Eating disorders literature, August 2008

The measurement of impairment due to eating disorder psychopathology.

Oxford University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK.

Eating disorders have a profound and highly specific impact on psychosocial functioning. The aim of this research was to develop a measure of such secondary impairment. A 16-item, self-report instrument was developed, the Clinical Impairment Assessment (CIA), which was designed to measure such impairment overall and in three specific domains (personal, cognitive, social). The psychometric properties of the instrument were evaluated using data collected in the context of a transdiagnostic treatment trial. The findings consistently supported the utility of the instrument with the CIA being shown to have high levels of internal consistency, construct and discriminant validity, test-retest reliability, and sensitivity to change. The CIA should be of value to clinicians when assessing patients with eating disorders and their response to treatment. It should also help inform epidemiological research.

PMID: 18710699 [PubMed - as supplied by publisher]

Do obsessive compulsive symptoms mediate the relationship between maternal eating psychopathology and restrictive feeding practices?

Department of Human Sciences, Loughborough University, Leicestershire, United Kingdom.

OBJECTIVE:: Symptoms of maternal eating disorders have been linked with the use of maladaptive restrictive child feeding practices. However, how these symptoms impact upon restriction in child feeding is poorly understood. The aims of this research were to assess whether symptoms of obsessive compulsiveness, which are often comorbid with eating disorder symptoms, mediate the relationships between maternal eating disorder symptoms and the use of restrictive feeding practices. METHOD:: A total of 128 mothers of children aged 2-6 years completed measures of their restrictive feeding practices, symptoms of eating disorders, and obsessive compulsiveness. RESULTS:: Maternal restriction was positively correlated with symptoms of drive for thinness, bulimia, and checking and cleaning obsessions and compulsions. Cleaning obsessions and compulsions mediated the relationships between maternal drive for thinness and feeding restriction. CONCLUSION:: Cleaning obsessions and compulsions may help to explain the relationships between some symptoms of maternal eating disorders and the use of restrictive feeding practices. (c) 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2008.

PMID: 18704918 [PubMed - as supplied by publisher]

Hepatocellular injuries observed in patients with an eating disorder prior to nutritional treatment.

Department of Internal Medicine, St. Luke's International Hospital, Tokyo. tukamsa@luke.or.jp

BACKGROUND/AIMS: Although hepatocellular injuries are occasionally observed in patients with an eating disorder, such as anorexia nervosa (AN), it remains unclear how malnutrition in patients with AN causes hepatocellular damage. In this retrospective study, we aimed to reveal the characteristics of hepatocellular injuries in patients with an eating disorder without any nutritional treatment, to eliminate the possible hepatotoxic effects of nutritional support. SUBJECTS AND METHODS: Twenty-five patients with an eating disorder who visited St. Luke's International Hospital were enrolled. No nutritional treatment had been performed for these patients. The diagnosis of eating disorder as well as typing (anorexia nervosa or bulimia nervosa) was made according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-4). We reviewed the charts of these patients and examined the clinical parameters. RESULTS: Elevation of serum alanine aminotransferase (ALT) was found in 13 out of 25 (52%), all of whom were categorized as AN. In 13 AN patients with elevated ALT, the median of serum ALT values was 92 [39-438] IU/L. The body mass index (BMI) was significantly lower (13.5 vs. 17.3, p=0.011), and the duration since the onset of AN was shorter (4.2 years vs. 8.9 years, p=0.037) in patients with elevated ALT. The age was younger in patients with elevated ALT, even though not significant (24.5 vs. 29.8, p=0.139). Logistic regression analysis revealed that only BMI was a significant determinant for the development of hepatocellular injuries (OR=3.46; 95% CI 1.06-11.34, p=0.041). Imaging studies failed to demonstrate any abnormalities, including fatty liver. CONCLUSION: The current study indicated that lower BMI might significantly contribute to the development of hepatocellular injuries in AN patients prior to any nutritional treatments.

