.18, P = 0.048), and depression history (OR = 2.8, 95% CI: 0.76- 5.79, P = 0.037) were substantially more common among patients with bulimia. Also, the serum levels of fasting blood sugar (P < 0.001), HbA1c (P = 0.04), cholesterol (P = 0.03), triglycerides (P = 0.01), blood urea nitrogen (P = 0.03), and pro-inflammatory cytokines including IL-1β, IL-6, and TNF-α were significantly higher in BN candidates for LSG (P ≤ 0.001).
Conclusion:
Our findings reveal that lifestyle-related risk factors and a depression history were both related with a significantly increased risk of BN among the candidates for LSG. Furthermore, there is a relationship between clinical characteristics as well as levels of various biochemical and cytokines parameters in serum of BN patients.
... The lifetime prevalence of BN in Western countries has been estimated to be between 0.9% and 4.6%(Wade, Keski-Rahkonen & Hudson, 2011). The relatively high prevalence of BN means that effective and accessible interventions are essential. ...
The focus of this thesis is eating disorders, specifically treatment outcomes for individuals with eating disorders. This thesis consists of three parts. The first part of the thesis is a systematic literature review on the treatment outcomes and dropout rates for men with eating disorders. Men with eating disorders are often excluded from research because of the low prevalence rates of eating disorders in men. The consequence of this is that treatment guidelines are developed based on research that has few, if any, male participants. This review aimed to review the currently available evidence on men’s treatment outcomes and dropout rates, and consider whether these are similar to women’s treatment outcomes and dropout rates. The clinical and research implications of the findings of the review are discussed. The second part of the thesis is an empirical paper on the feasibility of a 12-week Dialectical Behaviour Therapy (DBT) skills group for women with bulimia nervosa. The results showed significant improvements in the participant’s eating disorder symptoms and functional impairment following the intervention. Feedback from participants also suggested that the intervention was acceptable to clients. Limitations, clinical implications, and research implications of the study are discussed. The data collection for this study was conducted jointly with another trainee investigating the change in acceptance and mindfulness following a DBT skills group. The third part of this thesis is a critical appraisal that reflects on some of the issues that arose during the research process. This critical appraisal focuses on three topics, the practical problems that arose in the research, the group processes that were observed in the DBT skills groups, and the relationship between sexuality and eating disorders in men.
... Within the United States, the prevalence of eating disorders (ED) has risen dramatically in the last several decades. [1][2][3] Additionally, the rise of ED and body image dissatisfaction increases during the collegiate years. 4,5 According to the National Institute of Mental Health, 6 ED are often lifethreatening conditions that have physical and emotional repercussions on the bodies of both males and females. ...
Objectives: This study examined how goal orientation, motivational climate, and exercise could be used to predict college students’ eating disorder symptomology. Participants: Recruited in February 2017, the participants included 275 college-aged students from a university in the southeastern United States. Methods: Using achievement goal theory as the framework to conceptualize motivations behind eating disorder behaviors, each participant filled out questionnaires related to goal mindsets, perceptions of the social climate in the university recreation center, and exercise habits. Data were analyzed using multiple regression analyses, with R coefficients being used to evaluate prediction models. Results: The results of the study suggested that goal orientation and ego-involving climate were the only significant predictors of eating disorder symptomology, accounting for 3.4% of the total variance. Conclusions: This study provided preliminary evidence of the importance of studying achievement goal theory-related variables that contribute to our understanding of eating disorder symptomology in the collegiate population.
... In this time, young people are going through a plethora of biological, psychological, and social changes, some of which make them susceptible to the development of mental health disorders, including eating disorders (Kessler et al., 2007;Volpe et al., 2016). It is estimated that 10 million men in the United States will experience an eating disorder in their lifetime (Wade, Keski-Rahkonen, & Hudson, 2011), and the lifetime prevalence rate among adolescent males is 1.5% (Merikangas et al., 2010). Furthermore, prevalence rates of eating disorders among college-enrolled males are higher at 3-5.5% (Eisenberg, Nicklett, Roeder, & Kirz, 2011;Sonneville & Lipson, 2018). ...
Males with eating disorders are underdiagnosed and undertreated, which may be a result of inadequate guidance and training to assess and treat eating disorders for medical professionals. This may be particularly problematic for adolescent males given the focus of eating disorders research and treatment on adolescent females. Furthermore, there is a paucity of research to guide screening, medical treatment, and training of health professions in adolescent males with eating disorders. The development of eating disorders education and training for medical professionals are included in the 21st Century Cures Act, which further emphasizes the opportunity to develop treatment guidelines individualized to male patients. This last word calls for the development of specific medical treatment guidelines for adolescent males with eating disorders.
... 10 Among those affected by an eating disorder diagnoses, the majority are female. 11 In community samples, 10% of females and 1% of males experience some type of eating disorder in early or middle adolescence. 12 DE and associated mental, familial and physical issues pose a serious threat to the developmental processes associated with adolescent and young adulthood. ...
Eating disorders are a serious, life-threating condition impacting adolescents and young adults. Providers in primary care settings have an important role in identifying disordered eating (DE) symptoms. Unfortunately, symptoms go undetected in 50% of patients in medical settings. Using the behavioral health screen, this study identified DE risk profiles in a sample of 3620 female adolescents and young adults (ages 14–24), presenting in primary care. A latent class analysis with twenty psychosocial factors identified three DE risk groups. The group at highest risk for DE was characterized by endorsement of internalizing symptoms and a history of trauma. The next risk group consisted of those with externalizing symptoms, particularly substance use. The group at lowest risk for DE reported more time spent with friends compared to their peers. Primary care providers and psychiatric teams can benefit from knowing the psychosocial risk patterns affiliated with DE, and using brief, comprehensive screening tools to identify these symptoms.
... Results were able to encapsulate both helpful/supportive and hurtful/unsupportive messages, and these findings will be helpful for treatment centers who may incorporate them in recovery programs. At least 20 million women in the United States suffer from an eating disorder (Wade, Keski-Rahkonen, & Hudson, 2011). Anorexia nervosa has the highest mortality rate of any mental disorder; one in five anorexia nervosa patients die by suicide (Arcelus, Mitchell, Wales, & Nielsen, 2011); other causes of death in anorexia nervosa are the consequences of starvation and alcohol-related diseases (Franko et al., 2013). ...
This study analyzed how clinically diagnosed women with eating disorders described the hurtful messages from parents, siblings, and peers that triggered eating disorder symptomology as well as the healing messages that assisted with coping and recovery. Three themes overlapping across all groups were revealed for hurtful messages: 1) critical, 2) social modeling, and 3) direct comparison. Our findings show that fathers, siblings, and peers similarly used teasing. Other points of distinction were uncovered for fathers: aggressive messages and denial of eating disorder. Competition with female siblings and friends was also a triggering factor for young females with eating disorders. Four distinct categories of healing messages were identified: 1) emotional, 2) instrumental, 3) informational, and 4) appraisal. Point of distinction for friends’ and siblings’ healing messages was absence of negative comments about weight and appearance. Results were able to encapsulate both helpful/supportive and hurtful/unsupportive messages, and these findings will be helpful for treatment centers who may incorporate them in recovery programs.
... Estimates of lifetime DSM-5 1 BN, with more relaxed criteria, are between 4% and 6.7%. 4 Community incidence rates based on tracking eating disorders in general practice suggest that there has been a decrease in the presentation of BN in primary care across several countries. [5][6][7] There has, however, been an increase in disordered eating not necessarily meeting diagnostic criteria, 8 with 23% of women in community samples between 22 and 27 years reporting the presence of disordered eating (moderate dissatisfaction with weight or shape accompanied by either a body mass index <17.5, ...
Estimates of lifetime bulimia nervosa (BN) range from 4% to 6.7% across studies. There has been a decrease in the presentation of BN in primary care but an increase in disordered eating not meeting full diagnostic criteria. Regardless of diagnostic status, disordered eating is associated with long-term significant impairment to both physical and mental quality of life, and BN is associated with a significantly higher likelihood of self-harm, suicide, and death. Assessment should adopt a motivationally enhancing stance given the high level of ambivalence associated with BN. Cognitive behavior therapy specific to eating disorders outperforms other active psychological comparisons.
... As reviewed previously, most research on the links among attachment, emotion regulation, and disordered eating has focused on women. Research on men's disordered eating has increased recently, however, demonstrating that a substantial minority of men report disordered eating behaviors (Wade, Keski-Rahkonen, & Hudson, 2011). The current literature on disordered eating in men has largely focused on their unique body image issues of desire for muscularity (vs. ...
In this study, we examined a structural equation model in which attachment anxiety and avoidance were associated with binge eating and restricted eating behaviors through distinct emotion regulation difficulties of emotional reactivity and emotional cutoff among college women (n = 744) and men (n = 200). As predicted, attachment anxiety was associated with emotional reactivity which, in turn, was associated with binge eating. Attachment avoidance was associated with emotional cutoff which, in turn, was associated with restricted eating, both in college women and men. Two gender differences were found: the association between emotional cutoff and binge eating was statistically significant only for women, and the association between emotional reactivity and binge eating was stronger for men than for women. Clinical implications are suggested, specifically the importance of addressing attachment insecurities and distinct emotion regulation difficulties related to serving college women and men with binge eating and/or restricted eating behaviors.
... While acknowledging the potentially mimetic competitiveness of religious fasting, Girard contends that the medieval convents knew how to handle this minor nuisance, affecting-according to Girard-a few hundred people at most compared to the millions worldwide suffering from EDs today (Wade, Keski-Rahkonen, and Hudson 2011): ...
French historian and literary critic René Girard (1923--2015), most widely known for the concepts of mimetic desire and scapegoating, also engaged in the discussion of the surge of eating disorders in his 1996 essay Eating Disorders and Mimetic Desire. This article explores Girard's ideas on the mimetic nature and origin of eating disorders from a clinical psychiatric perspective and contextualizes them within the field of eating disorders research as well as in relation to broader psychological, sociological and anthropological models of social comparison and non-consumption. Three main themes in Girard's thinking on the topic of eating disorders are identified and explored: the `end of prohibitions' as a driving force in the emergence of eating disorders, eating disorders as a phenomenon specific to modernity, and the significance of `conspicuous non-consumption' in the emergence of eating disorders.
... In the United States, thousands of people of all genders suffer from eating problems of one form or another such as anorexia or bulimia (Wade, Keski-Rahkonen, & Hudson, 2011). As others have found, weight is a central issue in the perpetration of bullying of many children (Puhl & Latner, 2007;Puhl, et al., 2013). ...
