Showing papers in "International Journal of Eating Disorders in 2003"

Review of the prevalence and incidence of eating disorders

Abstract: Objective To review the literature on the incidence and prevalence of eating disorders Methods We searched Medline using several key terms relating to epidemiology and eating disorders and we checked the reference lists of the articles that we found Special attention has been paid to methodologic problems affecting the selection of populations under study and the identification of cases Results An average prevalence rate for anorexia nervosa of 03% was found for young females The prevalence rates for bulimia nervosa were 1% and 01% for young women and young men, respectively The estimated prevalence of binge eating disorder is at least 1% The incidence of anorexia nervosa is 8 cases per 100,000 population per year and the incidence of bulimia nervosa is 12 cases per 100,000 population per year The incidence of anorexia nervosa increased over the past century, until the 1970s Discussion Only a minority of people who meet stringent diagnostic criteria for eating disorders are seen in mental health care © 2003 by Wiley Periodicals, Inc Int J Eat Disord 34: 383–396, 2003

A Longitudinal Examination of Patterns in Girls' Weight Concerns and Body Dissatisfaction from Ages 5 to 9 Years

Abstract: Objective To examine the development of girls' weight concerns and body dissatisfaction from ages 5 to 9 years and how change and continuity in these constructs from age 5 to 7 years is associated with girls' eating attitudes, dietary restraint, and dieting status at age 9. Methods Weight concerns, body dissatisfaction, and weight status were assessed for 182 girls when they were 5, 7, and 9 years old, and their eating attitudes, dietary restraint, and dieting status were assessed when they were 9. Results Girls tended to maintain their rank in weight concerns and body dissatisfaction across ages 5 to 9 years, and associations among girls' weight concerns, body dissatisfaction, and weight status increased with age. In addition, positive associations were found between changes in girls' weight concerns, body dissatisfaction, and weight status across ages 7 to 9. Finally, girls' who reported high weight concerns or high body dissatisfaction across ages 5 to 7 reported higher dietary restraint, more maladaptive eating attitudes, and a greater likelihood of dieting at age 9, independent of their weight status. Conclusion Girls' reported weight concerns and body dissatisfaction across middle childhood showed consistency over time, were systematically related to their weight status, and predicted their dietary restraint, eating attitudes, and the likelihood of dieting at age 9. These results reflect patterns identified among adolescent girls and women. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 320–332, 2003.

The clinical significance of binge eating disorder.

Abstract: Objective Current controversy exists regarding the status of binge eating disorder (BED) as a diagnostic entity. A critique of the literature is provided to address the question of whether BED represents a clinically significant syndrome. Method The scientific evidence is considered through addressing five questions that are key in evaluating the clinical utility of any mental disorder. Results Individuals with BED meaningfully differ from individuals without eating disorders, and share important similarities to, yet are distinct from, individuals with anorexia nervosa (AN) and bulimia nervosa (BN). BED is associated with co-occurring physical and mental illnesses, as well as impaired quality of life and social functioning. Questions about the course of the disorder and the optimal treatment regimen for the syndrome need to be explored further. Discussion BED's distinctive combination of core eating disorder psychopathology, and other co-occurring physical and psychiatric conditions, impaired psychosocial functioning, and overweight constitute an eating disorder of clinical severity and a significant public health problem. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: S96–S106, 2003.

Ethnicity and differential access to care for eating disorder symptoms.

Abstract: Objective The impact of ethnicity on access to health care for eating disorder symptoms among participants in the 1996 National Eating Disorders Screening Program (NEDSP) was examined in two studies. Method Self-report and clinician-assessed data were analyzed from 9,069 participants in an educational and two-stage screening program for eating disorders in Study I. In Study II, both cross-sectional and prospective data from a randomly selected sample of 289 participants from the same program were analyzed to investigate the impact of ethnic minority status on both help-seeking patterns and clinician referral patterns for eating disorder symptoms. Results Even after controlling for severity of self-reported eating disorder symptoms, both Latino and Native American participants in the NEDSP were significantly less likely than Whites to receive a recommendation or referral for further evaluation or care. Ethnic minority subjects with self-acknowledged eating and weight concerns were also significantly less likely than non-minority participants to have been asked by a doctor about eating disorder symptoms. Only one marginally significant difference was found between ethnic minority and non-minority respondents with respect to their help-seeking behaviors, namely, ethnic minority subjects were less likely (at the level of a trend) to seek eating disorders treatment within 1½–2 years following the NEDSP. Discussion These data suggest that clinician bias may be an important barrier to access to care for eating disorder symptoms in ethnic minority populations. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 205–212, 2003.