PMID: 18703853 [PubMed - in process]

Dropping insulin to drop pound. The practice of withholding insulin as a way to lose weight is a serious eating disorder with devastating consequences.

PMID: 18686325 [PubMed - indexed for MEDLINE]

A pilot intervention to reduce eating disorder risk in Latina women.

Northeastern University, MA, USA.

OBJECTIVE: The current study tested the effects of an eating disorder risk reduction programme (Food, Mood and Attitude (FMA)) with Latina women. METHOD: Fifty-two female Latina college students were screened. Of these, 28 eligible women were administered a questionnaire packet prior to and approximately 2 months and again 1 year after completing a 2-hour computer-based risk reduction programme called FMA and participating in two 2-hour discussion groups about risk factors for eating disorders. RESULTS: Paired sample t-tests indicated significant changes from pre- to post-assessment on the Eating Disorder Examination Questionnaire (EDEQ)-shape concerns subscale (p = .002), Eating Disorder Inventory-2 (EDI-2)-body dissatisfaction (BD) subscale (p < .001) and the Body Shape Questionnaire (BSQ; p = .006). Significant changes in binge frequency also occurred (p = .006). Changes on three of these measures were maintained at the 1-year follow-up assessment. CONCLUSIONS: This small-scale study suggests that FMA may reduce some risk factors for eating disorders in Latina college women. Copyright (c) 2008 John Wiley & Sons, Ltd and Eating Disorders Association.

PMID: 18683899 [PubMed - as supplied by publisher]

Binge eating disorder pharmacotherapy clinical trails-who is left out?

Lindner Center of Hope, Mason, OH, USA.

OBJECTIVE: This report examined the characteristics of subjects interested in binge eating disorder (BED) pharmacotherapy trails who were ineligible for participation. METHODS: Data on 2685 potential subjects interested in participating in five different placebo-controlled monotherapy trails of BED were analysed. RESULTS: Of the 2685 potential subjects, 1230 (45.8%) were ineligible because they did not meet entry criteria, 586 (21.8%) were eligible for participation, 531 (19.8%) were not interested in the study and 338 (12.6%) were not contacted. Among the 1230 ineligible candidates, 525 (42.7%) were taking exclusionary psychotropic medication, 305 (24.8%) did not meet specified BED criteria, 157 (12.7%) were out of the required age (n = 83) or weight (n = 74) range, 212 (17.2%) had prohibited medical (n = 78) or psychiatric (n = 134) disorders and 31 (2.5%) were participating in weight loss programmes. DISCUSSION: Given the complexity of BED, future pharmacotherapy studies should examine a broader range of subjects, including subjects with subthreshold forms of BED, those with comorbid disorders and elderly subjects. Copyright (c) 2008 John Wiley & Sons, Ltd and Eating Disorders Association.

PMID: 18683898 [PubMed - as supplied by publisher]

Eating disorders in ballet dancing students: Problems and risk factors.

Departament de Psiquiatria i Psicobiologia Clínica, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.

OBJECTIVE: To study the prevalence of symptoms of eating disorders and risk eating behaviours and the relationship between life at a dance school and the risk of developing an eating disorder (ED) in an adolescent population of Spanish dance students. METHODS: Questionnaires were used to assess attitudes to eating, cultural influences on the body shape model, eating disorders (DSM-IV) and risk factors for eating disorders in 76 adolescent dance students (age 12-17 years) at the Barcelona Theatre Institute. Subjects were compared with a community sample of 453 female adolescents. To study the relationship between ED and characteristics of this particular school, an original questionnaire was administered to 105 students at the school aged from 12 to 21 years. RESULTS: The prevalence of eating disorders and several risk attitudes and behaviours were similar in the dance students and the female adolescents from the general population. Students at risk of eating disorders perceived greater pressure from coaches concerning eating, appearance, weight and artistic performance; they felt less satisfied with their weight and weighed themselves more often; they avoided performing so as not to exhibit their body in public, disliked comparing their body with their peers and believed that audiences paid a great deal of attention to their bodies. In contrast, Body Mass Index (BMI) had hardly any influence on these experiences. Depressive symptoms were associated almost exclusively with experience of stressors and aversive situations. CONCLUSIONS: Dance school students do not necessarily present a greater risk of ED than other girls of the same age. The risk of ED may be associated with greater pressure from coaches, with attitudes related to the ED itself, or with depressive symptoms, rather than with the BMI. Copyright (c) 2008 John Wiley & Sons, Ltd and Eating Disorders Association.