Childhood bullying is a well-known public health problem worldwide. Research has described numerous health and mental health effects on victims, bullies, and bystanders. While there are studies of contemporaneous consequences, there is still much to be discovered in terms of the impact of childhood bullying lasting into adult life. This qualitative inquiry investigated the aftermath of childhood bullying for young adults in terms of their health, mental health, and relationship issues. Further, it asked participants for their definitions of bullying. The study was part of a mixed methods inquiry. For the qualitative portion, seventy-two graduate and undergraduate students in the U.S., ages eighteen to twenty-nine, participated as a purposive sample. The majority of participants were Caucasian and female, though twenty-eight percent represented minority groups. Semi-structured interviews were conducted lasting approximately one hour each. A participatory action research approach was taken to understand the lived experiences and perceptions of the young adults. Grounded theory was utilized in reviewing the data for thematic responses. Member checks and triangulation were employed to substantiate credibility, authenticity, and coherence of the data. Content analysis revealed lasting 2 consequences in a) mental and psychological well-being b) eating disorders, weight, and body image, and c) relationship and trust issues. Results are indicative of the need for further research on childhood bullying as it affects later adolescent and young adult development. Understanding the aftermath of childhood bullying is important in informing bullying interventions and maintaining a focus on early prevention efforts.
... In the United States, thousands of people of all genders suffer from eating problems of one form or another such as anorexia or bulimia (Wade et al. 2011). As others have found, weight is a central issue in the perpetration of bullying of many children (Puhl and Latner 2007;Puhl et al. 2013). ...
Childhood bullying is a well-known public health problem world-wide. Research has described numerous health and mental health effects on victims, bullies, and bystanders. While there are studies of contemporaneous consequences, there is still much to be discovered in terms of the impact of childhood bullying lasting into adult life. This qualitative inquiry investigated the aftermath of childhood bullying for young adults in terms of their health, mental health, and relationship issues. Further, it asked participants for their definitions of bullying. The study was part of a mixed-methods inquiry. For the qualitative portion, 72 graduate and undergraduate students in the U.S., ages 18 to 29, participated as a purposive sample. The majority of participants were Caucasian and female, though 28% percent represented minority groups. Semi-structured interviews were conducted lasting approximately 1 h each. A participatory action research approach was taken to understand the lived experiences and perceptions of the young adults. Grounded theory was utilized in reviewing the data for thematic responses. Member checks and triangulation were employed to substantiate credibility, authenticity, and coherence of the data. Content analysis revealed lasting consequences in (a) mental and psychological well-being (b) eating disorders, weight, and body image, and (c) relationship and trust issues. Results are indicative of the need for further research on childhood bullying as it affects later adolescent and young adult development. Understanding the aftermath of childhood bullying is important in informing bullying interventions and maintaining a focus on early prevention efforts.
... Second, the study examined individuals 16-18 years old. This age range is too limited in view of the fact that 95% of individuals with eating disorders are 12 to 25 years old (29) and that eccentric eating behaviors may be found also in adults and elder individuals (30). A specific number of times a day (e.g., once), in the morning, at noon, at night, at precise times (e.g., 13:10), dry things, foods with some kind of sauce, foods in a soup, foods that have been immersed in water before eating, one specific kind of food in each meal (e.g., 1 or 2), in each meal a specific number of varied food stuffs, in each meal only one kind of food substance (e.g., carbohydrates), drinking water after each mouthful, not drinking water before or after eating for at least one hour, when one is alone, when all windows are closed, outside the home, at home, things that have a specific color (e.g., green, white), with wooden cutlery, foods with a specific surface (e.g., smooth, rough), with the fingers, when it is possible to produce sounds during eating, in a completely silent environment, foods whose precise composition is known, foods prepared in one's presence, foods prepared only by oneself, vegetables, fruits, proteins, for a specified duration of time (e.g., 2 or 5 minutes), in a standing position, in dim light (raw food), things that have not Supplement no. 1. Items of the EEH been cooked in any way, things that have been cooked for at least one hour, on wooden plates, on plates of a certain shape, pauses of specific duration between different plates, a specific time after being outside, specific time after doing sport, fasting one or two days a week, foods without odor, foods with specific size on the plate, foods with specific form (e.g., round, long, grains), foods that have not been refrigerated, foods that have been cooked no more than 10 minutes prior to serving, after making relaxation for at least 15 minutes, after taking a bath or a shower, changing one's diet completely every two weeks, one specific kind of food (e.g., chicken legs, liver, sausage), without any sugar, tiny quantities, chewing each mouthful a specific number of times (e.g., 12), keeping the food in the mouth for a specific duration of time before swallowing it, spitting a specific number of times prior to putting food in one's mouth, keeping strange materials in the mouth before putting in food (e.g., matches, pebbles), meat that comes from herbivorous animals, food without any spices whatsoever, foods that have been consumed by the Neanderthals, powdery food. ...
Background:
The study deals with particular kinds of eating habits that are unusual, not focused on weight, different from eating disorders, and not pathological. They are characterized by features such as the kind, amount, manner and style of eating that deviate from the common ones in their family or culture. They would be included today under the DSM- 5 categories of Avoidant restricting food intake disorder (AR-FID), and unspecified feeding or eating disorders (USFED). The question was whether they are mild forms of eating disorders or an independent set of behaviors. The objective was to examine to which extent these atypical eating behaviors may be subsumed under the diagnostic category of eating disorders by testing their scores on the Cognitive Orientation Questionnaire of Eating Disorders (CO-ED), which is a measure of the general tendency for eating disorders.
Methods:
The sample included 250 high school students (120 boys, 130 girls), 16-18 years old. They were administered the Eating Attitudes Test (EAT-26), the Eccentric Eating Habits (EEH) questionnaire and the Cognitive Orientation of Eating Disorders (CO-ED).
Results:
EAT-26 and EEH were uncorrelated. High scorers on the EAT-26 scored higher than high and low scorers on EEH in several variables of the CO-ED. High and low scorers on EEH differed in most variables of the CO-ED.
Conclusions:
EEH is manifestation of the general tendency for eating disorders but differs from eating disorders and may be considered as an independent manifestation of eating disorders.
... 43 Eating disorders are on the rise ( Engel et al. 2007). It is estimated that 30 million 44 people in the United States have an eating disorder, and many more have unhealthy 45 eating behaviors (Reba-Harrelson et al. 2009;Wade et al. 2011). While eating dis- 46 orders are increasing among males ( Strother et al. 2012), females are more likely to 47 develop eating disorders (Fairburn and Harrison 2003). ...
From weight loss to illness management, mHealth has the potential to help many people track and manage their health. Mobile health applications for weight loss or weight loss apps, in particular, are becoming increasingly popular. Through Google Play and the App Store, weight loss app developers paint a picture of a healthy lifestyle. While these apps may be a promising method to combat the obesity epidemic in places like the United States, what do we really know about the users of weight loss apps and how these apps affect them? The aim of this chapter is to explore these questions by focusing on the unintended users, uses, and consequences of weight loss apps by using eating disorders as a case study. There has been a recent push for understanding the role technology, such as social media, plays on eating disorders and related behaviors. Missing in this research are studies on the impact of weight loss apps on eating disorders even though they contain similar content. Additionally, weight loss apps enable and promote dieting, which is a risk factor for developing an eating disorder. This chapter first explores the unintended users of weight loss apps, then the unintended uses of these apps (i.e., eating disorder maintenance or recovery), and finally the unintended consequences of weight loss apps using qualitative data (from both forum posts and interviews), previous work, and popular media articles. This research has a number of implications for mHealth design, healthcare, and education.
... At the other end of the spectrum, 1% to 5% of the population falls into the category of binge eating disorder, not yet an approved psychiatric diagnosis (4). Anorexics are more likely to be female (90%-95%); 80% of bulimics are female and 60% of BEDs are female (5). Eating disorders begin early, with 10% being diagnosed in children less than 10 years of age. ...
There is a commonly held view that eating disorders are lifestyle choice. Eating disorders are actually serious and often fatal illnesses, obsessions with food, body weight, and shape may also signal an eating disorders. Common eating disorders include anorexia nervosa, bulimia nervosa, night-eating syndrome, eating disorders not otherwise specified and binge-eating disorders. Eating disorders occur in men and women, young and old, rich and poor and from all cultural backgrounds; they result in about 7000 death a year as of 2010, making them the mental illnesses with the highest mortality rate. The chance for recovery increases the earlier they are detected, therefore, it is important to be aware of some of the warning signs of an eating disorder. In this review, different types of eating disorder, their side effects, complications and treatments are discussed.
... Individuals battle with a dietary issue need to look for specific offer assistance. The prior a man with a dietary issue looks for treatment, the more noteworthy the probability of physical and passionate healing [22]. Many individuals with dietary problems battle to get to and talk their emotions, feel snowed under with a feeling of negated and pointlessness, particularly when confronted with determining difficulties of youthful and early adulthood [23]. ...
A portion of youthful females may acknowledge unpredictable dietary patterns because of shameful problems about their body shape or weight, others utilize sustenance to comfort themselves as far as unforgiving conditions in their social or instructive lives. Different components can bring about these issues. This is on the grounds that specific perspectives are solid in one's choice to eat certain foodstuffs. Such solid components incorporate companion weight, family standards, social practices, accessibility of various foodstuffs, and desires.
... An Icelandic study found male-female ratios of lifetime prevalence rates of eating disorders to be 1:2.8 for all eating disorders, 1:3.5 for anorexia, 1:2 for bulimia nervosa, 1:1.7 for binge eating disorder, and 1:2.9 for eating disorders not otherwise specified (EDNOS; Kjelsås, Bjørnstrøm, & Götestam, 2004). Wade, Keski-Rahkonen, and Hudson (2011) further suggest that 20 million women and 10 million men suffer from a clinically significant eating disorder. Mond (2014) argue that binge eating behaviors may be just as prevalent in men as they are in women, and that purging among men may be more common than originally thought. ...
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This study uses cultural domain analysis to understand the similarities and differences in ideal male body image between Americans and South Koreans. The prevalence of body image and eating disorders is rising all over the world, in women and in men. Due in large part to universalist assumptions about masculinity, the ways in which men’s body image is understood across cultures are understudied. Further, cross-cultural research on body image often fails to account for the effect of cultural differences through anything more than a nominal variable. Therefore, this study demonstrates an emically valid and scientifically reliable mixed methods approach to the study of body image that can be used in multidisciplinary research to more effectively operationalize “culture.” Results show that Americans understand body ideals largely through the dimension of individual control, while South Koreans understand body ideals through the dimensions of importance and desirability. Americans also more strongly endorse the instrumental aspects of male bodies, while South Koreans focus on their ornamental qualities, reflecting differing cultural scripts for achieving and projecting masculine status. Specifically, while Americans endorse highly muscular male bodies as ideal, South Koreans endorse more slender, “prettier” male images, of which one prominent example is the kkonminam, or “beautiful flower boy.”
... Although it seems to affect adolescents and young females in general, people of all ages and sexes may have an eating disorder. In the United States, 20 million females and 10 million males suffer from a clinically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge-eating disorder, or eating disorder not otherwise specified (EDNOS) (Wade, Keski-Rahkonen, and Hudson 2011). Despite the wide range of prevalence of eating disorders (2.17%-26%) due to differences among countries and variations in research methods (Alpaslan et al. 2015;Chisuwa and O'Dea 2010;Pedro et al. 2016), the overall incidence and prevalence of eating disorders in adolescents and young adults has increased over the past decade (Rosen 2010). ...
