Showing papers in "International Journal of Eating Disorders in 2006"

Twelve-year course and outcome predictors of anorexia nervosa

Abstract: Objective The current study presents the long-term course of anorexia nervosa (AN) over 12 years in a large sample of 103 patients diagnosed according to criteria in the 4th ed of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Method Assessments were made at the beginning of therapy, at the end of therapy, at the 2-year follow-up, at the 6-year follow-up, and at the 12-year follow-up Self-rating and an expert-rating interview data were obtained Results The participation rate at the 12-year follow-up was 88% of those alive There was substantial improvement during therapy, a moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 12 years posttreatment Based on a global 12-year outcome score, 275% had a good outcome, 253% an intermediate outcome, 396% had a poor outcome, and 7 (77%) were deceased At the 12-year follow-up 190% had AN, 95% had bulimia nervosa-purging type (BN-P), 190% were classified as eating disorder not otherwise specified (EDNOS) A total of 524% showed no major DSM-IV eating disorder and 0% had binge eating disorder (BED) Systematic—strictly empirically based—model building resulted in a parsimonious model including four predictors of unfavorable 12-year outcome explaining 45% of the variance, that is, sexual problems, impulsivity, long duration of inpatient treatment, and long duration of an eating disorder Conclusion Mortality was high and symptomatic recovery protracted Impulsivity, symptom severity, and chronicity were the important factors for predicting the 12-year outcome © 2005 by Wiley Periodicals, Inc

Emotional overeating and its associations with eating disorder psychopathology among overweight patients with Binge eating disorder

Abstract: Objective The current study examined emotional overeating in overweight patients with binge eating disorder (BED). A new measure—the Emotional Overeating Questionnaire (EOQ)—was developed to measure the frequency of overeating in response to emotions. The internal consistency, test-retest reliability, and factor structure of this measure were examined, and its associations with eating disorder psychopathology, depression, and gender were explored. Method Two hundred twenty consecutive overweight (body mass index [BMI] ≥ 25) treatment-seeking BED patients (48 men and 172 women) were administered the EOQ, which assesses overeating frequency in response to six emotions (anxiety, sadness, loneliness, tiredness, anger, and happiness). A subset of patients (n = 83) completed the measure again approximately 1 week later. BMI was measured, and participants completed measures of eating disorder psychopathology. Results The EOQ was internally consistent (α =.85), its items were significantly and moderately correlated (range .32 to .70) with each other, and principal components analysis revealed one factor accounting for 58% of the variance. The EOQ items and total score were characterized by good test-retest reliability (intraclass correlation coefficients [ICCs] ranged from .62 to .73). Significant correlations were found between the emotional overeating items and total score, and binge frequency, eating disorder features, and depressive symptomatology. Emotional overeating was unrelated to BMI, and men and women reported similar rates of emotional overeating. Conclusion Emotional overeating was significantly associated with binge frequency, eating disorder features, and depression, but was not related to BMI or gender. © 2005 by Wiley Periodicals, Inc.

Features associated with excessive exercise in women with eating disorders.

Abstract: Objective: Excessive exercise and motor restlessness are observed in a substantial number of patients with eating disorders. This trait has been studied extensively among animal models of activity anorexia nervosa (AN) and may hold particular interest as an endophenotype for AN. We explored features associated with excessive exercise across subtypes of eating disorders. Method: Participants were female probands and affected female relatives from the multi-site international Price Foundation Genetic Studies with diagnoses of AN, bulimia nervosa (BN), and both AN and BN or eating disorder not otherwise specified (ED-NOS) (N ¼ 1,857). Excessive exercise was defined based on responses to the Structured Interview for Anorexic and Bulimic Disorders (SIAB). Results: Among the eating disorder diagnostic groups, excessive exercise was most common among the purging subtype of AN. Individuals who reported excessive exercise also reported lower minimum BMI, younger age at interview, higher scores on anxiety, perfectionism, and eating disorder symptom measures, more obsessions and compulsions, and greater persistence. Conclusion: Excessive exercise may be associated particularly with the purging subtype of AN as well as with a constellation of anxious/obsessional temperament and personality characteristics among women with eating disorders. V C 2006 by

Ana and the Internet: a review of pro-anorexia websites.

