Article

Increased rates of eating disorders and their symptoms in women with major depressive disorder and anxiety disorders

Authors:
Article

Increased rates of eating disorders and their symptoms in women with major depressive disorder and anxiety disorders

If you want to read the PDF, try requesting it from the authors.

Abstract

Background Individuals with eating disorders (EDs) have increased rates of major depressive disorder (MDD) and anxiety disorders. Yet, few studies have investigated rates of EDs and their symptoms in individuals presenting with MDD/anxiety disorders. Identifying potential disordered eating in people with MDD/anxiety disorders is important because even subclinical disordered eating is associated with reduced quality of life, and undiagnosed eating pathology may hinder treatment progress for both MDD/anxiety disorders and comorbid EDs. Method We compared rates of EDs (anorexia nervosa, bulimia nervosa, binge‐eating disorder, and other specified feeding and eating disorders) and their symptoms in 130 women with, and 405 women without, lifetime MDD or an anxiety disorder (generalized anxiety disorder, obsessive–compulsive disorder, social phobia, specific phobia, panic disorder, agoraphobia, or post‐traumatic stress disorder) recruited from the population‐based Michigan State University Twin Registry. Lifetime ED and MDD/anxiety diagnoses, and lifetime clinically significant disordered eating behaviors (e.g., binge eating, excessive exercise) were assessed using the Structured Clinical Interview for DSM‐IV (SCID). Results Among participants with lifetime MDD or any anxiety disorder, 13% met criteria for a lifetime ED and 39% reported engaging in at least one lifetime clinically significant disordered eating behavior (e.g., binge eating) on the SCID. In contrast, only 3% of participants without a history of MDD/an anxiety disorder met criteria for a lifetime ED, and only 11% reported lifetime clinically significant disordered eating behavior. Discussion Our findings suggest that women with MDD and anxiety disorders have elevated rates of EDs, and it is therefore imperative to screen for disordered eating in these populations.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Both are the most common comorbid diagnoses in eating disorders [8,9], especially in adolescence [10]. In a recent study on 15-to 25-year-old females, those with lifetime major depressive disorder or anxiety disorder were four times more likely to have a lifetime eating disorder [11]. Similar to anxiety disorders, individuals with an eating disorder use dysfunctional strategies such as disordered eating to cope with their emotions [12]. ...
... In line with previous findings [11,15,16,21,25], greater anxiety/depression was associated with more severe eating disorder symptomatology. Thus, results support the cumulative detrimental effect of co-occurring anxiety, depression, and eating disorder symptoms. ...
Article
Full-text available
Adolescents and young adults, particularly females, are highly vulnerable to the development of anxiety disorders, depression, and eating disorders. Comorbid anxiety disorder or depression in eating disorders are associated with greater symptom severity, poorer prognosis, and burden of illness. Nonetheless, studies on what affects the relationship between anxiety, depression, and eating disorders in female at-risk samples are scarce. Using hierarchical linear modeling, the present study examined potential moderators to explain between-person differences in the association between anxiety, depression, and eating disorder-related impairment within 12- to 25-year-old females (N = 320). High impairment in anxiety/depression was associated with more severe eating disorder symptoms. Older age as well as greater impairment in mood dysregulation, self-esteem, and perfectionism were linked to more severe eating disorder symptomatology. Whereas mood dysregulation, self-esteem, and perfectionism had no statistically significant moderating effects, younger age appeared to augment the association of anxiety/depression and eating disorder symptomatology. Preventive care in particular needs to consider age-related effects as eating disorder symptoms are associated more strongly with symptoms of anxiety and depression in early adolescence.
... Anxiety impacts physical health, lifestyle, and academic performance and during the COVID-19 pandemic, university students report di cultly coping with stress adequately (10,12). Stress is a known trigger for undereating and overeating (13) and even in non-pandemic times, the relationship between anxiety and eating behaviors and attitudes is documented (14,15). In college students, anxiety and depression are associated with changes in food choices and total caloric intake (16) and anxiety is associated with food insecurity (17). ...
Preprint
Full-text available
Background COVID-19 has impacted mental health globally, however, relationships between anxiety and eating behaviors during the pandemic have not been explored. This study evaluated anxiety, eating attitudes and behaviors, and associations between anxiety and eating behaviors in students at a large public University in the United States during the COVID-19 pandemic. Methods Current undergraduate and graduate/professional students completed a cross-sectional survey in fall 2020. Demographic information, indicators of anxiety in the past two weeks assessed by the Generalized Anxiety Disorder Screener (GAD-7), and eating behaviors assessed by the Adult Eating Behavior Questionnaire (AEBQ) were evaluated. A score ≥ 10 on the GAD-7 indicated anxiety (≥ 15 indicated severe anxiety). Eating behaviors were reported via Likert scale and combined into eight AEBQ subscales; subscale mean and standard deviation were reported. Differences in mean AEBQ subscale scores were examined between participants with and without anxiety via Mann-Whitney U tests. Multivariate linear regression was utilized to examine associations between GAD-7 score and individual AEBQ subscale scores, adjusting for age, gender, race/ethnicity, and student status. Results The final sample included 1243 students (57% undergraduates). In the full sample, 51.9% experienced anxiety in the past two weeks; 24.6% had severe anxiety. Subgroups with the highest prevalence of anxiety included non-cisgender participants (73.6%), the youngest age group [18–20 years of age (62%)], undergraduate students (60.7%), and Hispanic/Latino participants (57.5%). Participants with anxiety had significantly lower AEBQ scores for enjoyment of food and significantly higher scores for emotional over and under-eating, food fussiness, food and satiety responsiveness, and hunger than those with no anxiety (p < 0.01). In adjusted analyses, GAD-7 score was significantly and positively associated with hunger, food responsiveness, emotional over-eating, satiety responsiveness, and food fussiness and negatively associated with enjoyment of food. Conclusions The prevalence of anxiety is overwhelming in undergraduate and graduate/professional students amidst the COVID-19 pandemic. Eating behaviors differ significantly in those with anxiety; increasing anxiety severity was associated with undesirable eating behaviors including hunger and emotional over-eating. Universities and health professionals must consider strategies to address anxiety, particularly in younger students, non-cis-gender students, and across race/ethnicities keeping in mind associations between anxiety and eating behaviors.
... The internalizing spectrum includes symptoms related to depression, anxiety, and negative affect more broadly, as well as perfectionistic and obsessive traits (e.g., preoccupation with details, rules, lists, order, and organization; excessive conscientiousness, rigidity, stubbornness). Importantly, extant data suggest that these types of symptoms/traits are highly comorbid with eating disorders and their symptoms across development and are strong predictors of the later development of clinical pathology (e.g., Bardone-Cone et al., 2006;Boone et al., 2014;Bulik et al., 1997;Culbert et al., 2015;Davis & Fischer, 2013;Deep et al., 1995;Garcia et al., 2020;Killen et al., 1996;Leon et al., 1999;Stice, 2002;Stice, 2016Tyrka et al., 2002Vohs et al., 1999). Indeed, some data suggest that eating disorders and their symptoms load on a factor with these types of internalizing symptoms (Forbush et al., 2017). ...
Article
Twin studies demonstrate significant environmental influences and a lack of genetic effects on disordered eating before puberty in girls. However, genetic factors could act indirectly through passive gene–environment correlations (rGE; correlations between parents’ genes and an environment shaped by those genes) that inflate environmental (but not genetic) estimates. The only study to explore passive rGE did not find significant effects, but the full range of parental phenotypes (e.g., internalizing symptoms) that could impact daughters’ disordered eating was not examined. We addressed this gap by exploring whether parents’ internalizing symptoms (e.g., anxiety, depressive symptoms) contribute to daughters’ eating pathology through passive rGE. Participants were female twin pairs (aged 8–14 years; M = 10.44) in pre-early puberty and their biological parents (n = 279 families) from the Michigan State University Twin Registry. Nuclear twin family models explored passive rGE for parents’ internalizing traits/symptoms and twins’ overall eating disorder symptoms. No evidence for passive rGE was found. Instead, environmental factors that create similarities between co-twins (but not with their parents) and unique environmental factors were important. In pre-early puberty, genetic factors do not influence daughters’ disordered eating, even indirectly through passive rGE. Future research should explore sibling-specific and unique environmental factors during this critical developmental period.
... Short and long-term impacts of pandemic-induced stress and anxiety are also emerging. Stress and anxiety are known triggers for undereating, overeating, and other maladaptive eating attitudes and behaviors [19,20]. In college students, anxiety and depression are associated with changes in food choices and total caloric intake [21]. ...
Article
Full-text available
Background: COVID-19 has impacted mental health globally, however, associations between anxiety and appetitive traits during the pandemic are unreported. This study evaluated anxiety symptom severity and associations with appetitive traits in students at a large public University in the U.S. during the pandemic. Methods: Current undergraduate and graduate/professional students completed a cross-sectional survey in fall 2020. Demographic information, anxiety symptoms in the past 2 weeks assessed by the Generalized Anxiety Disorder Scale (GAD-7), and appetitive traits assessed by the Adult Eating Behavior Questionnaire (AEBQ) were evaluated. Mean scores for eight AEBQ scales (four food approach and four food avoidance traits) were calculated. Differences in mean scores were examined between participants with moderate to severe anxiety symptoms (GAD-7 score ≥ 10) and those with mild to no anxiety symptoms (GAD-7 score < 10) via independent samples t-tests and effect sizes. Associations between GAD-7 score and individual appetitive traits were also examined, adjusting for age and gender. Results: Of the 1243 students who completed the survey (57% undergraduates; mean age = 26.5 years), 51.9% reported moderate to severe anxiety symptoms. Groups experiencing the highest degree of moderate to severe anxiety symptoms included transgender, gender fluid, and other-gendered participants (73.6%); the youngest age group [18-20 years (62%)]; undergraduate students (60.7%); and Hispanic/Latinx participants (57.7%). Participants with moderate to severe anxiety symptoms had higher scores for most food approach and avoidance traits but lower scores for enjoyment of food than those with mild to no anxiety symptoms. Effect sizes were largest for hunger and emotional over-eating (Cohen's d = 0.31 and 0.30, respectively). Adjusting for age and gender, GAD-7 score was significantly and positively associated with hunger, emotional over-eating, food and satiety responsiveness, and food fussiness and negatively associated with enjoyment of food. Conclusions: Over half of students at a U.S. University reported moderate to severe anxiety symptoms during COVID-19. More severe anxiety symptoms were associated with increased hunger, emotional over-eating, and food and satiety responsiveness and decreased enjoyment of food. Universities must consider strategies to address anxiety, particularly in younger students; transgender, gender fluid, and students of other genders; and across race/ethnicities keeping in mind associations with appetitive traits.
... Identifying ED in subjects with depressive disorders is critical given the high rate of antidepressants resistance in this population (54), yet most people with ED go undetected even among psychiatric outpatients as they often seek care for comorbid mental disorders (55). Other authors have advocated the need to screen for disordered eating in subjects with Major Depressive Disorder (56). ...