Adverse effects of social pressure to be thin on young women: An experimental investigation of the effects of "fat talk".

Abstract: Objective Experiments have found that pressure to be thin from the media promotes body dissatisfaction and negative affect, but the effects of social pressure to be thin have not been examined experimentally. Thus, this study tested whether social pressure to be thin fosters body dissatisfaction and negative affect. Method Young women (N = 120) were randomly assigned to a condition wherein an ultra-thin confederate complained about how fat she felt and voiced intentions to lose weight or a control condition wherein she discussed a neutral topic. Results Exposure to social pressure to be thin resulted in increased body dissatisfaction but not negative affect. The effects were not moderated by initial thin-ideal internalization, body dissatisfaction, or social support. Discussion Results support the assertion that peer pressure to be thin promotes body dissatisfaction but suggest that this factor may not contribute to negative affect. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: 108–117, 2003.

Epidemiology of binge eating disorder.

Abstract: Objective: First described over 50 years ago, binge eating disorder (BED) only recently has become the focus of epidemiologic studies. This article provides a comprehen- sive review of these studies. Method: Relevant studies were examined and summarized in the form of a narrative review. Results: Similar to the early studies of bulimia nervosa (BN), the first generation of epidemiologic studies of BED is limited in scope or methodology. They focus on prevalence rates and provide only basic demographic characteristics and often use less than optimal sampling or assessment methods. Discussion: Results suggest that the demographic profile of BED may be more diverse than that of BN. Future studies should evaluate complex etiologic models in representative samples that include men and a broader range of ethnic minority groups. # 2003 by Wiley Perodicals, Inc. Int J Eat Disord 34: S19-S29, 2003.

Causes and recovery in anorexia nervosa: the patient's perspective.

Abstract: Objective: We explored anorexic patients' subjective accounts of the causes of their anorexia and of the factors that fostered recovery. Subjective accounts could assist in understanding this complicated and often intractable disorder. Method: All female new referrals to an eating disorders service underwent extensive interviews including open- ended questions about their beliefs concerning the causes of their anorexia nervosa and factors that led to recovery. Responses were categorized by two independent raters. Results: The most commonly mentioned perceived causes were dysfunctional families, weight loss and dieting, and stressful experiences and perceived pressure. The three most commonly cited factors contributing to recovery were supportive nonfamilial relationships, therapy, and maturation. Discussion: Individuals with anorexia nervosa perceive both external (family environment) and personal factors (dieting and stress) as contributory to their disorders. The results underscore the importance of interpersonal factors in recovery from anorexia nervosa and suggest that attention to this area in treatment may be beneficial. # 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 143-154, 2003.

Binge eating in children and adolescents

Abstract: Objective To establish what is known about binge eating in children and adolescents and to identify unresolved questions. Method We reviewed relevant studies to highlight and synthesize salient research findings. Discussion Available research has suggested that loss of control over eating may be more important than consumption of an objectively large amount of food in the assessment of binge eating in children. In addition, dieting may not be associated consistently with binge eating in children. Behavioral correlates of binges may include eating in the absence of hunger, eating in response to strong emotions or external cues, and eating in secret. On the basis of available research, provisional research criteria for binge eating disorder (BED) in children are suggested to stimulate further study of pediatric samples. We emphasize the need for prospective studies on the relationships among aberrant eating, weight and mood, and the inclusion of boys and girls of different ethnicities. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: S47–S57, 2003.

Brain dopamine is associated with eating behaviors in humans

Abstract: Objective Eating behavior in humans is influenced by variables other than just hunger-satiety including cognitive restraint, emotional distress, and sensitivity to food stimuli. We investigate the role of dopamine (DA), a neurotransmitter involved with food motivation, in these variables. Methods We used the Dutch Eating Behavior Questionnaire (DEBQ) to measure Restraint, Emotionality, and Externality in 10 subjects. We correlated DEBQ scores with brain DA levels. Positron emission tomography and {11C}raclopride uptake were used to measure baseline D2 receptors (neutral stimulation) and to assess changes in extracellular DA to food stimulation (display of food). Results Restraint was correlated with DA changes with food stimulation (higher restraint, greater responsivity), emotionality was negatively correlated with baseline D2 receptors (higher emotionality, lower D2 receptors), whereas externality was not. These correlations were significant in the dorsal but not in the ventral striatum. Discussion These results provide evidence that DA in the dorsal striatum is involved with the restraint and emotionality components regulating eating behavior and that these two dimensions reflect different neurobiologic processes. © 2003 by Wiley Periodicals, Inc.Int J Eat Disord 33: 136–142, 2003.