Abstract: Objective: The purpose of this article is to describe the content of pro-anorexia websites, both qualitatively and quantitatively. Method: An Internet search protocol was developed to identify pro-anorexia websites. A grounded theory approach was used to generate themes from Internet-based information. Basic descriptive analysis was employed to report on key website characteristics. Results: Twenty pro-anorexia websites met inclusion criteria. Saturation of themes was achieved after review of 12 websites. Key website characteristics included purpose of website (75%), information about webmaster (67%), website disclaimers (58%), and information on “tips and tricks” (67%). Religious metaphors, lifestyle descriptions, and “thinspiration” (inspirational photo galleries and quotes that aim to serve as motivators for weight loss) were frequently present. A total of 10 themes were generated. The most prevalent themes included control, success, and perfection. Conclusion: Health-care providers and caregivers should be aware of pro-anorexia websites and their content, as these websites contain information that promote and support anorexia nervosa. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006

Impulsivity in women with eating disorders: Problem of response inhibition, planning, or attention?

Abstract: Objective: Impulsivity is generally believed to be more characteristic of individuals with “bulimic” than with “restrictive” eating disorders (EDs). However, studies have not exhaustively explored the association between EDs and various component dimensions of the impulsivity construct. Method: We conducted a multidimensional assessment of impulsivity in 84 women with bulimia nervosa (BN), 37 with anorexia nervosa (AN: 19 “restricters” and 18 “bingers–purgers”), and 61 normal-control participants. To assess multiple components of impulsivity, participants completed a battery of self-report questionnaires and a performance test. Results: Compared with normal-control participants, all ED groups showed attentional problems. However, only women suffering BN or AN-binge purge subtype showed elevations on motoric forms of impulsivity, whereas women with BN were the only group to report tendencies toward reckless behavior. Conclusion: These findings suggest that binge-eating behavior coincides with problems of response inhibition, whereas a risk-taking attitude may be a unique characteristic of individuals with BN. © 2006 by Wiley Periodicals, Inc.

What is recovery in adolescent anorexia nervosa

Abstract: Objective The principal aim of this study is to describe the types of problems faced in defining recovery from anorexia nervosa (AN) as well as to illustrate the magnitude that various definitions have on recovery rates for AN. Method Comparative rates of recovery from AN using a range of definitions (percent ideal body weight, psychological recovery, and combinations of these variables) were calculated using long-term outcome data from a study of adolescents treated for AN. In addition, a Kaplan–Meier survival analysis was used to model recovery over the long-term follow-up period. Results Recovery rates varied highly, depending on the definition used, from 57.1% to 94.4%. Using survival analysis, the mean time to remission for weight (>85% ideal body weight) was 11.3 months, significantly shorter than for Eating Disorder Examination score recovery at 22.6 months (log rank = 16.1, p = 0.0001). Conclusion Agreement of definitions of recovery may be dependent on specific goals of a particular study or treatment; however, in order to compare and contrast categorical outcomes, a consistent definition of recovery is needed in the literature. Both weight and psychological symptoms appear to be important in a definition of recovery. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006

Time trends in the incidence of eating disorders : A primary care study in the Netherlands

Abstract: Objective This Dutch epidemiological study used primary care-based data to examine changes in the incidence of eating disorders in the 1990s compared to the 1980s. Method A nationwide network of general practitioners, serving a representative sample of the total Dutch population, recorded newly diagnosed patients with anorexia nervosa (AN) and bulimia nervosa (BN) in their practices during 1985–1989 and 1995–1999. Results The overall incidence of AN was stable (from 7.4 to 7.7 per 100,000). However, the incidence among 15–19-year-old females increased significantly (from 56.4 to 109.2 per 100,000). The incidence rate of BN decreased nonsignificantly from 8.6 to 6.1 per 100,000. Conclusion The time trend of an increasing AN incidence among the high risk group continued to the end of the past century. The BN incidence did not rise as was expected. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006