The aim of the study was to examine the relationships among food addiction, eating attitudes, emotional appetite, and self-esteem of young adults aged 18–30 years by using a structural model. This cross-sectional study was conducted with 1,058 volunteers (male = 307, female = 751). The hypothesis that self-esteem of young adults influences their eating attitudes was supported in the study (β = –0.081, p < .05). Another hypothesis was also supported, so self-esteem had a positive effect on food addiction (β = 0.280, p < .05). Furthermore, eating attitude has mediating effects on the relationships between self-esteem and food addiction and between emotional appetite and food addiction. Individuals’ eating attitude, food addiction, emotional appetite, and self-esteem scores were found to be related to each other. This article provides valuable data for studies of disordered eating attitudes, emotional state, and food addiction that are thought to be important for young adults in the future.
... In bulimia nervosa it is 1.0%; however, rates are much higher in females than males (3.5% versus 0.9%, respectively; Hudson et al., 2007). In the U.S., an estimated 20 million females and 10 million males meet criteria for an ED at some point during their lifetime (Wade et al., 2011). While prevalence rates vary globally, other industrialized countries in Europe observed an increased prevalence among adolescent girls in recent years (Smink et al., 2012), though this finding may simply reflect better ED identification. ...
Objective:
Research investigating the link between eating disorder (ED) diagnosis and executive dysfunction has had conflicting results, yet no meta-analyses have examined the overall association of ED pathology with executive functioning (EF).
Method:
Effect sizes were extracted from 32 studies comparing ED groups (27 of anorexia nervosa, 9 of bulimia nervosa) with controls to determine the grand mean effect on EF. Analyses included effects for individual EF measures, as well as an age-based subgroup analysis.
Results:
There was a medium effect of ED diagnosis on executive functioning, with bulimia nervosa demonstrating a larger effect (Hedges's g=-0.70) than anorexia nervosa (g=-0.41). Within anorexia nervosa studies, subgroup analyses were conducted for age and diagnostic subtype. The effect of anorexia nervosa on EF was largest in adults; however, subgroup differences for age were not significant.
Conclusions:
Anorexia and bulimia nervosa are associated with EF deficits, which are particularly notable for individuals with bulimia nervosa. The present analysis includes recommendations for future studies regarding study design and EF measurement.
... Although traditionally discouraged as a diagnosis before adulthood, borderline personality disorder frequently emerges in late childhood or early adolescence 414 . Within eating disorders, anorexia nervosa appears to have a mean age of onset between 16 and 19 years, with bulimia nervosa slightly later between 17 and 25 years 415 . ...
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma-related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.
... Although traditionally discouraged as a diagnosis before adulthood, borderline personality disorder frequently emerges in late childhood or early adolescence 414 . Within eating disorders, anorexia nervosa appears to have a mean age of onset between 16 and 19 years, with bulimia nervosa slightly later between 17 and 25 years 415 . ...
... Eating disorders (EDs) are serious psychiatric disorders with core features such as disturbance in body image, extreme eating behaviors, and weight control (1,2). The lifetime prevalence rate of EDs is 2-8% in the US (3), and 20-20.6% of the college students were at risk of an eating disorder in some South-East Asian countries (4). ...
Background: Sleep problems and eating disorders (EDs) are both serious public health concerns often seen in young adults. Yet, the underlying mechanisms for such associations are largely unknown. This study aims to examine potential serial multiple mediation effects of problematic smartphone use (PSU) and psychological distress (i.e., depressive and anxiety symptoms) in the relationship between sleep quality and disordered eating behaviors/attitudes (DEBs).
Methods: A total of 4,325 students from two Tibet universities in China (2,657 females and 1,668 males) completed an online survey that included the following measurements: Eating Attitude Test-26 for disordered eating behaviors/attitudes, the Chinese Version of Pittsburgh Sleep Quality Index (CPSQI), Smartphone Addiction Scale—Short Version (SAS-SV) for problematic smartphone use, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) for psychological distress.
Results: While the direct path linking sleep quality and DEBs was not found to be significant (Standardized β = 0.006, 95% CI = −0.0667~0.0970), both PSU (Standardized β = 0.016, 95% CI = 0.0256~0.0591) and anxiety symptoms (Standardized β = 0.014, 95% CI = 0.0203~0.0526) may mediate a link between sleep quality and DEBs; serial multiple mediation analysis revealed that a serial indirect pathway of “sleep quality -> PSU -> anxiety symptoms -> DEBs” existed(Standardized β = 0.001, 95% CI = 0.0002~0.0012). Similarly, while the direct path linking sleep quality and DEBs was not found to be significant (Standardized β = 0.006, 95% CI = −0.0667~0.0970), both PSU (Standardized β = 0.020, 95% CI = 0.0337~0.0692) and depressive symptoms (Standardized β = 0.015, 95% CI = 0.0139~0.0652) may mediate a link between sleep quality and DEBs; serial multiple mediation analysis revealed that a serial indirect pathway of “sleep quality -> PSU -> depressive symptoms -> DEBs” existed (Standardized β = 0.001, 95% CI = 0.0006~0.0038).
Conclusions: Psychological and behavioral factors may comprehensively work together, leading to flow-on effects from sleep problems to disordered eating behaviors among university students. Appropriate interventions that target problematic smartphone use could thus potentially reduce anxiety and depression levels, which in turn will provide a buffer against the negative impact of poor sleep quality on eating disorder symptoms.
... Meanwhile, the National Eating Disorders Association (2013) has estimated that nearly 20 million women and girls suffer from clinically significant EDs, but unreported cases hide the real extent of this figure (Wade, Keski-Rahkonen, & Hudson, 2011). Health experts have agreed that currently reported ED incidences barely skim the surface as "physicians are not required to report EDs to a health agency, and people with these problems tend to be secretive" (ANRED, 2011, para. ...
Pro-eating disorder (ED) scholarship in the field of new media studies largely consists of text, discourse, and theoretical analyses. far fewer studies involve audience work with women in eating disorder subcultures online to cross-reference scholarly analyses with the women's own experiences. Using a foucauldian theoretical framework, this study provides data from in-depth interviews with 10 practicing-ED bloggers on how they felt silenced by the media deadlock of the thin ideal and sought vocal expression online. The findings call for an expansion of scholarly discourse beyond catch-all "pro-ED" terminology to better capture women's experiences with online identity formation. Additionally, considering blogging's revival with women's lifestyle blogs, it is vital to understand online ED subcultures' foundations in the blogosphere to better position future research addressing online female identity in emerging social media.
... Due to the greater prevalence of eating disorders in the group of women [30], and therefore the existence of a greater risk for the development of a wrong attitude towards the body and eating in this group, the study focused only on a group of women [31]. The aim of the study was to assess the role of emotional eating and body mass index in the relationship between the desire to consume chocolate and avoiding social situations related to eating and body exposure. ...
Objectives:
The aim of the study was to determine the role of emotional eating and body mass index (BMI) in the relationship between the desire to consume chocolate and avoiding social situations related to food and body exposure in women with normal weight.
Methods:
The direct effect, the indirect effect, the buffer effect, and the moderated mediation model were tested. The study involved 311 women. The mean age was 25.56 years (SD = 8.99), and the BMI was 23.19 kg/m2(SD = 1.80). The Three-Factor Eating Questionnaire, the Attitude to Chocolate Questionnaire and the Body Image Avoidance Questionnaire were used in the study.
Results:
The results show that asignificant weak positive relationships exist between: (1) emotional eating and BMI, (2) emotional eating, BMI and avoiding social situations related to food and body exposure, (3) avoiding social situations and the desire to eat chocolate. However, asignificant moderate positive correlation is observed in the relationship between emotional eating and the desire to consume chocolate. The relationship between body mass index and the desire to consume chocolate is insignificant. Emotional eating is also an important complete mediator of the relationship between avoiding social situations related to food and body exposure and the desire to consume chocolate. However, it does not moderate the relationship between these variables. With reference to the moderated mediation model, BMI at the statistically significant level interacts with the avoidance of situations related to food and body exposure and the proposed model proves to be significant.
Conclusions:
Our results prove that emotional eating is significantly associated with chocolate consumption and avoiding situations related to eating and body exposure.
... When we take into account the relatively high prevalence of EDs in the Australian community [30][31][32], a health system that syphons off treatment of a relatively common and complex mental and physical condition to a small, specialised, dislocated sector of health, while patients continue to present outside of that sector, across all parts of a system staffed by people who feel unskilled and unwilling to provide service-it is perhaps unsurprising that multiple service and consumer experience issues arise [33]. This is not to say specialist services are not needed. ...
Background:
It seems to be a truth universally acknowledged that pathways to care for people with eating disorders are inconsistent and difficult to navigate. This may, in part, be a result of the complex nature of the illness comprising both mental and medical ill-health across a broad range of severity. Care therefore is distributed across all parts of the health system resulting in many doors into the system, distributed care responsibility, without well developed or integrated pathways from one part of the system to another. Efforts in many parts of the world to redesign health service delivery for this illness group are underway, each dependent upon the local system structures, geographies served, funding sources and workforce availability.
Methods:
In NSW-the largest populational jurisdiction in Australia, and over three times the size of the UK-the government embarked six years ago on a program of whole-of-health system reform to embed identification and treatment of people with eating disorders across the lifespan and across the health system, which is largely publicly funded. Prior to this, eating disorders had not been considered a 'core' part of service delivery within the health system, meaning many patients received no treatment or bounced in and out of 'doorways'. The program received initial funding of $17.6 million ($12.5 million USD) increasing to $29.5 million in phase 2 and the large-scale service and workforce development program has been implemented across 15 geographical districts spanning almost one million square kilometres servicing 7.75 million people.
Conclusions:
In the first five years of implementation there has been positive effects of the policy change and reform on all three service targets-emergency departments presentations, hospital admissions and community occasions of service as well as client hours. This paper describes the strategic process of policy and practice change, utilising well documented service design and change strategies and principles with relevance for strategic change within health systems in general.
... Researchers have found that 31% of women without a history of anorexia nervosa or binge eating reported having purged to control weight [87]. Other studies have found 25% of college women have engaged in binging and purging as a weight loss method [90]. Dieting behaviors and unhealthy weight control methods are also risk factors for developing an eating disorder [89,91,92]. ...
Personal informatics tools can help users self-reflect on their experiences. When reflective thought occurs, it sometimes leads to negative thought and emotion cycles. To help explain these cycles, we draw from Psychology to introduce the concept of rumination—anxious, perseverative cognition focused on negative aspects of the self—as a result of engaging with personal data. Rumination is an important concept for the Human Computer Interaction community because it can negatively affect users’ well-being and lead to maladaptive use. Thus, preventing and mitigating rumination is beneficial. In this conceptual paper, we differentiate reflection from rumination. We also explain how self-tracking technologies may inadvertently lead to rumination and the implications this has for design. Our goal is to expand self-tracking research by discussing these negative cycles and encourage researchers to consider rumination when studying, designing, and promoting tools to prevent adverse unintended consequences among users.
... Eating disorders research has primarily focused on women due to their overall greater risk (Smink et al., 2012;Wade et al., 2011). However, eating disorders among men are a notable public health problem particularly because they are often underdiagnosed and undertreated (Strother et al., 2012). ...