Article
Full-text available
Background and PurposeComorbidity between diabetes and depression, and diabetes and eating disorders (ED) conveys significant diagnostic, clinical and therapeutic implications. The present study was conducted on a sample of adult outpatients affected by Type 1 Diabetes (T1DM) to assess lifetime prevalence of ED; current prevalence of depression and Disturbed Eating Behaviors (DEB) and their impact on glycemic control. We hypothesized that patients with depression would have higher rates of lifetime ED and current DEB. We hypothesized a significant and independent association between DEB and the prevalence of depression.Materials and Methods The study was carried out using a cross-sectional design in a sample of 172 diabetic patients with T1DM aged from 17 to 55 years. Lifetime prevalence of ED according to DSM-5 criteria was assessed by means of the Module H modified of the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). The following questionnaires were used: Beck Depression Inventory–IA version (BDI-IA) and Diabetes Eating Problems Survey—Revised (DEPS-R), to assess respectively the current presence of depression and DEB. Socio-demographic, clinical, and laboratory data were also collected.ResultsHigh rates of depression (35.5%) and DEB (19.2%) were observed in our sample of 172 adult outpatients with T1DM. Lifetime history of ED was present in 20.9% of the sample and was more frequently diagnosed in patients with current depression (34.4% vs. 13.9%, p = 0.002). Higher levels of DEB at DEPS-R significantly increased the odds of depression (adjOR: 1.09; 95% CI: 1.03–1.15; p = 0.003). The presence of DEB was associated with poor glycemic control. On the other hand, no association was found between depression and metabolic compensation.Conclusion Adult patients with T1DM and depression should be screened for ED and DEB. Treating DEB could positively impact both mood and glycemic control in this population. Further studies should be carried out on a larger patient population using a longitudinal design and an accurate method of evaluation to explore the complex relationship between diabetes, depression, ED, and DEB. Future research should investigate treatment strategies for DEB in T1DM patients and their impact on both psychopathological and metabolic outcomes.
... Our findings showed adolescents with disordered eating were significantly associated with high CDI scores (depression) compared to those without. This is in line with previous studies where severe depression is associated with more severe eating behavior (66). Although some studies suggested self-esteem and depression as mediators for disordered eating (67), the link between depression and eating disorders is not yet clearly established (68). ...
Article
Full-text available
Introduction Depression is a prevalent mental health condition worldwide and in Malaysia. Depression among adolescents has been steadily increasing. Self-esteem has been known to be associated with depression. It has been postulated that a poor lifestyle among adolescents is associated with depression. This paper aims to study the correlation of self-esteem, lifestyle (eating behavior, physical activity, and internet usage) with depression among Malaysian youth. Methodology This is a cross-sectional study among secondary school children from 5 random schools in an urban city of Kuala Lumpur, Malaysia. Those with intellectual disability and/or difficulty to comprehend Malay language, and without parental consent and assent, were excluded. Students from randomly selected classes aged 13-year-old to 17-year-old were invited to fill in these questionnaires: Socio-demographic Questionnaire, Rosenberg Self-esteem Questionnaire, Physical Activity Questionnaire (PAQ-A), Eating Disorder Examination Questionnaires (EDE-Q), Internet Addiction Test Scale (IAT), and Children's Depression Inventory (CDI). Result 461 students participated in the study. 21.5% of the participating students were found to have depression ( n = 99). Younger age and Chinese race showed significant association with adolescent depression with a p -value of 0.032 and 0.017 respectively. Other significant correlations with depression were self-esteem ( p = 0.013), disordered eating ( p = 0.000), lower physical activity ( p = 0.014) and problematic internet usage ( p = 0.000). Discussion The prevalence of depression among adolescents in this study (21.5%) is in line with previous prevalence studies in Malaysia. Self-esteem is postulated to be a moderating factor for depression hence explaining the significant association. A sedentary lifestyle may increase the risk of developing depression, The causal relationship between problematic internet usage and depression is complex and difficult to establish. This is similar to the relationship between problematic eating behavior and depression as well. Conclusion There is still a need to explore the causal relationship between lifestyle factors and depression among youth. Despite that, the results from this paper have accentuated the gravity of the importance of a healthy lifestyle among adolescents. An appropriate preventive measure is governmental strategies and policies aiming at improving a healthier lifestyle in this age group.
... Recent studies on patients with AN reported comorbidity rates of 40% for depression and up to 80% for anxiety disorders, with 20-30% for generalized anxiety disorder, and > 50% for social anxiety disorder [6,7]. Interestingly, data support also the other way round, since patients with major depressive disorder and anxiety disorders are diagnosed more often with a lifetime eating disorder when compared to people without affective or anxiety disorders [8] thus supporting a shared genetic and environmental vulnerability [9,10]. However, the debate is open on the time-relationship between anxious and depressive symptoms and AN onset and on their role as maintaining factors for AN. ...
Article
Full-text available
Purpose Anorexia nervosa (AN) is a life-threatening condition in which temperament, anxiety, depression, and core AN body-related psychopathology (drive for thinness, DT, and body dissatisfaction, BD) are intertwined. This relationship has not been to date disentangled; therefore, we performed a multiple mediation analysis aiming to quantify the effect of each component. Methods An innovative multiple mediation statistical method has been applied to data from 184 inpatients with AN completing: Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Eating Disorders Inventory-2, State-Trait Anxiety Inventory, and Beck Depression Inventory. Results All affective temperaments but the hyperthymic one were involved in the relationship with DT and BD. Only the anxious temperament had a significant unmediated direct effect on DT after the strictest correction for multiple comparisons, while the depressive temperament had a significant direct effect on DT at a less strict significance level. State anxiety was the strongest mediator of the link between affective temperament and core AN body-related psychopathology. Depression showed intermediate results while trait anxiety was not a significant mediator at all. Conclusion Affective temperaments had a relevant impact on body-related core components of AN; however, a clear direct effect could be identified only for the anxious and depressive temperaments. Also, state anxiety was the strongest mediator thus entailing interesting implications in clinical practice. Level of evidence V, cross-sectional study.
... A recent study suggested that 13% of participants with MDD had lifelong eating disorders and 39% showed clinically significant disordered eating behavior, versus 3% and 11%, respectively, of participants without diagnosed depressive disorders. Therefore, the authors concluded that the rate of altered eating behaviors is higher in women with depression [115]. Along these lines, it is well known that emotional hunger is one of the basic characteristics of eating disorders [116]. ...
Article
Full-text available
Major depressive disorder (MDD) is an incapacitating condition characterized by loss of interest, anhedonia and low mood, which affects almost 4% of people worldwide. With rising prevalence, it is considered a public health issue that affects economic productivity and heavily increases health costs alone or as a comorbidity for other pandemic non-communicable diseases (such as obesity, cardiovascular disease, diabetes, inflammatory bowel diseases, etc.). What is even more noteworthy is the double number of women suffering from MDD compared to men. In fact, this sex-related ratio has been contemplated since men and women have different sexual hormone oscillations, where women meet significant changes depending on the age range and moment of life (menstruation, premenstruation, pregnancy, postpartum, menopause…), which seem to be associated with susceptibility to depressive symptoms. For instance, a decreased estrogen level promotes decreased activation of serotonin transporters. Nevertheless, sexual hormones are not the only triggers that alter neurotransmission of monoamines and other neuropeptides. Actually, different dietary habits and/or nutritional requirements for specific moments of life severely affect MDD pathophysiology in women. In this context, the present review aims to descriptively collect information regarding the role of malnutrition in MDD onset and course, focusing on female patient and especially macro- and micronutrient deficiencies (amino acids, ω3 polyunsaturated fatty acids (ω3 PUFAs), folate, vitamin B12, vitamin D, minerals…), besides providing evidence for future nutritional intervention programs with a sex-gender perspective that hopefully improves mental health and quality of life in women.
... resulted in feelings of depression and anxiety in many individuals (Marazziti et al., 2020;Poli et al., 2020), and this has been linked to an increase in poor eating habits during quarantine, including emotional overeating (Gao et al., 2022), and consumption of unhealthy food (Landaeta-Diaz et al., 2021;Salazar-Fernandez et al., 2021). In addition, past studies have linked eating disorders to anxiety and depression (Godart et al., 2002;Keel et al., 2005;Swinbourne and Touyz, 2007;Swinbourne et al., 2012;Garcia et al., 2020;Sander et al., 2021) and significant changes in appetite and eating habits are established diagnostic criteria for depressive and anxiety disorders (American Psychiatric Association, 2013). Anxiety, in particular, has been linked to overeating or binge-eating (Polivy et al., 1994), and emotional eating in obese individuals (Schneider et al., 2010). ...
Article
Full-text available
Poor eating habits often lead to health concerns. While mental health conditions such as stress and anxiety have been linked as predictors for eating behaviors, cognitive factors may also contribute to eating practices during the early stages of the mandatory COVID-19 lockdown. In the current study, participants responded to a survey that asked them to judge the passing of time (PoTJ) and to produce short intervals ( via a time production task) as an index of the internal clock speed. Additionally, they responded to questions about snacking frequency and the tendency to overeat during lockdown. We observed that those who judged time to pass slowly also reported a greater tendency to snack and overeat during the pandemic. Additional analysis also revealed that the effect of PoTJ on snacking is moderated by the internal clock speed such that those who felt time was passing by slowly, and in combination with a faster internal clock (as indexed by shorter duration production), had a greater tendency to snack. The results suggest that different aspects of temporal cognition play potential roles in influencing different types of eating behaviors. Our findings therefore have implications for eating disorders, along with the potential of time-based intervention or behavioral modification approaches.
... Environmental factors promoting negative emotions such as a poor self-esteem, a high level of anxiety, and/or mood disorders appear to be particularly significant in EDs [13][14][15][16]. Recent studies reported that adverse life events can lead to the suppression of negative emotions through emotional overeating or restrained eating [17,18]. ...
Article
Full-text available
Purpose This study aims at clarifying the links between sexual violence and disordered eating (DE). Methods In a sample of 12,638 victims of self-reported sexual violence, we analyzed the situation of 546 victims that declared having developed DE. We assessed the characteristics of the assault (age, type of aggression) and the medical consequences (PTSD, depression, suicide attempts, anxiety disorders, etc.). Results DE prevalence was 4.3% in the victim sample. The age of the first assault in DE victims was significantly lower than that of the whole population (12 years vs 16 years for median; p < 0.001). A much higher prevalence of sexual assault consequences was present in victims developing DE with odd ratios (OR) for: self-mutilation (OR = 11.5 [8.29–15.95], p < 0.001); depression (OR = 5.7 [4.81–6.86], p < 0.001); self-medication (OR = 5.3 [3.86–7.19], p < 0.001); suicide attempts (OR = 4.5 [3.59–5.67], p < 0.001); post-traumatic stress disorder (OR = 3.8 [2.99–4.78], p < 0.001); anxiety troubles (OR = 5.2 [4.11–6.47], p < 0.001); alcoholism (OR = 4.0 [2.81–5.58], p < 0.001). Conclusion This study confirms the link between DE and sexual violence, especially in childhood, leading to severe psychological consequences. In this context, DE should be envisaged as a coping strategy accompanying emotional dysregulation due to traumatic events, and be treated as such. Level of evidence Level IV: Evidence obtained from multiple time series analysis such as case studies.