An update on the definition of excessive exercise in eating disorders research

Abstract: Objective The current study informed the definition of excessive exercise by examining relations between exercise behavior, eating-disordered behavior, and quality of life (QOL) in a community sample of women. Method Self-report measures of frequency of exercise, obligatory exercise and motivation for exercise, and of eating disorder psychopathology and QOL, were completed by 3,472 women aged 18-42 years who engaged in regular exercise. Results The extent to which exercise is intended to influence weight or shape and the degree to which guilt is experienced when exercise is postphoned were the exercise variables most strongly associated with elevated levels of eating disorder psychopathology and reduced QOL. Subgroups of participants who reported exercising solely for weight and shape reasons (n = 322 [9.3%]), intense guilt after postponement of exercise (n = 136 [3.9%]), or both (n = 116 [3.3%]), had markedly elevated levels of eating disorder psychopathology. There was no association between excessive exercise and reduced QOL after the effects of eating disorder psychopathology were statistically controlled. Conclusion The findings suggest that exercise is excessive when its postponement is accompanied by intense guilt or when it is undertaken solely to influence weight or shape. Operational definitions of excessive exercise might usefully include reference to these terms. The findings may also be of benefit in informing the content of prevention programs, which address dysfunctional exercise behavior. Excessive exercise is unlikely to be associated with impairment in psychosocial functioning in the absence of eating disorder psychopathology. It may, however, be a useful indicator of such psychopathology.

Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders.

Abstract: Objective The study examined treatment seeking for eating disorders in Mexican American and European American women. Method One hundred forty-five women with eating disorders (76 Mexican American, 69 European American) were diagnosed using the Structured Clinical Interview for DSM-IV-TR (SCID-IV) and Eating Disorder Examination (EDE). Results Only 28% of the sample reported having sought treatment for their eating problems and only 17% had received treatment. Both groups were equally likely to believe they have significant eating problems and to want help. However, Mexican Americans were less likely to have sought treatment and, having sought help, were less likely to have been diagnosed or treated. European Americans were more likely to have utilized psychotherapists, psychiatrists, and psychotropic medications, whereas Mexican Americans largely had sought help from general practitioners for weight concern. The two groups endorsed similar barriers to treatment seeking. Conclusion Results support clinical impressions that eating disorders largely go undetected and untreated. Nonspecialists may be likely to fail to detect eating disorders. © 2005 by Wiley Periodicals, Inc.

Comorbidity of body dysmorphic disorder and eating disorders: severity of psychopathology and body image disturbance.

Abstract: Objective The current study examined comorbidity and clinical correlates of eating disorders in a large sample of individuals with body dysmorphic disorder (BDD). Method Two hundred individuals with DSM-IV (4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; 1994) BDD completed reliable interviewer-administered and self-report measures, including diagnostic assessments and measures of body image, symptom severity, delusionality, psychosocial functioning, quality of life (QOL), and history of psychiatric treatment. Results A total of 32.5% of BDD subjects had a comorbid lifetime eating disorder: 9.0% had anorexia nervosa, 6.5% had bulimia nervosa, and 17.5% had an eating disorder not otherwise specified. Comparisons of subjects with a comorbid lifetime eating disorder (n = 65) and subjects without an eating disorder (n = 135) indicated that the comorbid group was more likely to be female, less likely to be African American, had more comorbidity, and had significantly greater body image disturbance and dissatisfaction. There were no significant group differences in BDD symptom severity, degree of delusionality, or suicidal ideation or attempts. Functioning and QOL were notably poor in both groups, with no significant between-group differences. However, a higher proportion of the comorbid eating disorder group had been hospitalized for psychiatric problems. This group had also received a greater number of psychotherapy sessions and psychotropic medications. Conclusion Eating disorders appear relatively common in individuals with BDD. BDD subjects with a comorbid eating disorder differed on several demographic variables, had greater comorbidity and body image disturbance, and had received more mental health treatment than subjects without a comorbid eating disorder. These findings have important implications for the assessment and treatment of these comorbid body image disorders. © 2005 by Wiley Periodicals, Inc.

Mirror exposure for the treatment of body image disturbance.