PMID: 18680209 [PubMed - as supplied by publisher]

[Treatment of compulsive buying.]

Psychosomatische und Psychotherapeutische Abteilung, Universitätsklinikum Erlangen.

Although compulsive buying is receiving increasing attention in research, it is largely ignored in clinical practice. Compulsive buying disorder (CBD) is defined as excessive and mostly senseless spending or excessive shopping impulses that cause marked distress, interfere with social or occupational functioning, and often results in financial problems. It is currently conceptualized as an "impulse control disorder not otherwise specified" (ICD-10 F63.9). CBD is associated with significant psychiatric co-morbidity particularly mood and anxiety disorders, obsessive-compulsive disorders, binge eating disorder, substance use disorders, personality disorders, and other impulse control disorders. Previous research indicates that many compulsive buyers also suffer from compulsive hoarding. There is no evidence-based treatment approach for CBD and treatment research on this topic is limited. Open label trials suggest that antidepressants could improve compulsive buying. However, small randomized controlled trials failed to demonstrate significant improvement over Placebo and the high placebo-response rate prevents any definitive statement on the efficacy of antidepressants. Two controlled cognitive-behavioral therapy (CBT) trials reported that group CBT is significantly more effective compared to waiting list control groups in the treatment of compulsive buying. Clinical and therapeutic implications are discussed.

PMID: 18677679 [PubMed - in process]

Effectiveness of day hospital treatment for anorexia nervosa and bulimia nervosa.

Unit for Eating Disorders Research, Institute of Clinical Psychology, Technical University of Dresden, Germany.

The aim of this observational study was to examine the short-term effectiveness of a structured, largely manualised day hospital treatment, as well as the stability of short-term effects in patients with anorexia nervosa (AN) and bulimia nervosa (BN). Eighty-three patients, 47 with AN and 36 with BN, were assessed at pre-treatment, at the end of the day hospital treatment and at follow-up approximately one year after post-treatment. Outcome measures were body mass index (BMI), disturbed eating attitudes and behaviours assessed by the Eating Disorder Inventory (EDI), frequency of bingeing and purging, and general psychopathology assessed by the Symptom Checklist-90 (SCL-90). At the end of the day hospital treatment, significant improvements could be found on all outcome variables (frequency of binge eating/vomiting/laxative abuse, BMI and core EDI-subscales 'drive for thinness'/'bulimia'/'body dissatisfaction'). Effect sizes were generally large (.74 > d < 2.44). The effects were maintained or improved until follow-up (18 months). At follow-up, 40.2% of AN patients and 40.4% of BN patients could be classified as remitted. General psychopathological impairment was also significantly reduced at post-treatment and maintained until follow-up. The results demonstrate both the short-term effectiveness and long-term stability of day hospital treatment in a large sample of patients with anorexia and BN. Copyright (c) 2008 John Wiley & Sons, Ltd and Eating Disorders Association.

PMID: 18668700 [PubMed - as supplied by publisher]

Many roads lead to Rome: Why does cognitive behavioural therapy remain unsuccessful for many eating disorder patients?

University Psychiatric Center K.U. Leuven, Campus Kortenberg, Belgium.

This paper makes the case that the widely used evidence-based 'CBT' approaches remain unsuccessful in many eating disorder patients. Six critical 'personal reflections' are formulated on why many patients remain totally resistant toward our therapeutic endeavours. My reflections suggest that probably many roads may lead to Rome. Copyright (c) 2008 John Wiley & Sons, Ltd and Eating Disorders Association.