Internalization of ideal body shapes in 9-12-year-old girls.

Abstract: Objective: Body dissatisfaction is reported in girls as young as 9 years old in Western countries. in the current study, internalization of the "thin ideal" was predicted to be a critical influence on the development of body dissatisfaction. Method: Participants (n = 356) were weighed and completed measures of body dissatisfaction, awareness and internalization of the thin ideal, and peer and maternal attitudes and behavior. Exposure to relevant print media was also assessed. Results: Body dissatisfaction was associated with a higher body mass index, although it was not restricted to overweight girls. Internalization mediated the relationship between awareness of the sociocultural standard of appearance and body dissatisfaction. Media exposure and peer and maternal weight-related attitudes and behavior were, in turn, related to awareness, supporting the hypothesized sociocultural processes. Discussion: Internalization operates as a central component in the development of body dissatisfaction, occurring at a young age in some girls. Internalization maybe a suitable target for preventive strategies. (C) 2003 by Wiley Periodicals, Inc.

Binge eating in obese children and adolescents.

Abstract: Objective The first goal of the current study was to examine the extent to which a population of obese children and adolescents have developed binge eating problems. The second goal was to generate variables that would distinguish obese binge eaters from obese non–binge eaters. Method A group of 126 children and adolescents seeking residential care because of their obesity was selected. A self-report version of the Eating Disorder Examination was administered. Results Binge eating episodes were reported by 36.5% of the obese youngsters. Six percent reported two or more episodes of binge eating a week. Obese binge eaters differed significantly from obese non–binge eaters in self-esteem and in a broad range of eating-related characteristics. Compared with obese non–binge eaters, the obese binge eaters were slightly younger. Obese binge eaters did not differ from obese non–binge eaters in degree of overweight or depression. Discussion Results suggest that binge eating is a prevalent problem among obese children and adolescents seeking help for their obesity. The marked difference between obese children with and without binge eating suggests the need for special treatment to focus on the problems of obese binge eaters. © 2002 by Wiley Periodicals, Inc. Int J Eat Disord 33: 78–84, 2003.

Obsessions and compulsions in anorexia nervosa subtypes

Abstract: Objective Obsession and compulsions in anorexia nervosa (AN) patients are often confused with the preoccupations and rituals that are characteristic of obsessive-compulsive disorder (OCD). We examined the type and frequency of characteristic OCD obsessions and compulsions in a large sample of AN patients. Method In personal interviews with 324 AN patients, we assessed lifetime histories of eating disorder symptomatology and obsessive-compulsive behaviors with valid semistructured interviews. Checklist category sums on the Yale-Brown Obsessive Compulsive Scale were compared between AN and OCD subjects using generalized estimating equations. Results Lifetime obsessions and compulsions occurred in 68% of the AN restricting type and in 79.1% of the AN binge/purge type. The AN subgroups did not differ from OCD controls inr frequency of obsessions in the symmetry and somatic categories or in the compulsion categories of ordering and hoarding. In all other categories, the AN subgroups had a significantly lower frequency compared with the OCD controls. Discussion Some common phenotype characteristics shared by most AN and OCD patients suggest these disorders may share common brain behavioral pathways. However, the lack of complete overlap indicates they most likely have different loci of pathology within those pathways. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 308–319, 2003.

Clarifying the role of impulsivity in bulimia nervosa.

Abstract: Objective With the goal of demonstrating that urgency impulsivity is associated with bulimic symptoms, not (lack of) planning impulsivity, the authors conducted two studies assessing these personality traits and bulimic symptoms in undergraduate women. Method In study 1 291 women completed urgency and deliberation scales of the NEO PIR and the BULIT-R. In study 2 101 women completed alternative measures tapping these personality constructs and the BULIT-R. Results In both studies, what is commonly assessed with impulsivity measures, a lack of planning, was not significantly associated with bulimic symptoms. However, urgency, the tendency to act rashly when experiencing negative affect, was positively correlated with bulimic symptoms. Discussion The authors suggest that future researchers assess urgency, not lack of planning, when assessing impulsivity as a risk factor for bulimia nervosa. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 406–411, 2003.