Abstract: Objective Body image disturbance is a risk factor for the development and persistence of eating disorders. Limitations of current treatments for body image disturbance prompted the development of a mirror exposure (ME) treatment. Method ME involves deliberate, planned, and systematic exposure to body image. The approach is nonjudgmental, holistic in focus, and mindful of present emotional experience. Complementary behavioral assignments aim to reduce avoidance and excessive checking. The current study evaluated the effectiveness of ME therapy (in a three-session format) compared with a nondirective (ND) therapy for 45 women with extreme weight and shape concerns. Results ME resulted in significant improvements at termination and follow-up in body checking and avoidance, weight and shape concerns, body dissatisfaction, dieting, depression, and self-esteem. As hypothesized, ME was significantly better than ND on many of the outcome measures. Conclusion ME is an effective treatment for body image disturbance and should be evaluated in the context of treatments for eating disorders. © 2005 by Wiley Periodicals, Inc.

Personality Traits after Recovery from Eating Disorders: Do Subtypes Differ?

Abstract: Objective: We compared individuals recovered from anorexia (AN) and bulimia nervosa (BN) to determine characteristics that are shared by or distinguish eating disorder (ED) subtypes. Method: Sixty women recovered for � 1 year from AN or BN were compared with 47 control women (CW). Assessments included the Yale-Brown-Cornell Eating Disorder Scale, the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory, the Yale-Brown Obsessive Compulsive Scale, the Temperament and Character Inventory, and Structured Clinical Interviews for DSM-IV. Results: Individuals recovered from an ED had similar scores for mood and personality variables that were significantly higher than the scores for CW. Few recovered subjects had Cluster B personality disorder. Most individuals recovered within 6 years of their ED onset. A latent profile analysis identified an ‘‘inhibited’’ and ‘‘disinhibited’’ cluster based on personality traits.

The meaning of self-starvation: Qualitative study of patients' perception of anorexia nervosa

Abstract: Objective: Anorexia nervosa (AN) patients tend to place a positive value on their symptoms. Many clinicians believe that this plays a central role in maintaining the disorder. However, empirical research on how patients attribute meaning to their symptoms is lacking. This study aims at systematically exploring the meaning that the patients with AN attribute to their anorectic behavior. Method: A qualitative, descriptive, phenomenological design was used. Eighteen women aged 20–34 with AN (DSM-IV) were interviewed with an informant-centered interview. The interviews were taperecorded, verbatim transcribed, coded, and analyzed phenomenologically, using a QSR-N*Vivo software program. Results: The psychological meanings that the informants attributed to their anorectic behavior could be summarized in eight constructs: ‘‘Security’’ (feeling of stability and security), ‘‘Avoidance’’ (avoiding negative emotions), ‘‘Mental strength’’ (inner sense of mastery), ‘‘Self-confidence’’ (feeling acknowledged and worthy of compliments); ‘‘Identity’’ (achieving new identity), ‘‘Care’’ (eliciting care from others), ‘‘Communication’’ (communicating difficulties), and ‘‘Death’’ (wishing to starve oneself to death). Conclusion: The eight constructs may have central functions in the maintenance of AN and should be regarded when patients’ motivation and goals for treatment are assessed. Further study of the possible functions of the constructs in maintaining AN is warranted. V C 2006

Development and psychometric validation of an eating disorder-specific health-related quality of life instrument

Abstract: Objective: Health-related quality of life (HRQOL) has been used increasingly as an outcome measure in clinical research. Although the generic quality of life instruments has been used in previous research, disease-specific instruments offer greater sensitivity and responsiveness to change than generic instruments. No such disease-specific instrument is currently available that applies to eating-disordered samples. Method: The current article reports on the development and validation of the Eating Disorders Quality of Life (EDQOL) instrument, a disease-specific HRQOL self-report questionnaire designed for disordered eating patients.

Stigmatization of anorexia nervosa.

Abstract: Objective: The current study examined the perceptions about an individual with anorexia nervosa (AN) relative to perceptions about a healthy person and a person with another mental or nonmental illness. Method: Ninety-one participants recruited from the community completed questionnaires targeting perceptions about 4 individuals: a healthy person, a person with asthma, a person with schizophrenia, and a person with AN. Results: Evaluations of personal characteristics were most negative for persons with AN. Participants believed the person with AN was most to blame for his/her condition, was best able to pull him/herself together if he/she wanted to, and was most acting this way for attention and that biological factors were least relevant in developing the illness. Conclusion: Negative perceptions of a person with AN fell into stigma categories of self-attribution and responsibility. These attitudes may contribute to reluctance to seek treatment among individuals with AN. © 2006 by Wiley Periodicals, Inc., Int J Eat Disord, 2006

Alexithymia and facial emotion recognition in patients with eating disorders.