... These findings are supported by a study conducted by Sander et al; they found that depression and anxiety were associated with increased eating disorder symptomatology, accounting for 81% of eating disorder symptoms [28]. Also, a study done by Garcia et al reported that women with a history of depression and anxiety were nearly four times as likely as women without a history of depression or anxiety to have a lifetime eating disorder condition [29], this just goes to show that individuals with pre-existing mental health conditions are more prone to eating disorders than the general population. Stress related to the lockdown and physical isolation was linked to a higher likelihood of binge-eating and dietary restrictions [30]. ...
Article
Full-text available
Aims: This study aims to identify the risk factors of eating disorders, evaluate the impact of the pandemic on those with or without pre-existing eating disorders and compare the impact of COVID-19 on the various eating disorders. Methodology: We searched Public/Publisher MEDLINE (PubMed) and Excerpta Medica dataBASE (EMBASE) databases from January 2019 to May 2021, 11 observational studies were selected out of 81 initially identified articles. The sample size ranged from 15 to 22,374 participants, with a total of 31,404 participants. Results: Individuals, especially females aged 18-25 years and 30-45 years were shown to be more susceptible to eating disorder risks and symptoms. Depression and anxiety were shown to be the most prevalent risk factors among all subjects. Exacerbation of symptoms was observed in subjects with the eating disorders except for the anorexia nervosa subgroup which showed minimal changes. Conclusion: This study established the fact that COVID-19 pandemic had a negative impact on the eating habits of people with or without pre-existing eating disorders (ED). This study also highlights the need for efforts to specifically identify evidence-based measures to support patients with ED during and after a pandemic.
... Several prominent etiologic theories highlight the role of negative affect (NA; i.e., negative emotions, including guilt, anger, and sadness) and emotion regulation difficulties in promoting LOC. These theories are consistent with evidence of elevated LOC among individuals with internalizing disorders (e.g., anxiety, depression) (18), and increased rates of internalizing disorders among people with EDs characterized by LOC (19). In other words, LOC may be one manifestation of more general negative emotionality and underlying difficulties with managing negative emotions among people with LOC-related disorders. ...
Article
Full-text available
Loss of control eating is a core, transdiagnostic eating disorder symptom associated with psychological distress, functional impairment, and reduced quality of life. However, the factors that contribute to persistent loss of control eating despite negative consequences are not fully understood. Understanding the mechanisms that maintain loss of control eating is crucial to advance treatments that interrupt these processes. Affect regulation models of loss of control eating hypothesize that negative emotions trigger loss of control eating, and that loss of control eating is negatively reinforced because it temporarily decreases negative affect. Several variations on this basic affect regulation model have been proposed, including theories suggesting that negative affect decreases during loss of control eating rather than afterwards (escape theory), and that loss of control eating replaces one negative emotion with another that is less aversive (trade-off theory). Experience sampling designs that measure negative affect and eating behavior multiple times per day are optimally suited to examining the nuanced predictions of these affect regulation models in people's everyday lives. This paper critically reviews experience sampling studies examining associations between negative affect and loss of control eating, and discusses the implications for different affect regulation models of loss of control eating. The review concludes by proposing an expanded affect-focused model of loss of control eating that incorporates trait-level individual differences and momentary biological and environmental variables to guide future research. Clinical implications and recommendations are discussed.
... A few studies have shown that an altered signaling between gut microbiota and host immune and neuroendocrine systems could also be implied in AN and BN [9]. Environmental factors promoting a poor self-esteem, a high level of anxiety and/or mood disorders appear to be particularly signi cant in EDs [10][11][12][13]. ...
Preprint
Full-text available
Purpose This study aims at clarifying the links between sexual violence and eating disorders (EDs). Methods In a sample of 12638 victims of sexual violence, we analyzed the situation of 546 victims that declared having developed ED. We assessed the characteristics of the assault (age, type of aggression) and the medical consequences (PTSD, depression, suicide attempts, anxiety disorders …). Results ED prevalence was 4.3% in the victim sample. The age of the first assault in ED victims was significantly lower than that of the whole population (12y vs 16 y for median; p<0.001). A much higher prevalence of sexual assault consequences was present in victims developing ED with odd ratios (OR) for: self-mutilation (OR = 11.5 [8.29-15.95], p<0.001); depression (OR=5.7 [4.81-6.86], p<0.001); self-medication (OR = 5.3 [3.86-7.19], p<0.001); suicide attempts (OR =4.5 [3.59-5.67], p<0.001); Post-traumatic stress disorder (OR = 3.8 [2.99-4.78], p<0.001) ; anxiety troubles (OR = 5.2 [4.11-6.47], p<0.001); alcoholism (OR =4.0 [2.81-5.58], p<0.001). Conclusion This study confirms the link between ED and sexual violence, especially in childhood, leading to severe psychological consequences. In this context, ED should be envisaged as a coping strategy accompanying emotional dysregulation due to traumatic events, and be treated as such.
Article
Súvislosť medzi zložením črevnej mikrobioty a prejavmi v správaní je pre vedu relatívne novou a veľmi zaujímavou oblasťou výskumu. Nesie v sebe prísľub možného využitia modulácie mikrobioty za účelom redukcie problematických behaviorálnych prejavov ako súčasť komplexného prístupu k pacientom s duševnou poruchou. Tento článok má za cieľ stručne opísať aktuálny stav poznatkov v tejto oblasti, so zameraním sa na vybrané cesty komunikácie medzi črevom a mozgom spojené s tvorbou neuroaktívnych molekúl, a tiež opisuje vzťah vybraných duševných porúch k zastúpeniu baktérií v čreve. Kľúčové slová: črevná mikrobiota, behaviorálne prejavy, duševné poruchy. The relationship between gut microbiota and behavior The relationship between the composition of gut microbiota and behavior is a relatively new and interesting field of research. It promises the possible use of modulation of microbiota to reduce problem behavior, as part of comprehensive approach to pa­ tients with mental disorders. This article aims to briefly describe the current state of knowledge in this area, focusing on selected pathways of communication between gut and the brain, which are associated with production of neuroactive molecules, and also describes the relationship with composition of the gut microbiota. Key words: gut microbiota, behavior, mental disorders.
Article
Objective: The purpose of this study was to compare symptom severity of eating disorders (EDs), depression and anxiety at admission and discharge for transgender and nonbinary (TNB) individuals and cisgender adult individuals receiving treatment for EDs at higher levels of care (HLOC), adding to the limited research in this area. Method: Participants were 25 TNB individuals and 376 cisgender individuals admitted to a HLOC ED treatment facility. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q), Patient Health Questionnaire-9, and Beck Anxiety Inventory at admission and discharge. Results: TNB individuals showed significant improvements on EDE-Q global scores between admission and discharge (Cohen's d = 1.27), and showed similar improvements on the EDE-Q over the course of treatment (Cohen's d = 0.06) when compared to cisgender individuals. TNB individuals had more severe depression at admission (Cohen's d = 0.61). Although depression improved over the course of treatment for both groups, TNB individuals showed less improvement (Cohen's d = 0.59). Suicidality was higher for TNB individuals on admission and discharge and did not improve significantly over the course of treatment (Cohen's d = 0.38). Discussion: This study provides preliminary evidence that TNB and cisgender individuals show similar improvement in ED symptoms during HLOC treatment. However, TNB individuals have more severe depression and less improvement in depression compared to cisgender individuals, without improvement in suicidality. TNB individuals may benefit from care targeting depression and suicidality during ED treatment. Public significance statement: TNB individuals have increased risk of EDs. Little research addresses how TNB individuals respond to ED treatment, which was traditionally created for cisgender individuals. We present one of the first studies examining ED treatment outcomes for TNB adults. TNB individuals showed improved ED symptoms with treatment, but less improvement in depression and their suicidality remained elevated. This suggests the need for targeted treatment.
Article
Eating behaviors are influenced by many factors including appetitive traits. Few studies have utilized latent profile analysis (LPA) to examine food approach and food avoidance appetitive traits. This study utilized LPA to define cluster profile groups based on appetitive traits in undergraduate and graduate/professional students at a large University in the southwest United States. Students completed a cross-sectional online survey in fall 2020 assessing demographic information, appetitive traits via the Adult Eating Behavior Questionnaire (AEBQ), and anxiety via the Generalized Anxiety Disorder Scale (GAD-7; higher scores indicate more severe anxiety symptoms). Appetitive traits were combined into eight scales (four food approach and four food avoidance traits). Latent profile analyses were conducted to identify homogenous subgroups of participants based on AEBQ scale scores. The final sample included 1243 students (mean age = 26.5 years, 73% female, 59% White, 57% undergraduates). LPA revealed four cluster profile groups: Cluster 1 (moderate eaters: lower than mean scores for food approach and avoidance traits), Cluster 2 (food seekers and avoiders: higher than mean scores for food approach and avoidance traits), Cluster 3 (food seekers: higher than mean for food approach traits), and Cluster 4 (food avoiders: higher than mean for food avoidance traits). Distribution of age, gender, race/ethnicity, and student status differed significantly between clusters. GAD-7 score was highest in Cluster 2 (food seekers and avoiders) and lowest in Cluster 1 (moderate eaters). Among the four LPA-defined cluster profile groups, students who endorsed both food approach and avoidance traits reported more severe anxiety symptoms compared to moderate eaters, food seekers, and food avoiders. It is useful to consider clusters of appetitive traits instead of individual appetitive traits when examining associations with physical and mental health.
Article
Background Comorbid anxiety is pervasive and carries an immense psychosocial burden for patients with bipolar disorder. Despite this, trials reporting anxiety-related outcomes in this population are uncommon, particularly with regards to monotherapies. Methods Patients (n = 31) with both bipolar I or II disorder in current depressive episodes were enrolled in a six-week, open-label, single-center trial assessing the efficacy of lithium monotherapy in treating symptoms depression and comorbid anxiety. Patients were mostly medication-free and lithium-naïve at baseline. Results Significant improvements in depression (HAMD) and anxiety (HAM-A) were observed at the six-week endpoint, with remission and response rates greater than 50%. There was a positive correlation between endpoint HAM-A scores and HAM-D scores, r = 0.80, (p < 0.01). Improvements were realized at low serum lithium concentrations (0.49 ± 0.20 mEq/l). Limitations Lack of placebo control and small sample size warrants validation in larger randomized studies. Conclusions Taken in the context of prior evidence, lithium may have an important role in treating comorbid anxiety in bipolar disorder, both as adjunct and monotherapy. Lower doses of lithium may provide equivalent efficacy and enhance tolerability and compliance.