Healthy weight control and dissonance-based eating disorder prevention programs: results from a controlled trial.

Abstract: Objective Because universal psychoeducational eating disorder prevention programs have had little success, we developed and evaluated two interventions for high-risk populations: a healthy weight control intervention and a dissonance-based intervention. Method Adolescent girls (N = 148) with body image concerns were randomized to one of these interventions or to a waitlist control group. Participants completed baseline, termination, and 1, 3, and 6-month follow-up surveys. Results Participants in both interventions reported decreased thin-ideal internalization, negative affect, and bulimic symptoms at termination and follow-up relative to controls. However, no effects were observed for body dissatisfaction or dieting and effects diminished over time. Discussion Results provide evidence that both interventions effectively reduce bulimic pathology and risk factors for eating disturbances. © 2002 by Wiley Periodicals, Inc. Int J Eat Disord 33: 10–21, 2003.

Binge eating disorder and obesity in 2003: Could treating an eating disorder have a positive effect on the obesity epidemic?

Abstract: Objective The purpose of this paper is to explore the relationship between binge eating disorder (BED) and obesity. Methods Recent literature relating to the etiology, risk factors, pathophysiology, and treatment of binge eating disorder was reviewed. Results The data suggest that binge eating may be a contributor to the development of obesity in susceptible individuals. Although eating disorders treatment in the absence of obesity treatment does not result in large weight losses, amelioration of binge eating does result in small weight losses and decreased weight regain over time. Discussion Our challenge in the future is to understand better the ways in which BED and obesity co-exist, and to find treatment strategies that will relieve the distress and dysfunction due to this disordered eating while enhancing appropriate weight loss or preventing further weight gain. Published 2003 by Wiley Periodicals, Inc.† Int J Eat Disord 34: S117–S120, 2003.

A preliminary controlled evaluation of a school‐based media literacy program and self‐esteem program for reducing eating disorder risk factors

Abstract: Objective This study compared the efficacy of a media literacy program and a self-esteem program designed to reduce general and specific risk factors for eating disorders. Method Four classes of 86 grade 8 students (53 boys and 33 girls), mean age of 13 years, were randomly assigned to either a control condition or one of the two intervention conditions. Assessment of general and specific risk factors was carried out at baseline, postintervention and 3-month follow-up. Results At postintervention the media literacy group had lower mean scores on weight concern than the control group (p =0.007) but the self-esteem group did not. There were some differences on self-esteem measures at the 3-month follow-up. Discussion Media literacy programs combined with an interactive, student-centered framework may potentially be a safe and effective way of reducing risk factors for eating disorders. The impact of teaching style needs to be further evaluated in prevention research. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 371–383, 2003.

The role of palatable food and hunger as trigger factors in an animal model of stress induced binge eating.

Abstract: Objective Dieting and stress are etiological factors in eating disorders, and dieting strongly predicts stress-induced overeating in the nonclinical population. We developed an animal model of binge eating in sated rats that is evoked by stress, but only in rats with a history of caloric restriction and only if highly palatable food (HPF) is available after stress. This study investigated the effect of known binge triggers, a taste of HPF and of hunger, on this type of binge eating. Method Female rats were cycled through the R/S protocol but this time were given just a taste of HPF with ad lib regular chow. After another R/S cycle, rats were stressed during restriction (while hungry) and were given HPF and chow. Results Although binge eating did not occur if only chow was available after stress, just a taste of HPF sufficed to increase chow intake to more than 160% (p < 0.001) of rats with a history of restriction only, stress-only, or neither. Hunger increased the proportion of chow consumed by both restricted groups, but stress magnified this hunger-induced overeating by increasing HPF intake to 137% of restriction-only rats (p < 0.001). Discussion These effects suggest that binge eating in this model is motivated by reward, not metabolic need, and parallels observations of binge triggers described in clinical binge-eating disorders. This strengthens the validity of using this animal model to target the physiology and treatment of eating disorders preceded by dieting and stress. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: 183–197, 2003.