Abstract: Objective: Patients with anorexia or bulimia nervosa are reported to show high levels of alexithymia and to have difficulties recognizing facially displayed emotions. The current study tested whether it could be that facial emotion recognition is a basic skill that is independent from alexithymia. Method: We assessed emotion recognition skills and alexithymia in a group of 79 female inpatients with eating disorders and compared them with a group of 78 healthy female controls. Instruments used were the Toronto Alexithymia Scale, the Facially Expressed Emotion Labeling (FEEL) test, and the revised Symptom Check List (SCL-90-R). Results: There were no significant differences between patients and controls in their emotion recognition scores, but patients with eating disorders displayed significantly more alexithymia and psychopathology. Emotion recognition in patients was not related to alexithymia, psychopathology, or clinical symptoms. Conclusion: We suggest that the reported alexithymia of patients with eating disorders is complex and independent from basic facial emotion recognition.

Never too old for eating disorders or body dissatisfaction: a community study of elderly women

Abstract: Objective: The aim of the study is to examine eating behavior and body attitude in elderly women. Method: A randomly selected nonclinical sample of 1,000 women, aged 60–70 years, was contacted for our questionnaire survey covering current eating behavior, weight history, weight control, body attitude, and disordered eating (DSM-IV). Results: The 475 (48%) women included in our analyses had a mean BMI of 25.1 but desired a mean BMI of 23.3. More than 80% controlled their weight and over 60% stated body dissatisfaction. Eighteen women (3.8%; 95% confidence interval: 2.3–5.9%) met criteria for eating disorders (ED; N = 1 anorexia nervosa, N = 2 bulimia nervosa, and N = 15 EDNOS) and 21 (4.4%) reported single symptoms of an ED. Conclusion: Although EDs and body dissatisfaction are typical for young women, they do occur in female elderly and therefore should be included in the differential diagnosis of elderly presenting with weight loss, weight phobia, and/or vomiting. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006

Predictors of dropout and remission in family therapy for adolescent anorexia nervosa in a randomized clinical trial

Abstract: Objective: The purpose of this study is to explore the predictors of dropout and remission in the treatment of adolescent anorexia nervosa (AN) using family therapy. Method: Data derived from a randomized clinical trial comparing short and long term family therapy for adolescents with AN were used. A rotated component analysis was employed to reduce the number of variables and to address problems of collinearity and multiple testing. Dropout was defined as participating in less than 80% of the assigned therapy. Participants were classified as remitted if they obtained an ideal body weight greater than 95% and a global eating disorder Examination score within two standard deviations of community norms at the end of 12 months. Results: Co-morbid psychiatric disorder and being randomized to longer treatment predicted greater dropout. The presence of co-morbid psychiatric disorder, being older, and problematic family behaviors led to lower rates of remission. A reduction of child behavioral symptoms, a decline in problematic family behaviors, and early weight gain were all within treatment changes that increased the chance of remission. Conclusion: Co-morbid psychiatric disorder, family behaviors, and early response to treatment are important factors when predicting dropout and remission in family therapy for adolescent AN. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006; 39:639–647

Habit learning and anorexia nervosa: a cognitive neuroscience hypothesis.

Abstract: Objective: Anorexia nervosa (AN) is characterized by abnormal behaviors involving eating and weight that are impressively resistant to change. The persistence of these behaviors likely plays an important role in the high relapse rate after initial treatment. Persistent, stereotyped behaviors are also characteristic of obsessive-compulsive disorder (OCD). This article presents a neurocognitive model of AN, based on comparisons with OCD. Method: This article reviews clinical, neuropsychological, and neuroimaging findings in both OCD and AN relevant to a neurobiological understanding of a potential mechanism of the perpetuation of AN. Results: The identification of specific neurocognitive disturbances in individuals with OCD has led to a compelling hypothesis of the neural mechanisms mediating this disorder. Evidence suggests that similar disturbances, involving neural circuits between the cortex and the basal ganglia, may be present in individuals with AN. Conclusion: Research on such neurocognitive disturbances has the potential both to inform understanding of neural mechanisms underlying AN and to lead to advances in treatment. © 2006 by Wiley Periodicals, Inc., Int J Eat Disord, 2006

Alexithymia and body image in adult outpatients with binge eating disorder.