Article
Objective: Knowledge gaps remain regarding whether syndemic conditions identify treatment-seeking individuals most at risk for suicidal thoughts and behaviors (STB). We employed latent class analysis to: (1) model treatment-seeking individuals' syndemic conditions, (2) examine latent classes across nonmedical social determinants, and (3) assess associations between class membership and STB. Method: Participants were 982 individuals presenting at a community mental health clinic between October 2014 and February 2020. The three-step latent class analytic approach was used. Regression analyses were employed to examine nonmedical social determinants and STB outcomes associated with class membership. Results: Participants were aged 18 to >72 (75.8% White; 76.7% heterosexual; 53.7% cisgender woman; 73.8% earned ≥$20,000 annually). Latent class analysis resulted in a three-class solution. Participants in Class 1 were characterized by low probabilities across syndemic conditions. Class 2 was characterized by high probabilities of anxiety and depression. Class 3 was characterized by high probabilities of eating disorders, anxiety, and depression. Participants of color, sexual minority participants, cisgender women, and those experiencing financial distress were more likely to be in classes characterized by syndemic conditions. Classes characterized by syndemic conditions, relative to no syndemic conditions, were associated with greater risk of STB. Conclusion: Findings confirm the concentrated clustering of co-occurring syndemic conditions among marginalized groups and highlight differing risks for those considering suicide or who have attempted suicide vs. those engaging in self-harm. Results underscore the need for resource allocation and multilevel interventions targeting syndemic conditions and suicidality for minority populations and those experiencing financial distress.
Article
Major Depressive Disorder (MDD) is a prevalent psychiatric disorder impacting 10-16% of Americans in their lifetime. Approximately 60% of individuals with MDD have comorbid anxiety disorders. Additionally, although scarce research has examined eating disorders (EDs) in depression, a bidirectional association exists between ED and MDD symptoms. The current pilot study (N = 31 individuals with moderate to severe depression) modeled networks of depressive, anxiety, and ED symptoms using intensive time-series data. This study also tested if temporal central symptoms predicted six-month clinical outcomes. The most central symptoms were guilt, self-dislike, lack of energy, and difficulty concentrating. Several anxiety and ED symptoms were also central, including physical anxiety, social anxiety, body dissatisfaction, and desire for thinness. The central symptom crying predicted six-month depression with a medium effect size. These findings suggest anxiety and ED symptoms may influence the day-to-day course of depression in some individuals with comorbid diagnoses, but predictors of symptoms across hours may differ from predictors across longer time scales (i.e., months). Time scale should be considered when conducting and interpreting research on MDD. Research, assessment, and treatment for MDD should continue to explore transdiagnostic approaches including anxiety and ED symptoms to optimize care for individuals with complex presentations.
Article
While maladaptive interpersonal behaviors have been implicated in models of psychopathology, particularly depression, maladaptive interpersonal behaviors have received limited attention in the eating disorder (ED) literature. Further, the extant literature on maladaptive interpersonal behaviors in relation to ED psychopathology has yet to be synthesized. Therefore, the aim of this systematic review was to characterize the literature on maladaptive interpersonal behaviors and ED psychopathology. Inclusion criteria for the review were: availability of the study in English, empirical journal article, inclusion of human subjects, and reporting an association between at least one maladaptive interpersonal behavior and one measure of ED psychopathology. Databases searched were PsycInfo and PubMed across all dates (up to September 2020). Data was extracted from articles, and main findings were synthesized; quality scores were provided using a modified version of the Newcastle Ottawa Scale. There were 35 studies with 36 independent samples included in the review. Most studies evidenced significant bivariate associations between maladaptive interpersonal behaviors and ED psychopathology. That is, higher levels of maladaptive interpersonal behaviors were generally associated with greater disordered eating, bulimic symptoms, and body image concerns. Although limited to a minority of studies, some studies identified prospective associations and significant mediators and moderators of associations. This systematic review supports further research on maladaptive interpersonal behaviors and ED psychopathology. Given a number of significant limitations in the literature identified in this review, there are an array of avenues for future research on maladaptive interpersonal behaviors and ED psychopathology.
Article
Full-text available
Characterized primarily by a low body-mass index, anorexia nervosa is a complex and serious illness¹, affecting 0.9–4% of women and 0.3% of men2–4, with twin-based heritability estimates of 50–60%⁵. Mortality rates are higher than those in other psychiatric disorders⁶, and outcomes are unacceptably poor⁷. Here we combine data from the Anorexia Nervosa Genetics Initiative (ANGI)8,9 and the Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED) and conduct a genome-wide association study of 16,992 cases of anorexia nervosa and 55,525 controls, identifying eight significant loci. The genetic architecture of anorexia nervosa mirrors its clinical presentation, showing significant genetic correlations with psychiatric disorders, physical activity, and metabolic (including glycemic), lipid and anthropometric traits, independent of the effects of common variants associated with body-mass index. These results further encourage a reconceptualization of anorexia nervosa as a metabo-psychiatric disorder. Elucidating the metabolic component is a critical direction for future research, and paying attention to both psychiatric and metabolic components may be key to improving outcomes.
Article
Full-text available
Background There exist few population-based data on the prevalence of eating disorders (EDs) and this is especially needed because of changes to diagnoses in the DSM-5. This study aimed to provide lifetime and 12-month prevalence estimates of DSM-5 anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) from the 2012-2013 National Epidemiologic Survey Alcohol and Related Conditions (NESARC-III). Methods A national sample of 36,306 U.S. adults completed structured diagnostic interviews (AUDADIS-5). Results Prevalence (standard error) estimates of lifetime AN, BN, and BED were 0.80% (0.07%), 0.28% (0.03%), and 0.85% (0.05%). 12-month estimates for AN, BN, and BED were 0.05% (0.02%), 0.14% (0.02%), and 0.44% (0.04%). Adjusting for age, race/ethnicity, education, and income, odds of lifetime and 12-month diagnoses of all three EDs were significantly greater for women than men. Adjusted odds ratios (AORs) of lifetime AN were significantly lower for non-Hispanic Black and Hispanic than for White respondents. AORs of lifetime and 12-month BN did not differ significantly by race/ethnicity. AOR of lifetime BED, but not 12-month, was significantly lower for non-Hispanic Black relative to non-Hispanic White respondents; AORs of BED for Hispanic and non-Hispanic White respondents did not differ significantly. AN, BN, and BED were characterized by significant differences in ages of onset, persistence and duration of episodes, and rates of current obesity and psychosocial impairment. Conclusions These findings for DSM-5-defined EDs, based on the largest national sample of U.S. adults studied to date, indicate some important similarities and differences to earlier smaller nationally representative studies.
Article
Full-text available
Changes in ovarian hormones predict changes in emotional eating across the menstrual cycle. However, prior studies have not examined whether the nature of associations varies across dysregulated eating severity. The current study determined whether the strength and/or nature of hormone/dysregulated eating associations differ based on the presence of clinically diagnosed binge episodes (BEs). Participants included 28 women with BEs and 417 women without BEs who provided salivary hormone samples, ratings of emotional eating, and BE frequency for 45 days. Results revealed stronger associations between dysregulated eating and ovarian hormones in women with BEs as compared to women without BEs. The nature of associations also differed, as progesterone moderated the effects of lower estradiol levels on dysregulated eating in women with BEs only. Although hormone/dysregulated eating associations are present across the spectrum of pathology, the nature of associations may vary in ways that have implications for etiological models and treatment.
Article
Full-text available
The primary aim of the Michigan State University Twin Registry (MSUTR) is on understanding developmental changes in genetic, environmental, and neurobiological influences on internalizing and externalizing disorders, with antisocial behavior and disordered eating representing our particular areas of interest. The MSUTR has two broad components: a large-scale, population-based registry of child, adolescent, and adult twins and their families (current N ~20,000) and a series of more focused and in-depth studies drawn from the registry (current N ~4,000). Participants in the population-based registry complete a family health and demographic questionnaire via mail. Families are then recruited for one or more of the intensive, in-person studies from the population-based registry based on their answers to relevant items in the registry questionnaire. These in-person assessments target a variety of biological, genetic, and environmental phenotypes, including multi-informant measures of psychiatric and behavioral phenotypes, census and neighborhood informant reports of twin neighborhood characteristics, buccal swab and salivary DNA samples, assays of adolescent and adult steroid hormone levels, and/or videotaped interactions of child twin families. This article provides an overview of the MSUTR and describes current and future research directions.
Article
Full-text available
Background: Much is still unclear about the role of personality in the structure of common psychiatric disorders such as depressive/anxiety disorders and alcohol dependence. This study will therefore examine whether various traits of negative emotionality and impulsivity showed shared or specific associations with these disorders. Method Cross-sectional data were used from the Netherlands Study of Depression and Anxiety (NESDA), including individuals with no DSM-IV psychiatric disorder (n = 460), depressive/anxiety disorder only (i.e. depressive and/or anxiety disorder; n = 1398), alcohol dependence only (n = 32) and co-morbid depressive/anxiety disorder plus alcohol dependence (n = 358). Aspects of negative emotionality were neuroticism, hopelessness, rumination, worry and anxiety sensitivity, whereas aspects of impulsivity included disinhibition, thrill/adventure seeking, experience seeking and boredom susceptibility. Results: Aspects of negative emotionality formed a homogeneous dimension, which was unrelated to the more heterogeneous construct of impulsivity. Although all aspects of negative emotionality were associated with alcohol dependence only, associations were much stronger for depressive/anxiety disorder only and co-morbid depressive/anxiety disorder with alcohol dependence. The results for impulsivity traits were less profound and more variable, with disinhibition and boredom susceptibility showing modest associations with both depressive/anxiety disorder and alcohol dependence, whereas low thrill/adventure seeking and high disinhibition were more strongly related with the first and the latter, respectively. Conclusions: Our results suggest that depressive/anxiety disorder and alcohol dependence result from shared as well as specific aetiological pathways as they showed the same associations with all aspects of negative emotionality, disinhibition and boredom susceptibility as well as specific associations with thrill/adventure seeking and disinhibition.