Neuroticism and low self-esteem as risk factors for incident eating disorders in a prospective cohort study.

Abstract: Objective: To assess the role of neuroticism and low self-esteem as risk factors for eating disorders (ED). Method: A representative sample of girls 12-21 years old from Navarre, Spain. Girls free from any ED in 1997 were followed up for 18 months and reevaluated using DSM-IV criteria. Multivariable logistic models were used to examine associations between neuroticism (Eysenck Inventory) or low self-esteem (36-item scale) and incident ED. Results: Higher levels of neurotic personality increased the risk of ED (adjusted odds ratio (OR) for the highest quartile, 3.3; 95% Cl; 1.6-4.8). High levels of self-esteem were protective (OR, 0.32; 95% CI, 0.16-0.66). Neuroticism was a more powerful predictor than low self-esteem. Discussion: Our results provide prospective evidence sup- porting the role of neuroticism and low self-esteem as major determinants of ED. # 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 271-280, 2003.

Genetic and environmental contributions to obesity and binge eating.

Abstract: Objective Binge eating is present in a substantial proportion of obese individuals. A tendency toward obesity has been identified as a risk factor for eating disorders such as bulimia nervosa and binge eating disorder. The purpose of this article was to determine the extent of overlap between genetic and environmental factors that contribute to the liability to obesity and binge eating. Research Method In a population-based sample of 2163 female twins, we conducted bivariate twin modeling to explore the relation between the genetic and environmental risk factors for obesity and binge eating. Results Bivariate twin modeling revealed substantial heritability for obesity (0.86: 95% CI, 0.77–0.94), moderate heritability for binge eating (0.49: 95% CI, 0.38–0.61), and a modest genetic correlation of +.34 (95% CI, 0.19–0.50) between the two traits. Conclusions Both binge eating and obesity are heritable conditions, and there seems to be only modest overlap in the genetic risk factors that increase liability to each condition. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 293–298, 2003.

Binge eating and psychopathology in severely obese adolescents

Abstract: Objective The authors describe binge eating and psychopathology in severely obese adolescents who are seeking treatment for obesity and search for specific psychological features that may be associated with binge eating. Method Obese adolescents (n = 102) were assessed with the Binge Eating Scale (BES), the State–Trait Anxiety Inventory for Children (STAIC), the Beck Depression Inventory (BDI), Coopersmith's Self-Esteem Inventory (SEI), and the Body-Esteem subscale from the Piers–Harris Children's Self-Concept Scale (PHCSS). They were also evaluated with the Montgomery and Asberg Depression Rating Scale (MADRS) and the Brief Scale for Anxiety (BSA). Two subgroups (i.e., binge eaters and non-binge eaters) were then established according to the BES score. Results Binge eating symptoms were frequent in this population and the binge eating dimension was related to high levels of anxiety and depression, as well as to low levels of self-esteem and body-esteem. The dimensions of anxiety and depression were associated specifically with binge eaters. Discussion As observed in the obese adult population, binge eating symptoms were found frequently in severely obese adolescents seeking treatment and were related strongly to studied parameters. Obese adolescents who binge eat are a subgroup with high psychopathologic distress. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: 235–243, 2003.

Perfectionism in anorexia nervosa : A 6-24-month follow-up study

Abstract: Objective This study examined the relationship between perfectionism and outcome in anorexia nervosa (AN). Method Seventy-three patients received inpatient treatment for AN. Participants completed the Eating Disorder Inventory (EDI) at admission to (n = 55), at discharge (n = 27), and at a median of 15.9 months (n = 49) after inpatient treatment. At follow-up, participants also completed the Multidimensional Perfectionism Scale (MPS) and their scores were compared with those of healthy controls. Results EDI Perfectionism was associated with illness status. A lower EDI Perfectionism score at admission was associated with a better response to treatment, which was subsequently associated with better outcome at follow-up. Both the good and poor outcome groups had significantly higher MPS total perfectionism scores than healthy controls. Discussion The EDI measures an aspect of perfectionism that is sensitive to illness status, whereas the MPS is less dependent on clinical state and may reflect a common personality trait that persists with remission of disease. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 225–229, 2003.

Pharmacologic treatment of binge eating disorder.