Abstract: Objective The current study elucidates the relations between alexithymia and body image in patients with binge eating disorder (BED). Method One hundred one patients with BED were evaluated. Alexithymia was measured with the Toronto Alexithymia Scale (TAS-20). The severity of BED was measured with the Binge Eating Scale (BES). Body concerns were assessed with the Body Shape Questionnaire-Short Version (BSQ-S), the Body Uneasiness Test (BUT), and the Body Attitude Test (BAT). Additional measures were the Rosenberg Self-Esteem Scale (RSES) and the Beck Depression Inventory (BDI). Results The prevalence of alexithymia in our sample was 39.6% (n = 40) and individuals with alexithymia showed higher scores on all rating scales. Higher body dissatisfaction, lower self-esteem, depressive symptoms, and the Difficulty in Identifying Feelings/Difficulty in Describing Feelings subscales of the TAS-20 were predictors of the severity of BED in the linear regression analysis. Conclusion Alexithymia was associated with more severe BED. Individuals with alexithymia and BED exhibited significantly poorer appearance evaluation and body satisfaction as well as higher depressive symptoms than individuals without alexithymia. © 2006 by Wiley Periodicals, Inc., Int J Eat Disord, 2006

Role of therapeutic alliance in family therapy for adolescent anorexia nervosa.

Abstract: Objective: The purpose of this study is to examine the role of therapeutic alliance in predicting treatment dropout, response and outcome in a cohort of adolescents with anorexia nervosa (AN) and their families who were treated using a manualized form of family-based therapy (FBT). Method: Independent assessors scored early and late therapeutic alliances for patients and parents using the Working Alliance Inventory-Observer (WAIo). Outcomes were weights and scores on the subscales of the Eating Disorder Examination at the end of 12 months of FBT. Results: Therapeutic alliance throughout treatment was strong both for adolescents and for their parents. A strong early alliance with adolescents was associated with early treatment response in terms of weight gain. A strong early alliance with parents prevented dropout, whereas a strong late parental alliance predicted their child's total weight gain at the end of treatment. Conclusion: Therapeutic alliance in both patients and parents treated with FBT is generally strong and likely contributes to treatment retention and treatment outcome. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006; 39:677–684

What is remission in adolescent anorexia nervosa? A review of various conceptualizations and quantitative analysis

Abstract: Objective The current article evaluated models of remission in anorexia nervosa (AN). Method A dataset from 86 adolescents with AN was used to model definitions of remission by using (a) Morgan–Russell categories, (b) criteria proposed by Pike, (c) criteria proposed by Kordy, et al. (d) DSM-IV-text revision criteria, (e) other weight thresholds, (f) psychological symptoms (Eating Disorder Examination [EDE] scores), and (g) combinations of these. Results The mean age was 15.2 ± 1.6 years. Remission rates varied from 3% to 96% depending on the method used. Combining percent ideal body weight and EDE scores appeared to reduce the variability in rates, capture the most meaningful aspects of remission, and avoid the pitfalls of other methods. Conclusion These methods of defining remission produce a wide range of outcomes, demonstrating the importance of defining remission consistently. Weight and psychological variables combined appear most important in defining remission. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006

Impact of interactive school-based media literacy lessons for reducing internalization of media ideals in young adolescent girls and boys.

Abstract: Objective: The primary objective of the current study was to examine the efficacy of single media literacy lessons in reducing media internalization in young adolescents. Method: Eleven classes of 237 students (100 girls and 137 boys; mean age = 13.79 years, SD = .42) randomly received 1 of 6 lessons. Eating disorder risk factors were assessed at baseline, and the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3) was used to assess media internalization postintervention. Results: At postintervention, boys had significantly lower SATAQ-3 scores on 4 of the 5 subscales (effect sizes = .42–.71), whereas girls had significantly lower scores on 1 subscale (effect size = .54). Higher baseline levels of dietary restraint, magazines bought/read, and perceived sociocultural pressure predicted smaller reductions in boys' scores, whereas depression predicted smaller reductions in girls' scores. Conclusion: The current study provides support that boys be included in eating disorder prevention programs and that media literacy may represent a promising prevention approach. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006.