Sexual assault victimization and eating disorder rates are high among college populations and have significant psychological, physiological, and social outcomes. Previous research has found a positive relationship between experiences of sexual assault and eating disorder symptoms; however, these analyses have primarily focused on female students. Using data from the 2017-2018 Healthy Minds Study, the aim of this study was to investigate the relationship between experiencing a sexual assault within the previous 12 months and screening positive for an eating disorder among cisgender college-enrolled men. It was hypothesized that college-enrolled men who report experiencing a sexual assault within the previous 12 months would be more likely to screen positive for an eating disorder. Analyses were conducted using a sample of 14,964 cisgender college-enrolled men. Among the sample, nearly 4% reported a sexual assault within the previous 12 months and nearly 16% screened positive for an eating disorder. Results from logistic regression analyses indicated that college-enrolled men who reported experiencing a sexual assault in the previous 12 months, compared to those who did not, had significantly greater odds of screening positive for an eating disorder (OR = 1.40, p < .01). Analyses also indicated that college-enrolled men who identified as gay, queer, questioning, or other sexual orientation and reported experiencing a sexual assault in the previous 12 months had greater odds of screening positive for an eating disorder (OR = 2.50, p < .001) compared to their heterosexual peers who did not experience a sexual assault in the previous 12 months. These results indicate that eating disorders may be a negative outcome among college-enrolled men who have experienced a sexual assault, particularly among sexual minority men. Thus, mental health professionals need to be adequately prepared to treat the underserved population of men who experience an eating disorder and who have experienced sexual assault.
... Recent estimates suggest that 20 million women and 10 million men suffer from an eating disorder at some point in their lives (Wade, Keski-Rahkonene, & Hudson, 2011). Not only are these rates on the rise (Hudson, Hiripi, Pope Jr., & Kessler, 2007;Striegel-Moore & Franko, 2003;Wade et al., 2011), but a significant majority of disordered eating cases also go unreported due to the secretive nature of the disorders (Beglin & Fairburn, 1992). ...
Nearly 14% of all youth display disordered eating patterns. Despite the prevalence of these disorders, there is limited literature on the integration of eating disorder support services in schools. Further, there is often limited eating disorder knowledge and training for school mental health (SMH) professionals. This paper describes a two-phase study involving qualitative and quantitative components examining the perspectives of adolescents in recovery from eating disorders, family members, and SMH professionals. Fourteen participants were recruited from an eating disorder treatment facility in the southeastern USA. Eight adolescent females who received treatment for disordered eating while in primary or secondary school and six of their mothers completed interviews. In addition, 720 SMH and allied professionals were surveyed on their knowledge and training in disordered eating identification and intervention and their perspectives on service provision, with 561 complete and usable surveys. Analyses of adolescent and family data revealed the following themes that hindered or helped recovery: Isolation, Perfectionism, Difficulties with Self-Acceptance and Comparison to Others, Uncertainty, Teacher Identification, Support in Recovery. Themes surrounding the benefits of including SMH services for this population included: Increased Awareness, Support in Recovery, Family Involvement, and Linking to Resources. Results revealed that the majority of SMH professionals did not receive training in the identification and/or intervention of disordered eating. Data suggested that lack of referrals and limited knowledge, skills, and time interfered with their ability to effectively identify and intervene. Findings provide a foundation for understanding the experiences of adolescents with disordered eating and the role of SMH programs in assisting them.
... At least 30 million people in the United States will experience eating disorders in their lifetime (Wade, Keski-Rahkonen, & Hudson, 2011). This represents just under 10% of the current population and includes people of all sizes. ...
When an overweight or obese patient presents with weight loss as a treatment goal, a psychologist may initially view this request as both positive and consistent with current public health campaigns. However, the psychologist must explore further because a significantly different clinical picture may emerge. Without knowledge specific to eating disorders and awareness of weight stigma, the psychologist could unwittingly cause harm to a patient with this presentation. This article addresses the following: the goal of weight loss; clinical considerations associated with atypical anorexia, a diagnosis signifying that criteria have been met for anorexia nervosa with the exception of low weight; and treatment of this eating disorder.
... At that point, this result may be interpreted as females are more prone to suffer with poor eating habits than males. According to Wade, Keski-Rahkonen and Hudson in the United States approximately 20 million females and 10 million males will suffer from an eating disorder or poor eating habits in their future life (Wade, Keski-Rahkonen, & Hudson, 2011 (Kush, Cochran, 1993). Having said this, the date of Kush and Cochran's studies are not current, and many concepts may have changed over the years. ...
According to several research eating habits are an important public health issue. This study
examines the possible relationship between controlling of one's own volitional actions and eating
habits. This thesis provides research to show how deficits in Sense of Agency could be related to
a person’s eating habits.
... [1][2][3]. Research has shown that people with eating disorders and disordered eating behaviors utilize various forms of technology, including forums, websites, blogs, and social media, to support their recovery process or maintain the symptoms of their disorder [4][5][6]. However, only a few studies have been conducted on the use of mobile health (mHealth) apps for weight loss (weight loss apps) by users with eating disorders and disordered eating behaviors, despite their popularity [7].Although many researchers have studied weight loss apps [8][9][10][11][12][13], few have studied weight loss apps in relation to disordered eating behaviors [14,15]. ...
Background:
Mobile health (mHealth) apps for weight loss (weight loss apps) can be useful diet and exercise tools for individuals in need of losing weight. Most studies view weight loss app users as these types of individuals, but not all users have the same needs. In fact, users with disordered eating behaviors who desire to be underweight are also utilizing weight loss apps; however, few studies give a sense of the prevalence of these users in weight loss app communities and their perceptions of weight loss apps in relation to disordered eating behaviors.
Objective:
The aim of this study was to provide an analysis of users' body mass indices (BMIs) in a weight loss app community and examples of how users with underweight BMI goals perceive the impact of the app on disordered eating behaviors.
Methods:
We focused on two aspects of a weight loss app (DropPounds): profile data and forum posts, and we moved from a broader picture of the community to a narrower focus on users' perceptions. We analyzed profile data to better understand the goal BMIs of all users, highlighting the prevalence of users with underweight BMI goals. Then we explored how users with a desire to be underweight discussed the weight loss app's impact on disordered eating behaviors.
Results:
We found three main results: (1) no user (regardless of start BMI) starts with a weight gain goal, and most users want to lose weight; (2) 6.78% (1261/18,601) of the community want to be underweight, and most identify as female; (3) users with underweight BMI goals tend to view the app as positive, especially for reducing bingeing; however, some acknowledge its role in exacerbating disordered eating behaviors.
Conclusions:
These findings are important for our understanding of the different types of users who utilize weight loss apps, the perceptions of weight loss apps related to disordered eating, and how weight loss apps may impact users with a desire to be underweight. Whereas these users had underweight goals, they often view the app as helpful in reducing disordered eating behaviors, which led to additional questions. Therefore, future research is needed.
This study examines six decades (1930 to 1990) of weight loss advertising in the New York Times, using a combination of qualitative content analysis and textual analysis methods to understand how the discourse of weight loss has evolved over the years in the United States. The findings of the study show that the discourse of weight loss evolved from self-control to self-improvement. It also notes greater representations of white women in weight loss advertising. Women’s portrayals evolve from glamorous and thin to curvaceous, feminine and sexually appealing, to youthful, bold and confident and finally to strong and muscular. The study concludes that weight loss advertising reflects the changing roles for woman in society, while simultaneously influencing attitudes about beauty and body though the creation of new cultural images. Collectively, the advertisements cultivate the belief among women that by controlling their bodies through diet and exercise, women can achieve success in all aspects of their lives, from relationships to careers.
Pro-eating disorder communities provide a refuge for individuals with eating disorders (EDs) who are ambivalent about seeking treatment. We investigated a pro-ED community on Reddit, an anonymous social networking platform with topical forums, to identify expression of behaviors aligned with ED symptoms and support for these behaviors. A content analysis on four weeks of topic-specific discussion threads (N = 125 comments, 115 replies to comments) was conducted to identify behaviors consistent with ED psychopathology and support for these behaviors (informational, tangible assistance, esteem/emotional support). Results indicated that the content aligned with expressions of clinically relevant ED psychopathology, with eating concerns (49/125) and shape concerns (47/125) being most prevalent. The majority (92/115) of replies provided esteem/emotional support to the comment author. Online interventions and/or recovery programs are needed to counteract reinforcing dialogue that occurs on social media sites, like Reddit, and promote ED recovery through supportive messages on these platforms.
The current study the relationship between eating disorders (EDs) and suicidal ideation and suicide attempt in adult inpatients. In particular, the present study investigated one potential mechanism, body dissatisfaction (BD), which may contribute to increased risk for suicide in adult ED patients. A sample of 432 psychiatric inpatients ranging from 18 to 65 years of age participated in the current study. Findings indicated that patients who have higher levels of BD also had higher levels of passive and active suicidal ideation and previous suicide attempts. Higher levels of BD were also related to increased suicidal ideation after controlling for depression and emotion dysregulation. Although additional risk factors for suicide should be investigated in adults with EDs, this study provides evidence regarding the relationship between BD and risk for suicide ideation and attempt.
Background: Eating disorder is very common among western countries but now-a-days it is introducing in India too due to the effect of globalization, Media, Magazine and tendency to have a perfect body shape which results in different health hazards. Aims: To examine the effect of yogic practises on eating disorder cognitions among adolescent girls in India. Method: All subjects (11 to 19 years) were taken from Tata Nagar (Jharkhand). Firstly 120 subjects selected for the study from 1056 subjects. Randomly they were divided into two groups, 40 subjects for control group and 80 subjects for experimental group. During yogic intervention most of subjects left the group for their personal reason. Lastly the experiment carried out on 40 subjects. Results: Significant effects of yogic practises on experimental group were found and no effect was found on the subjects who belonged to control group. Conclusions: These finding demonstrated that the effect of yoga has a positive impact on eating disorder cognitions among adolescent girls in India.
Eating disorders are unique in that they inherently have much medical comorbidity both as a part of restricting-type eating disorders and those characterized by purging behaviors. Over the last three decades, remarkable progress has been made in the understanding and treatment of the medical complications of eating disorders. Yet, unfortunately, there is much research that is sorely needed to bridge the gap between current medical knowledge and more effective and evidence-based medical treatment knowledge. These gaps exist in many different clinical areas including cardiology, electrolytes, gastrointestinal and bone disease. In this paper, we discuss some of the knowledge gap areas, which if bridged would help develop more effective medical intervention for this population of patients.
Objectives
Emotional states may play an important role in the development and maintenance of anorexia (AN) and bulimia nervosa (BN). This systematic review aimed to examine the evidence regarding the relationship that shame and guilt have with two eating disorders, AN and BN.
Methods
Four major databases (Pubmed, PsychINFO, Web of Science, Medline) were searched (up until April 2018) for studies measuring guilt or shame in clinically diagnosed AN and BN groups. Included papers were evaluated for risk of bias.