Abstract: Objective To review the findings from pharmacologic trials of binge eating disorder (BED) and to provide guidelines for pharmacologic treatment. Methods The literature was searched for studies of pharmacologic treatment of BED and related conditions, such as nonpurging bulimia nervosa. Results Placebo-controlled studies of desipramine, fluvoxamine, fluoxetine, sertraline, citalopram, dexfenfluramine, sibutramine, and topiramate have demonstrated the efficacy of these agents in the treatment of BED. An open trial of venlafaxine has offered preliminary evidence for the efficacy of this medication. Guidelines for pharmacologic management of BED are provided. Conclusions The literature offers support for the use of agents from three categories of medication (antidepressants, appetite suppressants, and anticonvulsants) in the treatment of BED. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: S74–S88, 2003.

Anger and core beliefs in the eating disorders.

Abstract: Objective The link between emotion and eating pathology has long been established, but relatively little is known about the role of anger, partly because the existing literature has tended to concentrate on anger as a unitary construct Nor is there any understanding of the cognitive factors that drive this affect in the eating disorders This study had two aims: to determine levels of different facets of anger across eating disorder diagnoses and behaviors; and to investigate whether facets of anger are related to the individual's negative core beliefs Method The sample consisted of 140 women who met DSM-IV criteria for eating disorders, and 50 female control participants (university undergraduates) The women completed self-report questionnaires of anger levels and unhealthy core beliefs, and the presence of bulimic behaviors was recorded at assessment Results The eating-disordered women had higher levels of state anger and anger suppression, particularly if the diagnosis included bulimic symptoms Different aspects of anger were associated with specific bulimic behaviors Unhealthy core beliefs were associated with higher levels of trait anger in both groups but with anger suppression in the clinical women only Discussion Suggestions are made regarding ways in which state anger and anger suppression might be understood and treated in women with eating disorders © 2003 by Wiley Periodicals, Inc Int J Eat Disord 34: 118–124, 2003

Body image and eating disturbance among south Asian-American women: the role of racial teasing.

Abstract: Objective: Acculturation and loss of ethnic identification have been proposed as risk factors for eating and body image disturbance among women of color. This study investigated whether being teased about racial or ethnic features might also play a role in these disturbances in minority women. Methods: One hundred twenty-two college women of South Asian descent completed questionnaire measures of disturbed eating behavior, body image dissatisfaction, distress, self-esteem, acculturation, ethnic identification, and racial teasing. Results: History of hurtful racial teasing, but not acculturation or ethnic disidentification, was associated with disturbed eating and body image, even after control- ling for distress, self-esteem, and body mass. Conclusion: The psychological impact of racial teasing may be a potent but neglected source of eating and body image disturbance among minority women. # 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: 142-147, 2003.

Anxiolytic effects of acute tryptophan depletion in anorexia nervosa.

Abstract: Objective: Recent studies have raised the question as to whether a dysregulation of the neurotransmitter serotonin may contribute to the alterations in mood seen in anorexia nervosa (AN). People with AN tend to be anxious, obsessional, perfectionistic, and harm avoidant. These traits are premorbid and persist after recovery. It has been suggested that increased activity of brain serotonin systems could contribute to this pathologic condition. Dieting in AN, which serves to reduce plasma levels of tryptophan (TRP), may serve to reduce symptoms of dysphoric mood. Method: Fourteen women currently symptomatic with AN (ILL AN), 14 women recovered from AN (REC AN), and 15 healthy control women (CW) underwent acute tryptophan depletion (ATD). Measures of psychological state were self- assessed at baseline and hourly after ATD to determine whether ATD would reduce negative mood. Results: ILL AN and REC AN had significantly higher mean baseline TRP/LNAA (tryptophan/large neutral amino acids) ratios compared with CW. In contrast to placebo, the ATD challenge demonstrated a significantly greater reduction in the TRP/LNAA ratio for ILL AN (� 95%) and REC AN (� 84%) compared with CW (� 70%). Both the ILL AN and REC AN had a significant reduction in anxiety on the ATD day compared with the placebo day. Discussion: These data demonstrate that a dietary-induced reduction of TRP, the precursor of serotonin, is associated with decreased anxiety in people with AN. Restricting dietary intake may represent a mechanism through which individuals with AN modulate a dysphoric mood. # 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 257-267, 2003.