Body checking in the eating disorders: Associations between cognitions and behaviors

Abstract: Objective: Body checking behaviors appear to be a manifestation of the cognitive distortions that are central to the maintenance of the eating disorders. However, there is little understanding of the cognitions that drive these behaviors. This study validates a novel measure of such cognitions (Body Checking Cognitions Scale [BCCS]) and examines the association between body checking cognitions, body checking behaviors, and general eating pathology. Method: Eighty-four eating-disordered women and 205 non-eating-disordered women each completed measures of body checking behaviors, body checking cognitions and eating pathology. A further 130 nonclinical women completed the measures to provide an independent cross-validation sample for the BCCS. Results: The BCCS was reliable and valid, and cross-validation with an independent sample confirmed the four-factor structure. Eating-disordered women were significantly more likely to experience body checking cognitions than healthy women. Those cognitions were associated with a significant proportion of variance in eating pathology, over and above the variance explained by checking behaviors. Conclusion: This study provides evidence for a range of beliefs underlying body checking behavior in eating-disordered women, suggesting that interventions addressing those beliefs might be pertinent in some cases. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006; 39:708–715

Use of extreme weight control behaviors with and without binge eating in a community sample: implications for the classification of bulimic-type eating disorders.

Abstract: Objective and Method: To inform the classification of bulimic-type eating disorders not meeting formal diagnostic criteria for bulimia nervosa (BN), levels of eating disorder psychopathology and functional impairment associated with subjective and objective bulimic episodes (SBEs and OBEs) and purging and nonpurging methods of weight control were examined in a large community-based sample of women (n = 5,232). Results: Participants who reported recurrent bulimic episodes had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not and this was the case whether the episodes were objective or subjective. Similarly, participants who reported the use of extreme weight control behaviors had higher levels of eating disorder psychopathology and functional impairment than those who did not, and this was the case whether purging or nonpurging behaviors were employed. The combination of bulimic episodes and extreme weight control behaviors was associated with particularly high levels of eating disorder psychopathology and functional impairment. Conclusion: The combination of bulimic episodes, objective or subjective, and extreme weight control behaviors, purging or nonpurging, is significant in terms of impairment in psychosocial functioning among individuals affected by eating disorders not meeting formal diagnostic criteria for BN. The combination of SBEs and extreme weight control behaviors, in particular, warrants further investigation.

Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women

Abstract: Objective: The current study investigated associations among eating disorders, depressive symptoms during pregnancy and postpartum, and perfectionism in a population-based sample of women. Method: Females who reported > or = 1 pregnancy (n = 1,119) completed questionnaires assessing perfectionism, eating disorder symptomatology, and depression during pregnancy and postpartum. Information regarding participants' history of major depressive disorder (mdd) was also available from structured psychiatric interviews completed during a previous wave of data collection. Results: Depressive symptoms during pregnancy and postpartum were high among women with a history of eating disorders. Both binge eating disorder (bed) and bulimia nervosa (bn) were positively associated with symptoms of postpartum depression (ppd), even when lifetime mdd was controlled. However, logistic regression indicated that women with a history of bn and bed are at particular risk of developing ppd symptomatology. Linear regression analyses conducted with the subset of the sample who endorsed a ppd screening item suggested that the severity of ppd symptomatology may be attributable to concern over mistakes, a specific aspect of perfectionism. Conclusion: These results highlight the importance of assessing specific features of perfectionism. In addition, they suggest that women with bn, bed, or high concern over mistakes may be at particular risk of developing ppd symptoms, and could benefit from prenatal screening.

Denial and minimization in adolescents with anorexia nervosa.