Results
Twenty‐four papers met the inclusion criteria. Several methodological issues were noted within the reviewed studies, including a lack of longitudinal data and unaccounted confounding variables. Nonetheless, shame was typically more common in those with AN and BN than controls, was positively related to the severity of symptoms, and associated with the onset of eating disorder‐related difficulties (e.g., binging or purging). Effect sizes were typically moderate to large. The role of guilt was less clear, with few studies and mixed results.
Discussion
There is preliminary evidence that shame is implicated in the aetiology of AN and BN presentations, whilst there is currently insufficient evidence of such a role for guilt. It remains unclear whether shame is a risk factor for the development of AN and BN or a consequence of these difficulties.
Practitioner Points
• Elevated shame appears to be a feature of anorexia (AN) and bulimia nervosa (BN).
• Shame appears to fluctuate with the occurrence of eating disordered behaviours like binging, purging or restricted eating.
• Guilt is less consistently linked to AN and BN presentations.
• Interventions directed at shame may be helpful for these populations.
• A lack of longitudinal data means the temporal features of these relationships are still unclear.
Objective
Few studies have investigated temporal trends in the incidence of eating disorders (EDs). This study investigated time trends in the age‐ and sex‐specific incidence of healthcare‐detected anorexia nervosa (AN) and bulimia nervosa (BN) from 2010 to 2016.
Methods
Data were retrieved from the Norwegian National Patient Register as defined by the International Classification of Diseases (ICD‐10): narrowly defined AN (F50.0), broadly defined AN (F50.0 + 50.1), narrowly defined BN (F50.2), and broadly defined BN (F50.2 + 50.3). The average annual percent changes (AAPCs) in incidence rates (IRs) were examined by Joinpoint regression analyses.
Results
The overall (i.e., both genders, ages 10–49) rates of AN were stable across the 7‐year period, with IRs ranging from 18.8 to 20.4 per 100,000 for narrowly defined AN and 33.2 to 39.5 per 100,000 for broadly defined AN, whereas overall rates of BN declined. Age‐ and gender‐stratification revealed a significant average annual increase in AN (narrow and broad) among 10‐ to 14‐year‐old girls. The incidence of broadly defined AN also increased significantly among females aged 15–19 years between 2010 and 2012, before leveling off. Nearly universal declines in the incidence of narrowly and broadly defined BN among females occurred. IRs among males were stable and comparatively low, with no significant trends toward increasing or decreasing rates of AN or BN over time.
Discussion
Although register‐based studies provide an underestimate of the true incidence and may not accurately reflect population‐level changes in true ED occurrence, this study extends our knowledge regarding trends in the detected incidence of EDs into the second decade of the 21st century.
Bu araştırmanın amacı üniversite öğrencilerinde yeme bozukluğu riski üzerinde etkili olan değişkenleri incelemektir. Araştırma İstanbul'da yer alan bir devlet ve bir vakıf üniversitesinde öğrenim gören 784 kadın, 296 erkek toplam 1080 katılımcı ile yürütülmüştür. Kişisel Bilgiler Formu, Rezzy Yeme Bozuklukları Ölçeği ve Anket Formu ile veriler toplanmıştır. Verilerin analizinde grubu tanımlamak için yüzde ve frekans, değişkenler arasındaki ilişkileri açıklamak için lojistik regresyon kullanılmıştır. Araştırmada yeme bozukluğu riskini açıklamaya yönelik 16 değişken bulunmaktadır. Sonuçlara göre tüm grup için risk faktörleri cinsiyetin kadın olması, daha küçük yaş, artan beden kütle indeksi, aile ile düzenli yemek yememe, yediklerini kısıtlama, fastfood yeme, yediği miktarı kontrol edememe, yemek anındaki duyguya göre yenilen miktarın değişmesi, kaygılı bir insan olma, rekabetçi bir insan olma, duyguların hızlı değişmesi, kendini başarılı biri olarak görmeme ve romantik ilişkiye sahip olmadır. Kadınlarda, yeme bozuklukları riskini en çok arttıran değişkenler yediklerini kısıtlama davranışı (2.75 kat) ve sigara kullanma (2.02 kat); erkeklerde yediklerini kısıtlama davranışı (3.81 kat) ve kaygılı bir insan olma (3.08 kat); ve tüm grup için yediklerini kısıtlama davranışı (3.04 kat) ve cinsiyetin kadın olması (1.81 kat) olarak bulunmuştur. Yeme bozukluğu riski için açıklanan varyans oranları kadınlar için %31, erkekler için %42.6 ve tüm grup için %33.2'dir. Beslenme ve psikoloji ile ilişkili çeşitli değişkenler yeme bozukluğu riski üzerinde etkili olabilmektedir. Yeme bozukluğu riski taşıyan üniversite öğrencilerinin belirlenerek psikolojik danışma hizmeti ve beslenme danışmanlığına ulaşımı sağlanmalıdır.
ABSTRACT The aim of this study is to investigate the variables affecting the risk of eating disorder among university students. The study was conducted with a total of 1080 people, 784 women and 296 men, at a state and aprivate university in Istanbul. Datas were collected by Personal Information Form, Rezzy Eating Disorders Scale and Questionnaire Form. In the analysis of the data, logistic regression was used to describe the relationship between variables; percentage and frequency was used to define the group. Risk factors for the whole group are being female, younger age, increased body mass index, not eating regularly with the family, the presence of restrictive eating habits, eating fast food, not being able to control the amount of food eaten, in the amount eaten according to the feeling at the time of the meal, being a worried person, being a competitive person, changing emotions quickly, not seeing oneself as a successful person and having a romantic relationship. In women, the variables that increase the risk of eating disorders most are the restriction of eating (2.75 times) and smoking (2.02 times). In men, the variables that most increase the risk of eating disorders are restrictive behavior (3.81 times) and being an anxious person (3.08 times). For the whole group, the variables that most increased the risk of eating disorders are restrictive eating (3.04 times) and being female (1.81 times). Variances explained for women, man and the whole group are %31, %42.6 and %33.2, respectively. Various variables associated with nutrition and psychology may have an impact on the risk of eating disorder. University students at risk of eating disorders should be identified and be provided psychological counseling and nutrition counseling for them.
Objective:
Despite calls for routine use of progress and outcome monitoring in private and intensive treatment centres for eating disorders (EDs), existing measures have limited relevance to these supervised treatment settings. This study sought to develop and validate the progress monitoring tool for eating disorders, a multidimensional measure for progress monitoring in the context of intensive ED treatment.
Method:
Thirty-seven items were generated by a team of content experts, clinicians, and administrative staff from the target treatment setting. Adolescent and adult females (N = 531) seeking residential ED treatment completed the items at admission as part of the clinic's routine assessment battery; 83% were retained for repeat assessment at discharge. Exploratory factor analysis was conducted for preliminary measure development.
Results:
Results yielded a five-factor, 26-item structure explaining 50% of total variance. Final construct domains included weight and shape concern, ED behaviours and urges, emotion avoidance, adaptive coping, and relational connection. The measure demonstrated adequate internal consistency, sensitivity to change during treatment, and convergence with validated assessment measures.
Conclusions:
Preliminary data support the progress monitoring tool for eating disorders as a novel and valid multidimensional measure of treatment-relevant constructs. This measure may have utility in measuring treatment progress for patients receiving intensive treatment for EDs.
Background: Along with the booming wellness movement in the United States there is a high prevalence of eating disorders. The pursuit of wellness through healthy eating can become an extreme obsession (orthorexia) in some individuals and can lead them down a path to ill health.
Research Objective: The research aims to discover if an intuitive eating approach would be effective as an eating disorder prevention program, specifically for orthorexia, in nutrition professionals and yoga teachers.
Along with the booming wellness movement in the United States there is a high prevalence of eating disorders. The pursuit of wellness through healthy eating can become an extreme obsession (orthorexia) in some individuals and can lead them down a path to ill health.
Research Objective: The research aims to discover if an intuitive eating approach would be effective as an eating disorder prevention program, specifically for orthorexia, in nutrition professionals and yoga teachers.
Distress and mental health issues among college students is an emerging topic of study. The aim of this research work is to illustrate academic and social risk factors and how they prove to be predictors of anxiety and depressive disorders. The methodology used is a cumulative literature review structured over 10 systematic phases, and is replicable. Showing considerable potential for cumulative research, the relevance of this study reflects the concern of the academic community and international governments. The articles selected range from categorization of disorders in relation to mental health, to reporting the condition of rhinestones and difficulties of students in university contexts. In conclusion, the research focusses upon predisposing, concurrent or protective factors relating to the mental health of university students, so that institutions can act on concrete dynamics or propose targeted research on this topic.
The cardinal feature of bulimia nervosa as well as an important feature in some cases of anorexia nervosa, binge eating is central to the proposed Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) scheme for classifying eating disorders. Despite its prevalence, no one volume has been devoted to synthesizing all that is known about binge eating and its treatment. Bridging a gap in the literature, this . . . text brings together significant, original contributions from leading experts from a wide variety of fields.
A valuable resource for all clinicians and researchers interested in eating problems and their treatment, "Binge Eating" also serves as a text for advanced courses on eating disorders, or as supplementary reading for students of psychopathology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Synopsis
A genetic analysis of the co-occurrence of bulimia and major depression (MD) was performed on 1033 female twin pairs obtained from a population based register. Personal interviews were conducted and clinical diagnoses made according to DSM-III-R criteria.
Additive genes, but not family environment, are found to play an important aetiological role in both bulimia and MD. The genetic liabilities of the two disorders are correlated 0·456. While unique environmental factors account for around half of the variation in liability to both bulimia and MD, these risk factors appear to be unrelated, i.e., each disorder has its own set of unique environmental risk factors. Thus, the genetic liability of bulimia and MD is neither highly specific nor entirely nonspecific. There is some genetic correlation between the two disorders as well as some genetic and environmental risk factors unique to each disorder. Limitations and directions for future research are discussed.
Background:
The study explored the genetic and environmental risk factors for both the behaviours and attitudes characteristic of disordered eating.
Methods:
In three waves of data collection, information was collected from female twins regarding their eating and attitudes towards eating, weight and shape. The first assessment consisted of a self-report questionnaire (1988-9) with 1682 women. The second assessment consisted of a semi-structured psychiatric interview schedule (1992-3), completed by 1852 women, many of whom had completed Wave 1 assessment. The third assessment, with 325 women chosen from Waves 1 and 2 (1995-6), consisted of a semi-structured interview (the Eating Disorder Examination).
Results:
As only one twin pair was concordant for lifetime bulimia nervosa at Wave 3 assessment, ordinal measures of all assessments were used in a multivariate genetic analysis. Results indicated that additive genetic and non-shared environmental influences best explained variance in liability to disordered eating, with about 60% (95% CI 50-68) of the variance explained by genetic factors. Comparison with a model allowing for the effects of shared environment indicated genetic factors accounted for a similar degree of variance (59%, 95% CI 36-68).
Conclusion:
Liability to the development of the behaviours and attitudes characteristic of eating disorders is best explained by both environmental and genetic factors, with covariation between the three measures best explained by a single latent phenotype of disordered eating which has a heritability of 60%.