Ecologic momentary assessment of eating-disordered behaviors

Abstract: Objective: This pilot study evaluated the feasibility of ecologic momentary assess- ment (EMA) to measure five eating disorder behaviors and to examine reactivity of these behaviors to this measurement approach. The pattern of correspondence between EMA and the Eating Disorder Examination (EDE) was also examined. Methods: Women with threshold or subthreshold anorexia and bulimia nervosa (N ¼ 16) recorded their eating disorder behaviors for 4 weeks on a hand-held computer. Upon completion of the EMA procedure, the EDE was administered. Results: Eighty-eight percent of the sample completed the EMA behavioral recording. No differences in behavioral frequency were found in the first and second halves of the EMA measurement period, suggesting that behaviors were not reactive to the methodology. Binging and excessive exercise were lower when measured by EMA compared with the EDE. Discussion: These results suggest that EMA is a feasible and valid approach to the measurement of disordered eating behaviors. # 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: 349-360, 2003.

Differential heritability of eating attitudes and behaviors in prepubertal versus pubertal twins.

Abstract: Objective Differential heritability of eating pathology in prepubertal, pubertal, and 17-year-old twins was examined using a population-based twin sample. Method Participants included 530 11-year-old (452 prepubertal, 78 pubertal twins) and 602 17-year-old female twins from the Minnesota Twin Family Study. Puberty was assessed with the Pubertal Development Scale, and general eating pathology was assessed with the total score from the Minnesota Eating Disorders Inventory (M-EDI). Results M-EDI total score intraclass correlations for the pubertal 11-year-old group were more similar to the 17-year-old twins' than the prepubertal 11-year-old twins, suggesting similar levels of genetic influence in the pubertal and older adolescent cohort. Model-fitting corroborated these impressions, indicating that genetic factors accounted for 0% of the variance in 11-year-old prepubertal twins but 54% of the variance in 11-year-old pubertal and 17-year-old twins. Discussion Findings suggest that a portion of the genetic influence on eating pathology may become activated during puberty. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 287–292, 2003.

Conformity and dietary disinhibition: a test of the ego-strength model of self-regulation.

Abstract: Objective Ego-strength depletion was examined as an explanation for dietary disinhibition in restrained eaters. We predicted that the depletion of ego strength resulting from having to choose whether to conform would undermine dietary restraint. Method Participants completed an Asch-type conformity task, after which they completed a taste-rating task in which food intake was measured. Results As predicted, restrained eaters who repeatedly exercised choice ate significantly more than did restrained eaters who did not exercise choice. Discussion An ego-strength model of dietary restraint is discussed. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 165–171, 2003.

Risk factors for anorexia nervosa: A national cohort study

Abstract: Objective To identify possible risk factors for anorexia nervosa through national registers. Method The study includes the entire Swedish population of 989,871 individuals born between 1973 and 1982. Patients with anorexia nervosa were identified through the Swedish Hospital Discharge Register from November 1990 to December 1999. Information about sociodemographic, perinatal, and psychosocial variables was obtained from different national registers. Attributable risk (AR) was calculated for potential risk factors. Results Females had the highest AR for hospital admission because of anorexia nervosa (89.2%). Another important risk factor was having parents born in northern, central, or eastern Europe (AR: 49.3%). Psychosocial risk factors also were associated with an increased risk for anorexia nervosa (AR: 7.6%), whereas perinatal complications had an AR of only 3.6%. Discussion The most important risk factors were related to the sociocultural context of the individual, thus supporting hypotheses of a sociocultural etiology of anorexia nervosa. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: 397–408, 2003.

What is this thing called BED? Current status of binge eating disorder nosology.

Abstract: Objective Although binge eating has been recognized as a clinically relevant behavior among the obese for more than four decades, the concept of binge eating disorder (BED) as a distinct psychiatric diagnosis is of much more recent origin. This article presents four ways of conceptualizing BED: a distinct disorder in its own right, as a variant of bulimia nervosa, as a useful behavioral subtype of obesity, and as a behavior that reflects psychopathology among the obese. It also summarizes the evidence supporting and disconfirming each model. Method The literature subsequent to the development of DSM-IV regarding the reliability and validity of BED and related conditions was reviewed selectively. Results The preponderance of the evidence suggests that BED differs importantly from purging bulimia nervosa and that BED is not a strikingly useful behavioral subtype of obesity. Discussion Further study is needed to definitively determine the validity of BED as a distinct eating disorder. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: S2–S18, 2003.