Article
Full-text available
Multivariate comorbidity research indicates mood and anxiety (internalizing) disorders share one or more common liabilities, but categorical, dimensional, and hybrid accounts of these liabilities have not been directly compared. We modeled seven internalizing disorders in a nationally representative sample of 43,093 individuals via confirmatory factor, latent class, exploratory factor mixture, and exploratory structural equation modeling analyses. A two-dimensional (distress-fear) liability structure fit best and replicated across gender, assessment waves, and lifetime/12-month diagnoses. These liabilities, not disorder-specific variation, predicted future internalizing pathology, suicide attempts, angina, and ulcer. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Article
Full-text available
Studies suggest that within-person changes in estrogen and progesterone predict changes in binge eating across the menstrual cycle. However, samples have been extremely small (maximum N = 9), and analyses have not examined the interactive effects of hormones that are critical for changes in food intake in animals. The aims of the current study were to examine ovarian hormone interactions in the prediction of within-subject changes in emotional eating in the largest sample of women to date (N = 196). Participants provided daily ratings of emotional eating and saliva samples for hormone measurement for 45 consecutive days. Results confirmed that changes in ovarian hormones predict changes in emotional eating across the menstrual cycle, with a significant estradiol × progesterone interaction. Emotional eating scores were highest during the midluteal phase, when progesterone peaks and estradiol demonstrates a secondary peak. Findings extend previous work by highlighting significant interactions between estrogen and progesterone that explain midluteal increases in emotional eating. Future work should explore mechanisms (e.g., gene-hormone interactions) that contribute to both within- and between-subjects differences in emotional eating. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Article
Full-text available
To investigate the prevalence of comorbid eating and anxiety disorders in women presenting for inpatient and outpatient treatment of an eating disorder and women presenting for outpatient treatment of an anxiety disorder. The prevalence of comorbidity was investigated from a sample of 152 women, which included 100 women presenting for treatment of an eating disorder and 52 women presenting for treatment of an anxiety disorder. Of women presenting for treatment of an eating disorder, 65% also met criteria for at least one comorbid anxiety disorder; 69% of these reported the onset of the anxiety disorder to precede the onset of the eating disorder. Of the anxiety disorders diagnosed, social phobia was most frequently diagnosed (42%) followed by post-traumatic stress disorder (26%), generalised anxiety disorder (23%), obsessive-compulsive disorder (5%), panic/agoraphobia (3%) and specific phobia (2%). We also found that 13.5% of women presenting for anxiety treatment also met criteria for a comorbid eating disorder. Furthermore, 71% (n = 5) reported the onset of the anxiety disorder to precede the onset of the eating disorder. The results of this study suggest that the prevalence of eating and anxiety disorder comorbidity is high. The present research should improve the clinical understanding of the comorbidity between eating disorders and anxiety disorders. In particular, it is anticipated that this research will have significant aetiological and therapeutic implications especially with regard to improving the clinical effectiveness of psychological treatments for eating disorders and highlighting the importance of screening for eating pathology in the clinical assessment of anxiety disorders.
Article
Full-text available
The extent to which subclinical levels of disordered eating affect quality of life (QOL) was assessed. Four waves of self-report data from Survey 2 (S2) to 5 (S5) of a national longitudinal survey of young Australian women (N = 9,688) were used to assess the impact of any level of disordered eating at S2 on QOL over the following 9 years, and to evaluate any moderating effects of social support and of depression. At baseline, 23% of the women exhibited some level of disordered eating, and they scored significantly lower on both the physical and the mental component scores of the SF-36 at every survey; differences in mental health were still clinically meaningful at S5. Social support and depressive symptoms each acted as a moderator of the mental component scores. Women with both disordered eating and low social support, or disordered eating and depression, had the worst initial scores; although they improved the most over time, they still had the lowest scores at S5. Higher social support at baseline resulted in women with disordered eating being largely indistinguishable from women without disordered eating who had low social support. Lower levels of depression resulted in women with disordered eating having a significantly better QOL than women with high levels of depression, regardless of eating status. This is the first study to examine the long-term impact of subclinical levels of disordered eating on QOL, and it suggests that even apparently minor levels of symptomatology are associated with significant and far-reaching deficits in well-being.
Article
Full-text available
Eating disorders are severe conditions, but little is known about the prevalence or correlates of these disorders from population-based surveys of adolescents. To examine the prevalence and correlates of eating disorders in a large, reprefentative sample of US adolescents. Cross-sectional survey of adolescents with face-to-face interviews using a modified version of the Composite International Diagnostic Interview. Combined household and school adolescent samples. Nationally representative sample of 10,123 adolescents aged 13 to 18 years. Prevalence and correlates of eating disorders and subthreshold conditions. Lifetime prevalence estimates of anorexia nervosa, bulimia nervosa, and binge-eating disorder were 0.3%, 0.9%, and 1.6%, respectively. Important differences were observed between eating disorder subtypes concerning sociodemographic correlates, psychiatric comorbidity, role impairment, and suicidality. Although the majority of adolescents with an eating disorder sought some form of treatment, only a minority received treatment specifically for their eating or weight problems. Analyses of 2 related subthreshold conditions suggest that these conditions are often clinically significant. Eating disorders and subthreshold eating conditions are prevalent in the general adolescent population. Their impact is demonstrated by generally strong associations with other psychiatric disorders, role impairment, and suicidality. The unmet treatment needs in the adolescent population place these disorders as important public health concerns.
Article
Full-text available
The objective of this study was to examine differences between a number of different purging behaviors used and outcome measures among eating disorder patients. Among 211 females who received inpatient or partial hospitalization eating disorder treatment, analyses of covariance and cross-tabulations identified associations among a number of different purging behaviors (vomiting, laxative use, diuretic use) used and psychological, behavioral, self-efficacy and quality of life measures at follow-up. Most patients (80.1%) reported purging for weight control. Use of different purging behaviors was significantly associated at follow-up with lower self-esteem, greater depression, higher state and trait anxiety, higher BMI, poorer self-efficacy for normative eating and body image, compromised quality of life, greater dietary restraint, and eating, shape and weight concerns. Furthermore, a higher percentage of those who used purging behaviors met criteria for a subthreshold or threshold eating disorder at follow-up compared to their non-purging peers. Eating disorder patients who use different purging behaviors are more compromised at follow-up than patients who do not purge. Due to the severe medical complications associated with different purging behaviors, future research should address best practices for clinical intervention and prevention.
Article
Full-text available
Loss of control (LOC) eating in youth is associated cross-sectionally with eating-related and psychosocial distress and is predictive of excessive weight gain. However, few longitudinal studies have examined the psychological impact and persistence of pediatric LOC eating. We administered the Eating Disorder Examination and self-reported measures of depressive and anxiety symptoms to 195 boys and girls (mean age = 10.4 years, SD = 1.5) at baseline and again 4.7 years (SD = 1.2) later to 118 of these youth. Missing data were imputed. Baseline report of LOC was associated with the development of partial- or full-syndrome binge eating disorder (p = .03), even after accounting for the contribution of sex, race, baseline characteristics (age, disordered eating attitudes, and mood symptoms), body mass index growth between baseline and follow-up, and years in study. Half (52.2%; 95% CI [1.15, 6.22]) of children who endorsed experiencing LOC at baseline reported persistence of LOC at follow-up (p = .02). Compared with children who never reported LOC eating or reported LOC only at baseline, those with persistent LOC experienced significantly greater increases in disordered eating attitudes (ps < .001) and depressive symptoms (p = .027) over time. These data suggest that LOC eating in children is a problematic behavior that frequently persists into adolescence and that persistent LOC eating is associated with worsening of emotional distress.
Article
Full-text available
Several studies suggest that a two-factor model positing internalizing and externalizing factors explains the interrelationships among psychiatric disorders. However, it is unclear whether the covariation between internalizing and externalizing disorders is due to common genetic or environmental influences. We examined whether a model positing two latent factors, internalizing and externalizing, explained the interrelationships among six psychiatric disorders (major depressive disorder, generalized anxiety disorder, separation anxiety disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder) in adolescents, and whether there are common genetic and environmental influences on internalizing and externalizing latent factors. Multivariate behavior genetic analyses of data from 1162 twin pairs and 426 siblings ascertained from the general population via the Colorado Center for Antisocial Drug Dependence (CADD) were conducted. We found support for a model positing two latent factors (internalizing and externalizing). These factors were moderately heritable and influenced by significant common genetic and nonshared environmental influences. These findings suggest that co-occurrence of internalizing and externalizing psychopathology in adolescents results from both genetic and environmental influences.
Article
Full-text available
The Multidimensional Personality Questionnaire (MPQ; A. Tellegen, 1982, in press) provides for a comprehensive analysis of personality at both the lower order trait and broader structural levels. Its higher order dimensions of Positive Emotionality, Negative Emotionality, and Constraint embody affect and temperament constructs, which have been conceptualized in psychobiological terms. The MPQ thus holds considerable potential as a structural framework for investigating personality across varying levels of analysis, and this potential would be enhanced by the availability of an abbreviated version. This article describes efforts to develop and validate a brief (155-item) form, the MPQ-BF. Success was evidenced by uniformly high correlations between the brief- and full-form trait scales and consistency of higher order structures. The MPQ-BF is recommended as a tool for investigating the genetic, neurobiological, and psychological substrates of personality.
Article
Objective In recent years there has been increased interest regarding the role of crime victimization in the development and/or maintenance of eating disorders, particularly bulimia nervosa. Method: To examine the relationship among assault, bulimia nervosa, and binge eating disorder, a national, representative sample of 3,006 women completed structured telephone interviews. Results: Lifetime prevalence of completed, forcible rape for respondents with bulimia nervosa was 26.6%, as compared with 11.5% for respondents with binge eating disorder and 13.3% for respondents without bulimia nervosa or binge eating disorder. Compared to respondents without bulimia nervosa or binge eating disorder, aggravated assault history was significantly more prevalent in women with bulimia nervosa (26.8%), as was a lifetime history of posttraumatic stress disorder (36.9%). Characteristics of sexual assault experiences were not associated with dysfunctional eating patterns. Specific types of disordered eating such as compensatory behaviors in bulimia nervosa were associated with higher rates of victimization. Conclusions: In sum, the significantly higher rates of both sexual and aggravated assault among women with bulimia nervosa compared with women without such a diagnosis support the hypothesis that victimization may contribute to the development and/or maintenance of bulimia nervosa. © 1997 by John Wiley & Sons, Inc. Int J Eat Disord 21: 213–228, 1997.
Article
Ovarian hormones are associated with risk for binge eating in women. Recent animal and human studies suggest that food-related reward processing may be one set of neurobiological factors that contribute to these relationships, but additional studies are needed to confirm and extend findings.
Article
The goal of this meta-analysis was to examine the associations between specific emotion regulation abilities (emotional awareness, emotional clarity) and strategies (acceptance of emotions, reappraisal, problem-solving, rumination, avoidance of emotions, and suppression), and eating pathology. A total of 96 studies and 239 effect sizes were included in the analysis. Relations between global and specific emotion regulation abilities and strategies and eating disorders and eating-related symptoms were examined. Results indicated medium-to-large effect sizes for the associations between adaptive emotion regulation and eating disorder and eating-related symptoms, and medium-to-large effect sizes for the associations between maladaptive emotion regulation and eating disorders and eating-related symptoms. In terms of specific emotion regulation strategies, large magnitude of associations were identified for the relations between lack of emotional awareness, clarity, acceptance, reappraisal, problem-solving, and eating disorders. Rumination, avoidance of emotions, and suppression also showed large associations with anorexia nervosa and bulimia nervosa. Overall, emotion regulation did not differ across eating disorders, a finding supporting the transdiagnostic character of emotion regulation problems in eating pathology. These findings have important theoretical and practical implications for prevention and intervention programs.