To examine the epidemiology of anorexia nervosa in men, we screened Finnish male twins born in 1975-79.
Men (N = 2122) from FinnTwin16 birth cohorts were screened for lifetime eating disorders by a questionnaire. The screen positives (N = 18), their male co-twins (N = 10) and those with lifetime minimum BMI< or =17.5 (N = 21) were administered the Structured Clinical Interview for DSM-IV anorexia nervosa. The incidence rate of anorexia nervosa for the presumed peak age of risk (10-24y) was 15.7 per 100,000 person-years; its lifetime prevalence was 0.24%. All probands had recovered from eating disorders, but suffered from substantial psychiatric comorbidity, which also manifested in their co-twins. Additionally, male co-twins displayed significant dissatisfaction with body musculature, a male-specific feature of body dysmorphic disorder.
Anorexia nervosa in males in the community is more common, transient and accompanied by more substantial comorbidity than previously thought.
Little is known about the epidemiology of bulimia nervosa outside clinical settings. We report the incidence, prevalence and outcomes of bulimia nervosa using for the first time a nationwide study design.
To assess the incidence and natural course and outcomes of DSM-IV bulimia nervosa among women from the general population, women (n=2881) from the 1975-79 birth cohorts of Finnish twins were screened for lifetime eating disorders using a two-stage procedure consisting of a questionnaire screen and the Structured Clinical Interview for DSM-IV (SCID). Clinical recovery was defined as 1-year abstinence from bingeing and purging combined with a body mass index (BMI) 19 kg/m2.
The lifetime prevalence of DSM-IV bulimia nervosa was 2.3%; 76% of the women suffered from its purging subtype and 24% from the non-purging subtype. The incidence rate of bulimia nervosa was 300/100000 person-years at the peak age of incidence, 16-20 years, and 150/100000 at 10-24 years. The 5-year clinical recovery rate was 55.0%. Less than a third of the cases had been detected by health-care professionals; detection did not influence outcome. After clinical recovery from bulimia nervosa, the mean levels of residual psychological symptoms gradually decreased over time but many women continued to experience significantly more body image problems and psychosomatic symptoms than never-ill women.
Few women with bulimia nervosa are recognized in health-care settings. Symptoms of bulimia are relatively long-standing, and recovery is gradual. Many clinically recovered women experience residual psychological symptoms after attaining abstinence from bingeing and purging.
The authors seek to clarify, from both an epidemiologic and genetic perspective, the major risk factors for bulimia nervosa and to understand the relationship between narrowly defined bulimia and bulimia-like syndromes.
Personal structured psychiatric interviews were conducted with 2,163 female twins from a population-based register. Psychiatric disorders were assessed using DSM-III-R criteria.
Lifetime prevalence and risk for narrowly defined bulimia were 2.8% and 4.2%, respectively. Including bulimia-like syndromes increased these estimates to 5.7% and 8.0%, respectively. Risk factors for bulimia included 1) birth after 1960, 2) low paternal care, 3) a history of wide weight fluctuation, dieting, or frequent exercise, 4) a slim ideal body image, 5) low self-esteem, 6) an external locus of control, and 7) high levels of neuroticism. Significant comorbidity was found between bulimia and anorexia nervosa, alcoholism, panic disorder, generalized anxiety disorder, phobia, and major depression. Proband-wise concordance for narrowly defined bulimia was 22.9% in monozygotic and 8.7% in dizygotic twins. The best-fitting model indicated that familial aggregation was due solely to genetic factors with a heritability of liability of 55%. A multiple threshold model indicated that narrowly defined bulimia nervosa and bulimia-like syndromes represented different levels of severity on the same continuum of liability.
The liability to fully syndromal bulimia nervosa, which affects around one in 25 women at some point in their lives, is substantially influenced by both epidemiologic and genetic risk factors. The same factors that influence the risk for narrowly defined bulimia also influence the risk for less severe bulimia-like syndromes.
The EDE is a semistructured interview which has been developed as a measure of the specific psychopathology of anorexia nervosa and bulimia nervosa. To establish its discriminant validity it was administered to 100 patients with anorexia nervosa or bulimia nervosa and to 42 controls. The two groups differed significantly on all items. Five subscales were derived on rational grounds and evaluated on the two populations. The alpha coefficients for each subscale indicated a satisfactory degree of internal consistency. The EDE provides clinicians and research workers with a detailed and comprehensive profile of the psychopathological features of patients with eating disorders.
Although prior family and twin studies have examined the relationship between the genetic and environmental risk factors for pairs of psychiatric disorders, the interrelationship between these classes of risk factors for a broad range of psychiatric disorders remains largely unknown.
An epidemiologic sample of 1030 female-female twin pairs with known zygosity, ascertained from the Virginia Twin Registry, were evaluated by a personal interview conducted by mental health professionals, assessing lifetime history of phobia, generalized anxiety disorder, panic disorder, bulimia nervosa, major depression, and alcoholism.
A multivariate twin analysis suggested the following. First, genetic, familial-environmental, and individual-specific environmental risk factors each cause a unique pattern of comorbidity among the six disorders. Second, genetic influences on these disorders are best explained by two factors, the first of which loads heavily on phobia, panic disorder, and bulimia nervosa and the second, on major depression and generalized anxiety disorder. Third, unlike other disorders, genetic influences on alcoholism are largely disorder specific. Fourth, familial-environmental influences on these disorders are best explained by a single factor that substantially influenced liability to bulimia nervosa only. Fifth, individual-specific environmental influences on the risk for these psychiatric disorders are best explained by a single factor, with highest loadings on generalized anxiety disorder and major depression and with large-disorder-specific loadings, especially on phobias, panic disorder, and alcoholism.
These results support the following hypotheses: First, each major risk factor domain (genes, family environment, and individual-specific environment) influences comorbidity between these disorders in a distinct manner. Second, genetic influences on these six disorders are neither highly specific nor highly nonspecific. Neither a model that contains a discrete set of genetic factors for each disorder nor a model in which all six disorders results from a single set of genes is well supported. Third, the anxiety disorders are not, from a genetic perspective, etiologically homogeneous. Fourth, most of the genetic factors that influence vulnerability to alcoholism in women do not alter the risk for development of other common psychiatric disorders. These results should be interpreted in the context of both the strengths and limitations of multivariate twin analysis.
Previous epidemiological studies of bulimia nervosa have generated differing estimates of the incidence and prevalence of the disorder. These differences are attributable, in part, to varying definitions of the illness and a range of methodologies. The authors sought to define the prevalence of bulimia nervosa in a nonclinical community sample, examine the clinical significance of DSM-III-R threshold criteria, and examine comorbidity.
Subjects across Ontario (N = 8,116) were assessed with a structured interview, the World Health Organization Composite International Diagnostic Interview, with specific questions added for bulimia nervosa. Subjects who met DSM-III-R criteria for bulimia nervosa were compared with those who were missing only the frequency criterion (two or more binge-eating episodes per week for 3 months).
In this sample, the lifetime prevalence of bulimia nervosa was 1.1% for female subjects and 0.1% for male subjects. The subjects with full- and partial-syndrome bulimia nervosa showed significant vulnerability for mood and anxiety disorders. Lifetime rates of alcohol dependence were high in the full-syndrome group. Rates of parental psychopathologies were high in both bulimic groups but tended to be higher in the subjects with full-syndrome bulimia nervosa. Both bulimic groups were significantly more likely to experience childhood sexual abuse than a normal female comparison group.
This study confirms other prevalence estimates of bulimia nervosa and its comorbid diagnoses from studies that were based on sound methodologies. It also points to the arbitrary aspects of the frequency of binge eating as a diagnostic threshold criterion for the disorder.
This study compares the characteristics of women with anorexia nervosa with those of women who have all the diagnostic features of that disorder except amenorrhoea.
The study uses data from a large community epidemiological survey of the mental health status of household residents in Ontario, Canada. A multi-stage stratified sampling design generated a sample of 4285 females aged 15-64. DSM-III-R diagnoses were made using the Composite International Diagnostic interview.
Eighty-four out of 4285 female respondents met full or partial-syndrome criteria for anorexia nervosa. Comparison of these two groups revealed few statistically significant differences in terms of demographics, psychiatric comorbidity, family history or early experiences.
Amenorrhoea did not discriminate between women with anorexia nervosa and women with all the features except amenorrhoea across a number of relevant variables. The authors question the utility of amenorrhoea as a diagnostic criterion.
An epidemiological study of anorexia nervosa and bulimia nervosa in primary care was performed using the General Practice Research Database (GPRD).
The GPRD was screened between 1988 and 1994 for newly diagnosed cases of anorexia nervosa and bulimia nervosa. The validity of the computer diagnosis was established by obtaining clinical details from a random sample of the general practitioners (GPs).
Incidence rates for detection of cases by GPs in 1993 was 4.2 per 100,000 population for anorexia nervosa, and 12.2 per 100,000 for bulimia nervosa. The relative risks of females to males was 40:1 for anorexia nervosa and 47:1 for bulimia nervosa. A threefold increase in the recording of bulimia nervosa was found from 1988 to 1993. Eighty per cent of anorexia nervosa cases and 60% of bulimia nervosa cases were referred to secondary care.
There is a continuing expansion of service need for bulimia nervosa. The majority of cases of eating disorders are referred to secondary services. There is scope for more effective management of bulimia nervosa in primary care.
Objective: The authors examined two cohorts of female inpatients with anorexia nervosa a decade apart to determine whether there had been any changes in terms of survival. Method: The Swedish National Registers, which contain information about hospital discharges and deaths for the entire population, were used to investigate differences in mortality. Subjects born between 1958 and 1967 and hospitalized due to anorexia nervosa between 1977 and 1981 (N=564) were compared with subjects born between 1968 and 1977 and hospitalized due to anorexia nervosa between 1987 and 1991 (N=554). The cohorts were followed from first hospital admission until 1992 and 2002, respectively. Results: Twenty-five deaths (4.4%) were recorded within the cohort hospitalized between 1977 and 1981, and seven deaths (1.3%) occurred in the cohort hospitalized between 1987 and 1991. The hazard ratio of death for the 1977-1981 cohort relative to the 1987-1991 cohort was 3.7. Conclusions: Mortality among female patients with anorexia nervosa in hospital care in Sweden has decreased dramatically, which is probably related to the introduction of specialized care units.
This meta-analytic review of prospective and experimental studies reveals that several accepted risk factors for eating pathology have not received empirical support (e.g., sexual abuse) or have received contradictory support (e.g., dieting). There was consistent support for less-accepted risk factors(e.g., thin-ideal internalization) as well as emerging evidence for variables that potentiate and mitigate the effects of risk factors(e.g., social support) and factors that predict eating pathology maintenance(e.g., negative affect). In addition, certain multivariate etiologic and maintenance models received preliminary support. However, the predictive power of individual risk and maintenance factors was limited, suggesting it will be important to search for additional risk and maintenance factors, develop more comprehensive multivariate models, and address methodological limitations that attenuate effects.