Abstract: Objectives This study examines symptoms of denial in 86 adolescents with anorexia nervosa (AN) using a dataset from a family therapy trial. Method Using the Restraint subscale of the Eating Disorders Examination (EDE) at baseline, participants were divided into deniers (n = 15), minimizers (n = 21), and admitters (n = 50). These subgroups were compared with analysis of variance (ANOVA; Tukey post-hoc analysis) on a variety of assessment and treatment variables at baseline and at 12 months. Results Although body mass index (BMI) was not significantly different, all subscale scores of the EDE were lower in the deniers compared with the admitters (p = .0001 for all subscales) at baseline. Minimizers also scored lower than admitters on 3 of 4 subscales (p = .0001 for the Restraint, Weight Concern, and Shape Concern subscales of the EDE). At baseline and at 12 months, there were no significant differences on the Youth Self-Report or the Child Behavior Checklist. At 12 months, the only significant difference was in the Restraint subscale, with deniers still scoring lower than admitters (p = .015). Conclusion Denial and minimization appear to be common processes occurring in adolescents with AN and present difficulties in assessment. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006

Nighttime eating: a descriptive study.

Abstract: Objective The definition of night eating syndrome (NES) is inconsistent across various studies and literatures. The goal of the current descriptive study was to collect data on participants who were selected using broad criteria for nighttime eating. Researchers have cogently argued for consideration of wide ranges including “subsyndromal” cases before reifying diagnostic constructs prematurely. Method One-hundred six participants with broadly defined nighttime eating problems were recruited through newspaper advertisements and were interviewed over the phone. The following instruments were administered: the Night Eating Questionnaire, the Night Eating Syndrome History and Inventory, the Eating Disorder Questionnaire, the Structured Clinical Interview for DSM-IV diagnoses and a Sleep Disorder Questionnaire. Results Thirty-one (29.2%) participants met the original criteria described by Stunkard et al. (Am J Med 1955;19:78) and only 14 (13.2%) participants met all of the most recent proposed criteria for NES (Birketvedt et al., JAMA 1999;282:657). The overlap between binge eating disorder (BED) and nighttime eating problems was modest in our sample with only 9 particiants meeting current BED criteria. One half of our sample was obese. Regular nocturnal eating was reported by 57.5% of the participants. Dieting was not a frequent precursor or antecedent of nocturnal eating. However, self-reported current parasomnias were quite frequent in our sample. Conclusion Our descriptive study confirms some of the observations made by other researchers. Nevertheless, nighttime eating is still an evolving concept that requires close collaboration between eating and sleep researchers. © 2006 by Wiley Periodicals, Inc., Int J Eat Disord, 2006

Relations between dietary restraint, depressive symptoms, and binge eating: A longitudinal study.

Abstract: Objective: Temporal relations between dietary restraint, depressive symptoms, and binge eating were tested by means of three competing models positing that (1) dietary restraint and depressive symptoms predict future increases in binge eating, (2) binge eating predicts future increases in dietary restraint and depressive symptoms, and (3) binge eating is reciprocally related to these two factors. Method: Longitudinal data from a community sample of Dutch females (N = 143; M age = 19.6) was used to test these relations while controlling for initial levels of these factors. Results: Dietary restraint did not predict future increases in binge eating, nor did binge eating predict future increases in dietary restraint. Depressive symptoms predicted future increases in binge eating, but binge eating did not predict future increases in depressive symptoms. Conclusion: Although this study had limited statistical power, the pattern of relations and effect sizes suggest that depressive symptoms, but not dietary restraint, increase risk of binge eating for late adolescent females. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006; 39:700–707

Evaluating the treatment of eating disorders from the patient's perspective

Abstract: Objective: This study investigated the evaluation of treatment of eating disorders (EDs) from the patient's perspective in a large community based sample in the Netherlands. It investigated perceived helpfulness of different types of treatment. Furthermore it investigated which patient and treatment characteristics contribute to the evaluation of treatment. Method: The Eating Disorder Examination questionnaire was administered to 44 anorexia nervosa (AN), 43 bulimia nervosa (BN), 69 EDNOS (ED not otherwise specified), and 148 former ED patients. A questionnaire specifically designed for the purpose of this study addressing treatment history and patient's evaluation of their treatment was administered. Results: There is a substantial patient and doctor delay in seeking and finding treatment. Treatment in specialized ED centers, self-help groups, and treatment with a partner were reported to be most helpful. Beneficial components of treatment reported in specialized ED centers refer to the communication skills of professionals, the therapist–patient working alliance, the contact with peers, and the focus of treatment on both ED symptoms as well as underlying issues. Conclusion: The patient's perspective on treatment of EDs does provide recommendations for the improvement of treatment of EDs that will facilitate clinical decision making and treatment planning. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006; 39:667–676