Article
The primary aim of the Michigan State University Twin Registry (MSUTR) is to examine developmental differences in genetic, environmental, neural, epigenetic, and neurobiological influences on psychopathology and resilience, particularly during childhood and adolescence. The MSUTR has two broad components: a large-scale, population-based registry of child, adolescent, and adult twins and their families (current N ~30,000) and a series of more focused and in-depth studies drawn from the registry (projected N ~7200). Participants in the population-based registry complete a family health and demographic questionnaire via mail. Families can then be recruited for one or more of the intensive, in-person studies from the population-based registry, using any one of several recruitment strategies (e.g., population-based, based on their answers to the registry questionnaire). These latter studies target a variety of biological, genetic, and environmental phenotypes, including multi-informant measures of psychiatric and behavioral phenotypes, functional and structural neuroimaging, comprehensive measures of the twin family environment (e.g., census and neighborhood informant reports of twin neighborhood characteristics, videotaped interactions of child twin families), buccal swab and salivary DNA samples, and/or assays of adolescent and adult steroid hormone levels. This article provides an overview of the MSUTR and describes current and future research directions.
Article
Objective: To determine the prevalence of eating disorders (EDs) in women with polycystic ovary syndrome (PCOS) and the effects of EDs on health-related quality of life. Design: Cross-sectional study. Setting: University practice. Patient(s): Women with PCOS (Rotterdam criteria; n = 148) and controls seen for routine gynecologic care (n = 106) from 2015 to 2016. Intervention(s): Eating Disorder Examination-Questionnaire (EDE-Q), Night Eating Questionnaire (NEQ), Hospital Anxiety and Depression Scale, and Health-Related Quality of Life Questionnaire (PCOSQ). Main outcome measure(s): EDE-Q and NEQ scores, prevalence of bulimia nervosa (BN), binge eating disorder (BED), and night eating syndrome (NES). Result(s): Women with PCOS were at an increased risk for overall abnormal EDE-Q scores compared with controls (12.16% vs. 2.83%; odds ratio [OR], 4.75; 95% confidence interval [CI], 1.36, 16.58). Clinically significant elevated scores were noted for shape and weight concern. In unadjusted analysis, body mass index (OR, 1.06; 95% CI, 1.01, 1.11), elevated depression score (OR, 5.43; 95% CI, 1.85, 15.88), and elevated anxiety score (OR, 6.60; 95% CI, 2.45, 17.76) were associated with an abnormal EDE-Q global score. In the multivariable model, PCOS was associated with abnormal EDE-Q global score (adjusted OR, 4.67; 95% CI, 1.16, 18.80). Elevated EDE-Q scores inversely correlated with PCOSQ scores (r = -0.57). The prevalence of BN was 6.1%, of BED was 17.6%, and of NES was 12.9% in women with PCOS, with no differences compared with controls. Conclusion(s): Women with PCOS, especially those with concurrent anxiety symptoms but independent of obesity, have a significantly increased risk of abnormal EDE-Q scores. Our findings suggest the need for routine screening for ED in this population.
Article
Major depression and eating disorders (EDs) are highly co-morbid and may share liability. Impaired emotion regulation may represent a common etiological or maintaining mechanism. Research has demonstrated that depressed individuals and individuals with EDs exhibit impaired emotion regulation, with these impairments being associated with changes in brain structure and function. The goal of this review was to evaluate findings from neuroimaging studies of depression and EDs to determine whether there are overlapping alterations in the brain regions known to be involved in emotion regulation, evidence of which would aid in the diagnosis and treatment of these conditions. Our review of the literature suggests that depression and EDs exhibit common structural and functional alterations in brain regions involved in emotion regulation, including the amygdala, ventral striatum and nucleus accumbens, anterior cingulate cortex, insula, and dorsolateral prefrontal cortex. We present preliminary support for a shared etiological mechanism. Future studies should consider manipulating emotion regulation in a sample of individuals with depression and EDs to better characterize abnormalities in these brain circuits.
Article
Eating disorders are conceptualized as categorical rather than dimensional in the current major diagnostic system (Diagnostic and Statistical Manual of Mental Disorders; 5th ed.; American Psychiatric Association, 2013) and in many previous studies. However, previous research has not critically evaluated this assumption or tested hybrid models (e.g., modeling latent variables with both dimensional and categorical features). Accordingly, the current study directly compared categorical, dimensional, and hybrid models for eating pathology in a large, population-based sample. Participants included 3,032 female and male twins (ages 9–30 years) from the Michigan State University Twin Registry. The Minnesota Eating Behaviors Survey was used to assess disordered eating symptoms including body dissatisfaction, weight preoccupation, binge eating, and compensatory behaviors. Results showed that dimensional models best fit the data in the overall sample as well as across subgroups divided by sex and pubertal status (e.g., prepubertal vs. postpubertal). It is interesting to note that the results favored more categorical models when using a case-control subset of our sample with participants who either endorsed substantial eating pathology or no/little eating pathology. Overall, findings provide support for a dimensional conceptualization of eating pathology and underscore the importance of using community samples to capture the full range of severity of eating pathology when investigating questions about taxonomy.
Article
Depression is often associated with weight gain but underlying mechanisms are unclear. This study assessed whether three psychological eating styles (emotional eating, external eating and restrained eating) act as mediators between depression and weight gain. We used structural equation modelling to test the hypothesized mediation models in a sample of 298 fathers and 294 mothers by assessing self-reported eating styles (Dutch Eating Behavior Questionnaire), depressive feelings (Depressive Mood List) and body mass index (BMI) at baseline and BMI after five years. In the model with emotional eating we also assessed the moderation effect of 5-HTTLPR genotype in a sub-sample of 520 Caucasians. All analyses were performed separately for the two sexes. Although the overall effect of depression on weight gain was statistically non-significant in both sexes, there was a causal chain between depression, emotional eating and weight gain in the mothers. Depressive symptoms were related to higher emotional eating and emotional eating predicted greater increases in BMI independently of depression. Moreover, the indirect effect (via emotional eating) of depression on BMI change was significant (Beta=0.18, P=0.026). This mediation effect was found to be independent of 5-HTTLPR genotype. No such mediation effect was found for the fathers. Further, external eating and restrained eating did not act as mediators between depression and weight gain in either sex. The finding that emotional eating acted as mediator between depression and weight gain in the mothers suggests that obesity interventions should take emotional eating into account.
Article
Obsessive-compulsive disorder (OCD) often co-occurs with anorexia nervosa (AN), a comorbid profile that complicates the clinical management of both conditions. This population-based study aimed to examine patterns of comorbidity, longitudinal risks, shared familial risks and shared genetic factors between OCD and AN at the population level. Participants were individuals with a diagnosis of OCD (N=519,814) or AN (N=58,462) in the Swedish National Patient Register between January 1992 and December 2009; their first-, second-and third-degree relatives; and population-matched (1:10 ratio) unaffected comparison individuals and their relatives. Female twins from the population-based Swedish Twin Register (N=58,550) were also included. Females with OCD had a 16-fold increased risk of having a comor-bid diagnosis of AN, whereas males with OCD had a 37-fold increased risk. Longitudinal analyses showed that individuals first diagnosed with OCD had an increased risk for a later diagnosis of AN (risk ratio, RR 53.6), whereas individuals first diagnosed with AN had an even greater risk for a later diagnosis of OCD (RR 59.6). These longitudinal risks were about twice as high for males than for females. First-and second-degree relatives of probands with OCD had an increased risk for AN, and the magnitude of this risk tended to increase with the degree of genetic relatedness. Bivariate twin models revealed a moderate but significant degree of genetic overlap between self-reported OCD and AN diagnoses (ra 0.52, 95% CI: 0.26-0.81), but most of the genetic variance was disorder-specific. The moderately high genetic correlation supports the idea that this frequently observed comorbid pattern is at least in part due to shared genetic factors, though disorder-specific factors are more important. These results have implications for current gene-searching efforts and for clinical practice.
Article
In a clinical population, we estimated the frequency of mood disorders among 271 patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in comparison to a control group matched for age and gender. The frequency of mood disorders was measured using the Mini International Neuropsychiatric Interview (MINI), DSM-IV version. Mood disorders were more frequent among eating disorder (ED) patients than among controls, with a global prevalence of the order of 80% for each ED group. The majority of the mood disorders comorbid with ED were depressive disorders (MDD and dysthymia). The relative chronology of onset of these disorders was equivocal, because mood disorders in some cases preceded and in others followed the onset of the eating disorders. Our sample was characterized by patients with severe ED and high comorbidities, and thus do not represent the entire population of AN or BN. This also may have resulted in an overestimation of prevalence. Mood disorders appear significantly more frequently in patients seeking care for ED than in controls. These results have implications for the assessment and treatment of ED patients, and for the aetio-pathogenesis of these disorders. Copyright © 2015. Published by Elsevier B.V.
Article
Objective To construct a virtual space of common adolescent psychiatric disorders, spanned by factors reflecting major psychopathological dimensions, and locate psychiatric disorders in that space; examine whether the major psychopathological dimensions can be hierarchically organized; and determine the distribution of the latent scores of individuals in the space spanned by those dimensions. Method Exploratory factor analyses of data from the National Comorbidity Survey Adolescent Supplement (NCS-A) using the psychiatric diagnoses as indicators were used to identify the latent major psychopathological dimensions. The loadings of the disorders on those dimensions were used as coordinates to calculate the distance among disorders. The distribution of individuals in the space was based on the latent scores on the factors reflecting the major psychopathological conditions. Results A model with three correlated factors provided an excellent fit (Comparative Fit Index [CFI]=0.97, Tucker-Lewis Index [TLI]=0.95, the root mean squared error of approximation [RMSEA]=0.008) for the structure of disorders and a 4-factor model could be hierarchically organized, ultimately yielding a general psychopathology factor. Distances between disorders ranged from 0.079 (between social phobia and generalized anxiety disorder [GAD]) and 1.173 (between specific phobia and conduct disorder [CD]). At the individual level, there were 546 distinct liabilities observed (22% of all 2,455 potential liabilities). Conclusion A novel way of understanding psychiatric disorders in adolescents is as existing in a space with a limited number of dimensions with no disorder aligning along one single dimension. These dimensions are hierarchically organized, allowing for analyses at different levels of organization. Furthermore, individuals with psychiatric disorders present with a broad range of liabilities, reflecting the diversity of their clinical presentations.