The purpose of the present study was to clarify genetic and environmental origins of psychological traits of eating disorders using a Japanese female twin sample. Participants were 162 pairs of female twins consisting of 116 pairs of monozygotic (MZ) twins and 46 pairs of dizygotic (DZ) twins in their adolescence. Psychological traits of eating disorders were assessed with five subscales of the Eating Disorder Inventory (EDI). As a result of using univariate twin analyses, among five subscales of EDI (maturity fears, ineffectiveness, interpersonal distrust, interoceptive awareness, and perfectionism), perfectionism showed significant additive genetic contributions and individual specific environmental effects. On the other hand, maturity fears, ineffectiveness, interoceptive awareness, and interpersonal distrust indicated significant shared environment contributions and individual specific environment effects. The results suggest the importance of both genetic and shared environmental influences on psychological traits of eating disorders in the present study.
Family studies have suggested that eating disorders and mood disorders may coaggregate within families. Previous studies, however, have been limited by use of univariate modeling techniques and failure to account for the correlation of observations within families. To provide a more efficient analysis and to illustrate multivariate logistic regression models for familial aggregation of two disorders, the authors analyzed pooled data from two previously published family studies (conducted in Massachusetts in 1984-1986 and 1986-1987) by using multivariate proband predictive and family predictive models. Both models demonstrated a significant familial aggregation of mood disorders and familial coaggregation of eating and mood disorders. The magnitude of the coaggregation between eating and mood disorders was similar to that of the aggregation of mood disorders. Similar results were obtained with alternative models, including a traditional univariate proband predictive model. In comparison with the univariate model, the multivariate models provided greater flexibility, improved precision, and wider generality for interpreting aggregation effects.
Eating disorders, such as anorexia nervosa (AN) and bulimia nervosa (BN), have genetic and environmental underpinnings. To explore genetic contributions to AN, we measured psychiatric, personality and temperament phenotypes of individuals diagnosed with eating disorders from 196 multiplex families, all accessed through an AN proband, as well as genotyping a battery of 387 short tandem repeat (STR) markers distributed across the genome. On these data we performed a multipoint affected sibling pair (ASP) linkage analysis using a novel method that incorporates covariates. By exploring seven attributes thought to typify individuals with eating disorders, we identified two variables, drive-for-thinness and obsessionality, which delimit populations among the ASPs. For both of these traits, or covariates, there were a cluster of ASPs who have high and concordant values for these traits, in keeping with our expectations for individuals with AN, and other clusters of ASPs who did not meet those expectations. When we incorporated these covariates into the ASP linkage analysis, both jointly and separately, we found several regions of suggestive linkage: one close to genome-wide significance on chromosome 1 (at 210 cM, D1S1660; LOD = 3.46, P = 0.00003), another on chromosome 2 (at 114 cM, D2S1790; LOD = 2.22, P= 0.00070) and a third region on chromosome 13 (at 26 cM, D13S894; LOD = 2.50, P = 0.00035). By comparing our results to those implemented using more standard linkage methods, we find the covariates convey substantial information for the linkage analysis.
Objective: To test women's ability to recall their past binging and purging behaviors. Design: Ten-year follow-up study of women who had participated in a cross-sectional survey during college. Subjects: In 1982, a sample of freshman and senior women at a large university in the Boston area were questioned about their weight, dieting history, bulimic symptoms, and eating patterns, attitudes, and concerns. In 1992, all subjects who responded to the 1982 survey were followed up to assess changes in bulimic symptoms and ability to recall past behaviors. Results: Among the 476 women who responded to both surveys, the percentage in 1992 who reported having ever binged and/or purged was less than the percentage in 1982, indicating that the recall of past behaviors was less than perfect. Denial in 1992 of ever having engaged in the behaviors ranged from 22% among the women who were self-inducing vomiting in 1982 to 64% among the women who had reported current fasting or strict dieting in 1982. Recall of past behaviors in 1992 was better among the women who had been current bingers or purgers in 1982.
Conclusion: Our results demonstrate that ability to recall past binging and purging is only modest. Therefore to better understand the mental and physical health consequences of these behaviors this information should be collected prospectively.
This paper presents age of onset data for anorexia nervosa and bulimia nervosa, derived from a sample of 323 patients referred to a tertiary referral center. Patients had anorexia nervosa (n = 39), bulimia nervosa (n = 173), or bulimia nervosa with a history of anorexia nervosa (n = 173). While the pattern of onset of anorexia nervosa and bulimia nervosa is similar up to age 25, there is a significant excess of new cases of anorexia nervosa beyond this point. Significantly, age of onset was constant for both anorexia nervosa and bulimia regardless of whether they occurred in isolation (anorexia or bulimia alone) or in concert in the same individual (bulimia with a history of anorexia nervosa).
Objective
The current study presents the long-term course of anorexia nervosa (AN) over 12 years in a large sample of 103 patients diagnosed according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).Method
Assessments were made at the beginning of therapy, at the end of therapy, at the 2-year follow-up, at the 6-year follow-up, and at the 12-year follow-up. Self-rating and an expert-rating interview data were obtained.ResultsThe participation rate at the 12-year follow-up was 88% of those alive. There was substantial improvement during therapy, a moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 12 years posttreatment. Based on a global 12-year outcome score, 27.5% had a good outcome, 25.3% an intermediate outcome, 39.6% had a poor outcome, and 7 (7.7%) were deceased. At the 12-year follow-up 19.0% had AN, 9.5% had bulimia nervosa-purging type (BN-P), 19.0% were classified as eating disorder not otherwise specified (EDNOS). A total of 52.4% showed no major DSM-IV eating disorder and 0% had binge eating disorder (BED). Systematic—strictly empirically based—model building resulted in a parsimonious model including four predictors of unfavorable 12-year outcome explaining 45% of the variance, that is, sexual problems, impulsivity, long duration of inpatient treatment, and long duration of an eating disorder.Conclusion
Mortality was high and symptomatic recovery protracted. Impulsivity, symptom severity, and chronicity were the important factors for predicting the 12-year outcome. © 2005 by Wiley Periodicals, Inc.
This paper discusses cultural considerations for classification of eating disorders.
The literature on epidemiology and phenomenology of eating disorders in culturally diverse populations was selectively reviewed to identify methodologic challenges in classification and characterization of prevalence and phenomenology.
Prevalence of eating disorders among culturally diverse populations is incompletely characterized. Few studies address the epidemiology of eating disorders or provide qualitative data on variation in presentation in these populations. Unrecognized cultural diversity may result in misclassification of cases.
Development of culturally valid assessments, ethnographic data on indigenous nosologic correlates and idioms of distress, and attention to phenomenologic diversity may have critical impact on understanding clinical presentations and risk factors that may be culturally particular. A flexible classificatory system for the eating disorders may help to encompass their culturally based phenomenologic diversity, facilitate culturally sensitive and strategic prevention strategies, and reduce ethnic disparities in access to care for them. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007
ObjectiveA substantial proportion of eating disorder presentations receive a DSM-IV diagnosis of eating disorder not otherwise specified (EDNOS), yet research comparing EDNOS with anorexia nervosa (AN) and bulimia nervosa (BN) is limited. The aim of this study was to further investigate EDNOS in clients at a UK Community Eating Disorder Service.Method
The Eating Disorder Examination (EDE) was used to generate DSM-IV diagnoses. Clinical profiles of EDNOS clients are compared with those of patients with AN and BN and cluster analysis used to identify subgroups based on presenting features rather than diagnosis.Results190 of 200 participants had a clinical eating disorder: 11 had AN, 45 had BN, 134 had EDNOS. Cluster analysis suggested four subgroups within the clinical sample: three with similar cognitive psychopathology but varied behavioural presentation, and one with less severe cognitive and behavioural features, but low mean BMI.DiscussionThese results highlight the need for further investigation into EDNOS and its usefulness as a diagnosis. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.
To review evidence of the clinical significance, distinctiveness, and prevalence of a newly characterized form of eating disorder not otherwise specified, purging disorder (PD).
Articles were identified by computerized and manual searches.
PD is a clinically significant disorder of eating that does not appear to differ meaningfully in severity from bulimia nervosa (BN). Preliminary evidence supports the distinctiveness of PD from BN, but no studies have directly examined PD in comparison with anorexia nervosa (AN). Epidemiological studies indicate that PD affects between 1.1 and 5.3% of young adult women in their lifetimes, reflecting lifetime prevalence rates comparable with those for AN and BN.
More research on PD is needed, particularly with regard to etiology, treatment, course, and outcome. Such work would be greatly facilitated by standardization of the syndrome's definition. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007
Objective
Although previous research has demonstrated a relationship between socioeconomic status (SES) and weight, the research has not been consistent regarding the relationship between SES and eating disorders. This analysis was designed to examine this relationship in a large community sample of adolescent girls (Grades 7 to 12). Method: Items were selected from a comprehensive self-report health survey completed by 17,571 adolescent girls. The relationships between SES and dieting behaviors and attitudes were examined using chi-square tests and analysis of variance (ANOVA) to control for body mass index. Results: Although there was a significant positive relationship between SES and some of the unhealthy dieting behaviors, there was no relationship between self-report of clinically significant eating-disordered behaviors (e.g., vomiting twice a week or more) and SES in this community sample. Discussion: This study suggests that while there may be a significant relationship between SES and dieting or other behaviors associated with eating disorders, this relationship does not apply to diagnostically significant behaviors. SES may be associated with differences in dieting or eating behaviors; however, among those young women who meet psychiatric criteria for an eating disorder, SES does not appear to be a significant factor. © 1997 by John Wiley & Sons, Inc. Int J Eat Disord 22: 15–23, 1997.
Objective
The current study sought to determine whether there are subtypes of bulimia nervosa (BN) differentiated by comorbid psychiatric disorders.Method
Data on comorbid psychiatric diagnoses in female relatives of probands and controls in the Collaborative Study of the Genetics of Alcoholism (COGA) who met criteria for BN (as outlined in the 3rd Rev. ed. of the Diagnostic and Statistical Manual of Mental Disorders) were analyzed using latent class analysis. Resulting latent classes were compared on a variety of variables related to impulsive behaviors and psychological functioning.ResultsThe best-fitting solution, a two-class model, yielded one class (72%) characterized by substance dependence, depression, antisocial personality disorder (ASPD), and anxiety disorders, and another characterized by depression. The highly comorbid class had more suicidality, more daily smokers, sought help for emotional problems, and had lower Global Assessment of Functioning (GAF) scores compared with those in the comorbid depression only class.DiscussionLatent class findings suggest the existence of two classes of BN differentiated by substance dependence, impulsive behaviors, and poorer psychological functioning. © 2004 by Wiley Periodicals, Inc.
Previous research has shown an association between bulimia (BN) and drug use disorders (DUD). The purpose of the present study was to investigate possible influences on the comorbidity between BN and DUD.
Participants included 490 monozygotic and 354 dizygotic female twins and 930 females from opposite sex pairs. Multiple logistic regression analyses were used to test shared correlates and mediators. Bivariate twin analyses were used to investigate the contribution of genes and environment to the correlation between BN and DUD.