PMID: 18666311 [PubMed - as supplied by publisher]

[No Effect of Spironolactone on Bulimia Nervosa Symptoms.]

Universitätsklinik für Psychosomatische Medizin und Psychotherapie, Universität Ulm.

Some case reports mention that Spironolactone, a mineral corticoid antagonist and aldosterone antagonist, reduces binging in patients with bulimia nervosa. Therefore, we decided to study these findings by using a randomized, double-blind, placebo controlled study design. In one study arm, patients with bulimia nervosa were treated with 150 mg Spironolactone per day; in the other arm, patients received a placebo for a total of 8 weeks. The target variables were the number of binges and the bulimia scale of the Eating Disorder Inventory. The study included 93 patients. The results show that the number of binges and the scores on the bulimia scale decreased somewhat, but this occurred in both groups. We were not able to show any significant statistical differences between the Spironolactone group and the placebo group. Additional evaluations, executed with data from the Symptom-Check-List (SCL-90R) and with other scales from the EDI-2 also showed no effect of Spironolactone. Therefore, a treatment with Spironolactone seems to have no effect on bulimia nervosa symptoms.

PMID: 18666040 [PubMed - as supplied by publisher]

[Survey of disordered eating and behaviour in children and adolescents]

Fachbereich Sozialwesen, Fachhochschule Bielefeld, Bielefeld, Germany. cornelia.thiels@fh-bielefeld.de

OBJECTIVE: To study in children and adolescents associations between body mass index and psychosocial problems including those typical for eating disorders. METHOD: 1057 pupils aged 10 to 17 years completed the Youth Self-Report (YSR) and the Eating Disorder Inventory for children (EDI-C). Socio-demographic data and information about height and weight were also gathered. RESULTS: Underweight girls reported fewer problems than those with normal weight. Overweight girls had higher scores than normal weight girls on six out of eleven EDI-C-scales (drive for thinness, bulimia, body dissatisfaction, ineffectiveness, interpersonal distrust, interoceptive awareness) as well as on the YSR-scales Anxious/depressed and Social problems. Similarly, overweight boys presented more social problems then those of normal weight and higher scores on the same EDI-C-scales as overweight girls with the exception of interpersonal distrust. Underweight boys differed from normal weight boys on the YSR in reporting more somatic complaints, but on none of the EDI-C scales. CONCLUSIONS: Overweight children and adolescents seem to suffer from psychosocial problems including those typical for eating disorders. Therefore, they require intervention not only for the prevention of medical consequences of overweight and obesity. In the treatment of overweight children and adolescents eating disorder symptoms need to be taken into account.

PMID: 18654958 [PubMed - in process]

Eating disorder symptoms among undergraduate varsity athletes, club athletes, independent exercisers, and nonexercisers.

Department of Psychology, University of Vermont, Burlington, Vermont.

OBJECTIVE:: To examine whether differences in eating disorder symptoms exist between women who are varsity athletes, club athletes, independent exercisers, and nonexercisers and to determine whether sports anxiety moderates any observed between-group effects. METHOD:: Two hundred seventy four female undergraduates completed the eating disorders inventory and the physical activity and sport anxiety scale and reported their exercise habits. RESULTS:: Women who participated in sports tended to have higher levels of eating disorder symptomatology than those who did not. Higher levels of sports anxiety were predictive of higher levels of bulimic symptoms and drive for thinness. Finally, the interaction of sports anxiety and level of athletic participation significantly predicted body dissatisfaction and bulimic symptoms. CONCLUSION:: Coaches and clinicians should be aware that athletes experience higher rates of eating disorder symptoms than nonathletes. Moreover, sports anxiety should be considered as a possible target of therapy among athletes. (c) 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2008.

PMID: 18651619 [PubMed - as supplied by publisher]