Article
Background: Comorbid conditions are common in individuals with anorexia nervosa (AN) and can raise issues for diagnosis, prognosis, and treatment planning. Methods: First, reported prevalence rates for depression and anxiety in children and adolescents with AN were reviewed. Diagnostic issues and current understanding of the temporal onset and interrelatedness of depression, anxiety, and AN were discussed. Second, existing research on the implications of comorbid depression and anxiety for outcomes related to AN was reviewed with the aim of identifying whether, and to what degree, comorbidity may impact outcomes including recovery. Finally, implications for clinical practice and recommendations for future research were outlined. Results: Although reported rates vary, comorbid depression and anxiety disorders are common in children and adolescents with AN. While research suggests that depression tends to onset subsequent to AN and abates with weight restoration, anxiety tends to pre-date eating disorder onset and to persist post recovery. There is currently insufficient evidence, particularly with children and adolescents, to conclude that these conditions necessarily disrupt engagement in treatment or foreshadow a poorer prognosis. Conclusions: Continued research is needed in understanding how depression and anxiety may relate to eating disorder presentation in the younger years and potentially impact on the treatment process.
Article
Objective: A large body of factor analytic research supports the idea that common mental disorders are organized along correlated latent dimensions termed internalizing and externalizing. Eating disorders (EDs) have been associated with both internalizing (mood and anxiety disorders) and externalizing (substance use, antisocial personality disorder) forms of psychopathology. Previous studies found that EDs are most strongly related to internalizing disorders. However, no previous factor analytic studies of EDs and the internalizing/externalizing dimensions have evaluated if EDs align with these spectra similarly for men and women. We examined the location of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) symptoms within this model of psychopathology among a sample of veterans, a population traditionally understudied in EDs. Method: Data were from two studies of veterans and their intimate partners (N = 453 men and 307 women). Participants were administered the Structured Clinical Interview for DSM-IV without skip-outs. Lifetime symptom severity scores were used in confirmatory factor analytic models. Results: A model with AN, BN, and BED symptoms loading onto the distress subfactor of the internalizing domain fit the data best in the full sample and the male and female subsamples. This model was statistically equivalent for men and women. Discussion: All three EDs loaded onto distress, indicating that these conditions overlap with psychopathology characterized by negative affect. Investigating latent dimensions of psychopathology is one approach to identifying common factors that partially account for patterns of comorbidity among psychiatric disorders, which may aid in translating research findings into clinical practice.
Article
This article is part of a Special Issue "Puberty and Adolescence". Puberty is one of the most frequently discussed risk periods for the development of eating disorders. Prevailing theories propose environmentally mediated sources of risk arising from the psychosocial effects (e.g., increased body dissatisfaction, decreased self-esteem) of pubertal development in girls. However, recent research highlights the potential role of ovarian hormones in phenotypic and genetic risk for eating disorders during puberty. The goal of this paper is to review data from human and animal studies in support of puberty as a critical risk period for eating disorders and evaluate the evidence for hormonal contributions. Data are consistent in suggesting that both pubertal status and pubertal timing significantly impact risk for most eating disorders in girls, such that advanced pubertal development and early pubertal timing are associated with increased rates of eating disorders and their symptoms in both cross-sectional and longitudinal research. Findings in boys have been much less consistent and suggest a smaller role for puberty in risk for eating disorders in boys. Twin and animal studies indicate that at least part of the female-specific risk is due to genetic factors associated with estrogen activation at puberty. In conclusion, data thus far support a role for puberty in risk for eating disorders and highlight the need for additional human and animal studies of hormonal and genetic risk for eating disorders during puberty.
Article
Objective: To determine sex differences in the prevalence and impact of specific eating disorder features on health-related quality of life (HRQoL). Method: A general population sample of men (n = 1,479) and women (n = 1,555) completed interviews that assessed HRQoL (Medical Outcomes Study Short Form, SF-36), and current regular occurrence of binge eating, extreme dietary restriction, purging, and overevaluation of weight or shape. Results: Men constituted a substantial minority (23-41%) of participants reporting eating disorder features. Objective binge eating had a greater impact on mental health impairment in men versus women, whereas the overevaluation of weight or shape had a greater impact on general and mental health impairment in women compared with men. Discussion: Eating disorder features that impact on HRQoL are now common in men; however, the impact of specific features may differ between sexes.
Article
BACKGROUND: Bipolar disorder (BPD) is a serious mental disorder and a leading cause of premature mortality worldwide. Prevalence and risk factors of BPD have not been well studied in multi-ethnic Asian populations. The study aimed to establish the prevalence of BPD and examine the associated socio-demographic correlates, comorbidity, severity, impairment and treatment contact in the Singapore resident population. METHODS: The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of the resident (citizens and permanent residents) population in Singapore. The diagnoses were established using the World Mental Health Composite International Diagnostic Interview version 3.0 (CIDI 3.0) diagnostic modules for lifetime and 12-month prevalence of select mental illnesses including BPD. RESULTS: The lifetime and 12-month prevalence estimates for BPD were 1.2% and 0.6%, respectively. More than two-thirds (69.4%) of respondents with lifetime BPD had other lifetime mental disorders, and approximately half (52.6%) of respondents with lifetime BPD also had at least one chronic physical condition; chronic pain was the most prevalent comorbid condition. LIMITATIONS: The data was based on respondents' self-report and there could be an element of recall bias and under-reporting. We also did not obtain information on mixed episodes and rapid cycling disorders. CONCLUSIONS: The high comorbidity, clinical severity, and role impairment associated with BPD exert a heavy toll at an individual and societal level.
Article
Objective To examine relationships between exercise behaviour, eating-disordered behaviour and quality of life in a community sample of women.Method Self-report measures of frequency of exercise, obligatoriness of exercise and motivation for exercise, and of eating disorder psychopathology and quality of life, were completed by 169 women aged 18–45 who engaged in regular exercise.ResultsExercising to improve appearance or body tone, and feelings of guilt following the postponement of exercise, were the exercise variables most strongly associated with elevated levels of eating disorder psychopathology and, in turn, reduced quality of life. There was no association between exercise behaviour and quality of life independent of the effects of eating disorder psychopathology.Conclusions Operational definitions of ‘excessive exercise’ might usefully include reference to the use of exercise to improve appearance or body tone and the experience of guilt following postponement of exercise. Inclusion of such information in prevention programmes for eating disorders may also be of benefit. ‘Excessive exercise’ is unlikely to be associated with impairment in psychosocial functioning in the absence of eating disorder psychopathology. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.
Article
BACKGROUND: Co-morbidity patterns in epidemiological studies of mental illness consistently demonstrate that a latent internalizing factor accounts for co-morbidity patterns among unipolar mood and anxiety disorders, whereas a latent externalizing factor underlies the covariation of substance-use disorders and antisocial behaviors. However, this structure needs to be extended to include a broader range of disorders.Method Exploratory and confirmatory factor analyses were used to examine the structure of co-morbidity using data from the Collaborative Psychiatric Epidemiological Surveys (n=16 233). RESULTS: In the best-fitting model, eating and bipolar disorders formed subfactors within internalizing, impulse control disorders were indicators of externalizing, and factor-analytically derived personality disorder scales split between internalizing and externalizing. CONCLUSIONS: This was the first large-scale nationally representative study that has included uncommon mental disorders with sufficient power to examine their fit within a structural model of psychopathology. The results of this study have important implications for conceptualizing myriad mental disorders.
Article
The mood disorders are prevalent and problematic. We review randomized controlled psychotherapy trials to find those that are empirically supported with respect to acute symptom reduction and the prevention of subsequent relapse and recurrence. We searched the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to identify appropriate articles. One hundred twenty-five studies were found evaluating treatment efficacy for the various mood disorders. With respect to the treatment of major depressive disorder (MDD), interpersonal psychotherapy (IPT), cognitive behavior therapy (CBT), and behavior therapy (BT) are efficacious and specific and brief dynamic therapy (BDT) and emotion-focused therapy (EFT) are possibly efficacious. CBT is efficacious and specific, mindfulness-based cognitive therapy (MBCT) efficacious, and BDT and EFT possibly efficacious in the prevention of relapse/recurrence following treatment termination and IPT and CBT are each possibly efficacious in the prevention of relapse/recurrence if continued or maintained. IPT is possibly efficacious in the treatment of dysthymic disorder. With respect to bipolar disorder (BD), CBT and family-focused therapy (FFT) are efficacious and interpersonal social rhythm therapy (IPSRT) possibly efficacious as adjuncts to medication in the treatment of depression. Psychoeducation (PE) is efficacious in the prevention of mania/hypomania (and possibly depression) and FFT is efficacious and IPSRT and CBT possibly efficacious in preventing bipolar episodes. The newer psychological interventions are as efficacious as and more enduring than medications in the treatment of MDD and may enhance the efficacy of medications in the treatment of BD.
Article
The present study assesses the prevalence of subclinical eating disorders and examines their comorbidity with mood and anxiety disorders in a sample of adolescent girls. A DSM-III-R computerized self-reported interview was administered to 833 adolescent girls (mean age=15.7±0.5 years) from a population sample to assess the prevalence of subclinical eating disorders, major depression, dysthymia, separation anxiety, and generalized anxiety disorders. The prevalence of subclinical anorexia nervosa (restricting subtype) was 3.5%, 13.3% for weight concerns (restricting subtype), 3.8% for subclinical bulimia nervosa, and 10.8% for subclinical binge eating disorder. Girls with subclinical anorexia nervosa had a higher prevalence of separation anxiety diagnosis, and they reported significantly more major depressive and generalized anxiety symptoms compared with girls reporting no eating disorders. Girls with weight concerns reported significantly more major depressive, separation, and generalized anxiety symptoms compared with girls reporting no eating disorders. Girls with subclinical bulimia nervosa or binge eating disorder had a higher prevalence of mood disorders (major depression and dysthymia) compared with girls reporting no eating disorders. Furthermore, girls with subclinical bulimia nervosa or binge eating disorder also reported significantly more anxiety symptoms (separation anxiety and generalized anxiety) compared with girls reporting no eating disorders. In summary, adolescent girls suffering from subclinical eating disorders should be investigated concomitantly for mood and anxiety disorders while those suffering from mood and anxiety disorders should be investigated simultaneously for subclinical eating disorders.
Article
Polycystic ovary syndrome (PCOS) is associated with high levels of depression, which impact quality of life and limit self-efficacy, yet less is known about prevalence of anxiety. This cross-sectional, observational study of community-based women with PCOS comprehensively examined mood and found that anxiety existed at higher levels than depression, anxiety was underdiagnosed, and more women with PCOS who reported infertility were depressed. (Fertil Steril (R) 2010;93:2421-3. (C) 2010 by American Society for Reproductive Medicine.)