Depression, neuroticism, and childhood sexual abuse (CSA) mediated the association between BN and DUD regardless of which disorder was used as the dependent variable. Analyses also indicated genetic and nonshared environmental overlap between BN and DUD.
The association between BN and DUD is due mostly to overlapping genetic influences with a smaller contribution from nonshared environment. Depression, neuroticism, and CSA are likely important shared correlates. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007
To present national estimates and correlates of lifetime and 12-month DSM-IV eating disorders for Latinos.
Data come from the National Latino and Asian American Study (NLAAS), a national epidemiological household survey of Latinos in the United States.
Latinos have elevated rates of any binge eating and binge eating disorder but low prevalence of anorexia nervosa and bulimia nervosa. The US born and those living a greater percentage of their lifetime in the US evidenced higher risk for certain eating disorders while severe obesity and low levels of education were significant correlates. Rates of treatment utilization were exceedingly low.
Standard eating disorder criteria may not be appropriate for understanding psychological morbidity of eating disorders for Latinos, particularly less acculturated Latinos, due to cultural differences in the presentation of eating disorder symptoms. Criteria for disturbed eating patterns that are more reflective of the illness experience of Latinos should be developed.
This report deals with certain theoretical and clinical aspects of the problem of overeating and obesity. It considers the advantages, especially in psychiatric research, if obesity were found to represent, not one disease, but the end stage of a variety of different conditions with differing etiologies. Experimentally-induced obesity in animals serves as a model of such a contingency since it can be produced by different methods, which result in different types of obesity. Some of the most striking differences have been found in the field of behavior, a recent study having demonstrated characteristic differences between the feeding patterns of obese and non-obese mice, and even between the feeding patterns of mice afflicted with different forms of obesity.
The eating behavior of obese human subjects is considered from this point of view, and three distinctive eating patterns are described. The first of these patterns is that of the night-eating syndrome, characterized by morning anorexia, evening hyperphagia, and insomnia. The second pattern is that of the eating binge, in which large amounts of food are consumed in an orgiastic manner at irregular intervals. The third pattern is that of eating-without-satiation which has been observed in persons suffering from damage to the central nervous system.
This meta-analysis involved 35 studies examining eating disturbance and body dissatisfaction in white and non-white populations and the role of acculturation in the development of eating-related psychopathology. While the role of acculturation in predisposing non-whites to eating disorders remains to be determined, mean effect sizes indicate that whites report more eating disturbance than non-whites. Differences are greatest when studies compare black and white college samples on measures of subclinical eating pathology, like dietary restraint, ideal body shape, and body dissatisfaction. They are weakest when non-clinic populations and clinical forms of eating disturbance, like bulimia nervosa, are examined. These findings suggest that the current literature may be incorrect in its view that subclinical and clinical forms of eating disturbance represent the poles of a single continuum. In addition, they call into question the belief that SES influences the development of eating pathology.
Individuals with bulimia nervosa have been shown to display heterogeneous profiles of comorbid psychiatric disturbance, possibly due to varying degrees of genetic and environmental vulnerability. Using information about comorbid psychiatric disturbances, we developed an empirically based classification of individuals with bulimia-spectrum disorders, and then explored whether or not the resulting phenotypes corresponded to variations in the serotonin transporter promoter polymorphism (5-HTTLPR) and exposure to childhood abuse.
Eighty-nine women aged 17 to 49 years with DSM-IV bulimia-spectrum disorders completed questionnaires assessing eating and general psychopathologic symptoms, participated in interviews assessing Axis I disorders and childhood abuse, and provided blood samples for genotyping. Data on lifetime Axis I disorders were analyzed using latent class analysis, and resulting classes were compared on eating and psychopathologic symptoms, 5-HTTLPR genotype, and childhood abuse. The study was conducted from June 2002 to October 2006.
The analysis yielded a model with 2 classes: a first class labeled low comorbidity (N = 59, 66%), characterized by a high likelihood of major depressive disorder, and another class labeled high comorbidity (N = 30, 34%), characterized by a high likelihood of major depressive disorder, anxiety disorder, and substance-use disorders. The high-comorbidity class displayed significantly higher dieting preoccupations and conduct problems, and showed a greater likelihood of carrying the 5-HTTLPR S allele and of childhood abuse than did the low-comorbidity class.
The present results are consistent with previous findings identifying a subgroup of individuals with bulimia characterized by high psychiatric comorbidity and suggest that the 5-HTTLPR polymorphism and childhood trauma may both be pertinent to explaining the presence of greater psychiatric comorbidity in bulimia-spectrum disorders.
A study was undertaken to assess the procedural validity of the Composite International Diagnostic Interview (CIDI) for the diagnosis of eating disorders.
The CIDI was administered to 44 patients consecutively admitted to an eating disorders unit. CIDI-generated diagnoses were compared with clinical diagnoses documented in patient files. Discrepancies between diagnoses were examined in detail.
A significant level of disagreement was apparent, particularly for anorexia nervosa patients. A large number of patients with symptoms requiring inpatient treatment did not reach criteria using CIDI's diagnostic algorithm.
Considerable difficulties remain in the use of standardized assessments, such as the CIDI, to diagnose eating disorders. While presenting features of the illness, for example, ego syntonic nature of the illness, secrecy, and denial, may be part of the reason, the questions used by the CIDI appear to be in need of some refinement.
Is there a resemblance between the contemporary anorexic teenager counting every calorie in her single-minded pursuit of thinness, and an ascetic medieval saint examining her every desire? Rudolph M. Bell suggests that the answer is yes. "Everyone interested in anorexia nervosa . . . should skim this book or study it. It will make you realize how dependent upon culture the definition of disease is. I will never look at an anorexic patient in the same way again."âHoward Spiro, M.D., Gastroenterology "[This] book is a first-class social history and is well-documented both in its historical and scientific portions."âVern L. Bullough, American Historical Review "A significant contribution to revisionist history, which re-examines events in light of feminist thought. . . . Bell is particularly skillful in describing behavior within its time and culture, which would be bizarre by today's norms, without reducing it to the pathological."âMary Lassance Parthun, Toronto Globe and Mail "Bell is both enlightened and convincing. His book is impressively researched, easy to read, and utterly fascinating."âSheila MacLeod, New Statesman
To test the hypothesis that the socio-cultural transition in the 1990s in Eastern Europe was associated with an increase in admissions for eating disorders (ED).
Cases of ICD-9 and ICD-10 ED in 1981, 1986 and 1992-2005 and first admissions for ICD-10 anorexia nervosa (AN) in 1994-2005 were retrieved from the Czech national register of hospital admissions. Age- and sex-adjusted admission rates (per 100,000) were calculated and time trends tested by Poisson regression.
The admission rate for ED in females aged 10-39 quadrupled from 2.6 (95% CI 2.1-3.0) in 1981 to 10.6 (95% CI 9.8-11.5) in 2001, and remained elevated till 2005. The rate of first-time admissions for AN in 10- to 39-old females increased from 4.5 (95% CI 3.6-5.4) in 1994 to 7.5 (95% CI 6.3-8.6) in 1999, followed by a non-significant decrease.
Temporal association of an increase in admissions with socio-cultural transition suggests that risk of severe ED including AN is culture-dependent.
Few data are available to estimate the prevalence of eating disorders (EDs) and their correlates in the community. This paper reports data on EDs obtained in the framework of the ESEMeD project, aimed at investigating the prevalence of non-psychotic mental disorders in six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain), using a new version of the Composite International Diagnostic Interview. The ESEMeD study was a general population cross-sectional household survey. In total, 21,425 respondents aged 18 or older provided data for the project between January 2001 and August 2003. A subsample (N=4139) underwent a detailed investigation on EDs. Lifetime estimated prevalence of anorexia nervosa, bulimia nervosa, binge eating disorder, sub-threshold binge eating disorder, and any binge eating were 0.48%, 0.51%, 1.12%, 0.72%, and 2.15%, respectively, and they were 3-8 times higher among women for all EDs. However, since people under 18 were excluded from this study, our prevalence should be taken as lower-bound estimate of real frequencies. Indeed, cumulative lifetime prevalence analysis showed that the majority of eating disorders had their initial onset between 10 and 20 years of age. Role impairment and comorbidity with other mental disorders were highly common, yet only small proportions of patients with a lifetime diagnosis of EDs requested medical treatment. It still has to be proven whether early diagnostic identification and access to specialized care can reduce the burden caused by these disorders.
We estimated the prevalence of eating disorders and maladaptive eating behaviors in a population-based sample and examined the association of maladaptive eating with self-rated physical and mental health.
A sample of 1,501 women (mean age = 31.2 years, SD = 6.2) were recruited using random-digit dialing to participate in a 20-min telephone interview about eating behaviors.
Weighted frequency analysis showed the prevalence of frequent binge-eating to be 4.1%, that of regular purging to be 1.1%, and that of frequent compensation to be 8.7%. Although we found none of the women to meet full criteria for anorexia nervosa, 0.6% met criteria for bulimia nervosa, 3.8% provisional criteria for binge eating disorder, and 0.6% criteria for a newly proposed entity, purging disorder. As many as 14.9% fell into a residual category representing subthreshold, but potentially problematic variants of eating disturbances. Logistic regression analyses showed that clinical-level maladaptive eating attitudes and behaviors predicted self-rated physical- and mental-health problems after sociodemographic factors were controlled.
This population-based survey provides prevalence estimates of BN, BED, and purging disorder that are compatible with those of recent epidemiological studies and shows that maladaptive eating attitudes and behaviors represent a substantial population burden.
This study was designed to investigate potential temperament endophenotypes for clinically significant importance of shape and weight.
Seven temperament risk factors for eating disorders and the Eating Disorder Examination were assessed in 699 female twins aged 12-15 years. Each variable was evaluated against the following endophenotype criteria: associated with illness in the general population; found in non-affected family members at a higher rate than in the general population; and, heritable.
All seven variables were significantly associated with clinically significant importance of shape and weight, while thin-ideal internalization, ineffectiveness, body dissatisfaction and sensitivity to punishment were found at significantly elevated levels in non-affected twins, when controlling for sister's temperament score. These four variables had genetic correlations with importance of shape and weight, ranging from 0.48 to 0.95.
Future research should evaluate the stability of the identified endophenotypes and their utility for predicting significant growth in importance of shape and weight, and also whether different endophenotypes emerge when the importance of weight and shape reaches its peak in adolescents, around 15 to 16 years of age.
Synopsis
Thirty patients were selected for a prospective study according to two criteria: (i) an irresistible urge to overeat (bulimia nervosa), followed by self-induced vomiting or purging; (ii) a morbid fear of becoming fat. The majority of the patients had a previous history of true or cryptic anorexia nervosa. Self-induced vomiting and purging are secondary devices used by the patients to counteract the effects of overeating and prevent a gain in weight. These devices are dangerous for they are habit-forming and lead to potassium loss and other physical complications. In common with true anorexia nervosa, the patients were determined to keep their weight below a self-imposed threshold. Its level was set below the patient‘s healthy weight, defined as the weight reached before the onset of the eating disorder. In contr