Article
The present study compared threshold, subthreshold BED (Binge Eating Disorder), and subjects without BED in a population of overweight/obese individuals seeking weight loss treatment, considering the sociodemografic features, the eating specific and general psychopathology, the organic and psychiatric comorbidity, the quality of life, and the emotional eating as a trigger factor for binge eating. Four hundred thirty eight overweight subjects seeking weight loss treatment have been evaluated by means of a clinical interview (SCID I), and different self-reported questionnaires, assessing the eating specific and general psychopathology. One hundred five subjects (24% of the sample) fulfilled the DSM-IV criteria of BED, 146 (33.3%) fulfilled the criteria of subthreshold BED, and 187 (42.7%) subjects were diagnosed overweight non-BED. The groups did not differ in terms of psychiatric comorbidity, diet attempts, quality of life, and psychopathology, while the presence of binge eating was associated to higher eating, weight, and shape concerns. Emotional eating was positively correlated to the presence/severity of binge eating.
Article
Some studies have found "hidden" eating disorders in psychiatric patients. However, eating behaviour, weight, and body image concerns are usually weakly assessed among psychiatric patients. a) To analyse the prevalence of eating disorders (ED) in patients referred from primary care for psychiatric assessment; and b) to analyse the psychopathological variables associated with these disorders. Methods. Ninety-three patients underwent psychometric assessment using Derogatis' Symptom Checklist-90-R, the Rosenberg Self-Esteem Scale, the Perceived Stress Questionnaire, the Eating Attitudes Test-40 (EAT-40), the Bulimic Investigatory Test, Edinburgh (BITE), and the Body Dissatisfaction Scale of the Eating Disorders Inventory-2. The subsequent clinical assessment, applying DSM-IV-R criteria for ED, was conducted by means of interview with those patients whose scores on the EAT-40 and BITE were above the cut-off points. The assessments confirmed one case of bulimia nervosa and three of unspecified eating disorder, these accounting for 1.07% and 3.22%, respectively. The existence of hidden ED in psychiatric patients, especially as regards bulimic behaviour, and the correlation between eating disorder symptoms and different psychopathological variables make it important for clinicians to conduct a proper assessment when faced with "anxiety and depressive syndromes", which are a common feature of primary care referrals for psychiatric assessment.
Article
The purpose of this study is to analyze the developmental relationships of adolescent-onset Axis I mental disorders and eating disorders (EDs). One thousand three hundred eighteen adolescent twins born from 1983 to 1987 completed a professionally administered semistructured psychiatric interview at the age of 14 years and a questionnaire follow-up at the age of 17.5 years. Eating disorders at the age of 17.5 years were significantly predicted by major depressive disorder (odds ratio, 5.9; 95% confidence interval, 2.6-15.3) and generalized anxiety disorder (GAD) (odds ratio, 4.7; 95% confidence interval, 1.8-15.6) at the age of 14 years, when baseline EDs were excluded. Early-onset major depressive disorder in combination with GAD increased the likelihood of developing EDs compared with either mood or anxiety disorders alone. Similar risks and trends were evident in within-family analyses of twin pairs discordant for baseline predictors and ED outcome. Depressive disorder and GAD that manifest at that age of 14 years predict future EDs. Analysis of discordant twins suggested that early-onset depressive disorder and GAD prospectively relate to EDs in adolescence, even after familial factors are taken into account.
Article
Although adolescent girls with elevated dietary restraint scores are at increased risk for future binge eating and bulimic pathology, they do not eat less than those with lower restraint scores. The fact that only a small proportion of individuals with elevated dietary restraint scores develop bulimic pathology suggests that some extreme but rare form of dietary restriction may increase risk for this disturbance. The authors tested the hypothesis that fasting (going without eating for 24 hr for weight control) would be a more potent predictor of binge eating and bulimic pathology onset than dietary restraint scores using data from 496 adolescent girls followed over 5 years. Results confirmed that only 23% of participants with elevated dietary restraint scores reported fasting. Furthermore, fasting generally showed stronger and more consistent predictive relations to future onset of recurrent binge eating and threshold/subthreshold bulimia nervosa over 1- to 5-year follow-up relative to dietary restraint, though the former effects were only significantly stronger than the latter for some comparisons. Results provide preliminary support for the hypothesis that fasting is a stronger risk factor for bulimic pathology than is self-reported dieting.
Article
We review psychometric and other evidence relevant to mixed anxiety-depression. Properties of anxiety and depression measures, including the convergent and discriminant validity of self- and clinical ratings, and interrater reliability, are examined in patient and normal samples. Results suggest that anxiety and depression can be reliably and validly assessed; moreover, although these disorders share a substantial component of general affective distress, they can be differentiated on the basis of factors specific to each syndrome. We also review evidence for these specific factors, examining the influence of context and scale content on ratings, factor analytic studies, and the role of low positive affect in depression. With these data, we argue for a tripartite structure consisting of general distress, physiological hyperarousal (specific anxiety), and anhedonia (specific depression), and we propose a diagnosis of mixed anxiety-depression.
Article
In recent years there has been increased interest regarding the role of crime victimization in the development and/or maintenance of eating disorders, particularly bulimia nervosa. To examine the relationship among assault, bulimia nervosa, and binge eating disorder, a national, representative sample of 3,006 women completed structured telephone interviews. Lifetime prevalence of completed, forcible rape for respondents with bulimia nervosa was 26.6%, as compared with 11.5% for respondents with binge eating disorder and 13.3% for respondents without bulimia nervosa or binge eating disorder. Compared to respondents without bulimia nervosa or binge eating disorder, aggravated assault history was significantly more prevalent in women with bulimia nervosa (26.8%), as was a lifetime history of posttraumatic stress disorder (36.9%). Characteristics of sexual assault experiences were not associated with dysfunctional eating patterns. Specific types of disordered eating such as compensatory behaviors in bulimia nervosa were associated with higher rates of victimization. In sum, the significantly higher rates of both sexual and aggravated assault among women with bulimia nervosa compared with women without such a diagnosis support the hypothesis that victimization may contribute to the development and/or maintenance of bulimia nervosa.
Article
To describe the diagnostic comorbidity and clinical correlates of posttraumatic stress disorder (PTSD) in adolescent psychiatric inpatients. Seventy-four adolescent inpatients were given a structured diagnostic interview, the revised version of the Diagnostic Interview for Children and Adolescents, and a battery of standard self-report measures to assess general trauma exposure, posttraumatic stress symptoms, suicidal behavior, dissociation, and depression. Ninety-three percent of subjects reported exposure to at least one traumatic event such as being a witness/victim of community violence, witnessing family violence, or being the victim of physical/sexual abuse. Thirty-two percent of subjects met diagnostic criteria for current PTSD, with sexual abuse cited as the most common traumatic stressor in 69% of PTSD cases. Girls were significantly more likely to develop PTSD than boys, although the total number of types of trauma did not differ by gender. Compared with psychiatric controls, male youngsters with PTSD were significantly more likely to have comorbid diagnoses of eating disorders, other anxiety disorders, and somatization disorder. Furthermore, male and female youngsters with PTSD were significantly more likely to have attempted suicide and report greater depressive and dissociative symptoms. In clinical populations of hospitalized adolescents exposed to multiple forms of trauma, PTSD is a common, but highly comorbid disorder. Specific multimodal assessments and treatments targeted to both PTSD and its comorbidity profile are warranted.
Article
The paper describes prevalence, impairments, patterns of co-morbidity and other correlates of DSM-IV social phobia in adolescents and young adults, separating generalized and non-generalized social phobics. Data are derived from the baseline investigation of the Early Developmental Stages of Psychopathology Study (EDSP), a prospective longitudinal community study of 3021 subjects, aged 14-24. Diagnoses were based on the DSM-IV algorithms of an expanded version of the Composite International Diagnostic Interview. Lifetime prevalence of DSM-IV/CIDI social phobia was 9.5% in females and 4.9% in males, with about one-third being classified as generalized social phobics. Twelve-month prevalence was only slightly lower, indicating considerable persistence. Respondents with generalized social phobia reported an earlier age of onset, higher symptom persistence, more co-morbidity, more severe impairments, higher treatment rates and indicated more frequently a parental history of mental disorders than respondents with non-generalized social phobia. History of DSM-IV social phobia was found to be quite prevalent in 14-24 year-olds. The generalized subtype of social phobia was found to have different correlates and to be considerably more persistent, impairing and co-morbid than non-generalized social phobia. Although generalized social phobics are more likely than non-generalized social phobics to receive mental health treatments, the treatment rate in this sample was low despite the fact that mental health services are free in Germany.
Article
This study investigates psychiatric comorbidity associated with eating disorder symptomatology among adolescents in the community. Four hundred three adolescents in the community were administered structured clinical interviews to assess mood, anxiety, eating, substance use, and personality disorders. Adolescents with dysthymia, panic and major depressive disorder were significantly more likely than those without these disorders to have an eating disorder. After controlling for the effects of other Axis I disorders and personality disorders, only dysthymia independently predicted the presence of an eating disorder. Several personality disorders were also associated with eating disorder symptoms. However, only obsessive-compulsive personality disorder predicted eating disorder symptoms after controlling for other personality disorders. Although previous research on adults has focused on the association between major depressive disorder and eating disorders, dysthymia may be more strongly associated with eating disorders among adolescents in the community. This association is not accounted for by psychiatric comorbidity.
Article
We report data on 1-year prevalence and comorbidity of depression, related impairment, treatment need, and psychiatric treatment among young adults. A sample of young urban adults (n=245) mean age 21.8 years was screened from a baseline population of 706 high-school students and given a semistructured clinical interview to evaluate 12-month prevalence of depression, psychosocial functioning according to DSM-IV GAF scale, need for psychiatric treatment, and use of mental health services. One in 10 young adults suffered from depression with associated psychosocial impairment, the female-to-male-ratio being approximately 2:1. Most depressive disorders were comorbid with other DSM-IV disorders, depression usually occurring secondary to other disorders. Comorbidity was related to impairment, treatment need, and treatment contacts. Less than half of the depressed young adults had ever contacted mental health services, and less than one-third reported treatment contacts during the index episode. Males were less likely than females to report previous treatment contacts or intention to refer to mental health services for their problems, but treatment contacts during the index episode were reported equally often by both sexes. A minority of the severely depressed young adults with associated impairment had sought treatment. Except for subjects with dysthymia, no gender difference emerged in treatment contact rates during the 12-month depression episode. Comorbidity showed important clinical implications by its relation to severity of depression and treatment contacts.
Article
Recent findings implicate body dissatisfaction in the development and maintenance of eating pathology. This paper reviews theory and empirical findings regarding the putative origins and consequences of body dissatisfaction because recent findings have not been synthesized or critically evaluated and because these findings have key etiologic and prevention implications. A computer-assisted literature review was conducted to locate relevant prospective and experimental studies. There is evidence that perceived pressure to be thin, thin-ideal internalization and elevated body mass, but not early menarche, increase the risk for subsequent body dissatisfaction. There is also consistent support for the assertion that body dissatisfaction is a risk factor for eating pathology and that this relation is mediated by increases in dieting and negative affect. This review provides support for the claim that sociocultural processes foster body dissatisfaction, which in turn increase the risk for bulimic pathology, and suggests that prevention and treatment interventions might be enhanced by focusing greater attention on body image disturbances.