Showing papers in "International Journal of Eating Disorders in 2009"

Gender difference in the prevalence of eating disorder symptoms.

Abstract: Objective—This study examined gender differences in prevalence of eating disorder symptoms including body image concerns (body checking or avoidance), binge eating, and inappropriate compensatory behaviors. Method—A random sample of members (ages 18 to 35) of a health maintenance organization was recruited to complete a survey by mail or on-line. Items were drawn from the Patient Health Questionnaire and the Body Shape Questionnaire. Results—Among the 3,714 women and 1,808 men who responded, men were more likely to report overeating whereas women were more likely to endorse loss of control while eating. Although statistically significant gender differences were observe, with women significantly more likely than men to report body checking and avoidance, binge eating, fasting, and vomiting, effect sizes (“Number Needed to Treat”) were small to moderate. Conclusions—Few studies of eating disorders include men, yet our findings suggest that a substantial minority of men also report eating disorder symptoms.

Academy for eating disorders position paper: eating disorders are serious mental illnesses.

Abstract: It is the position of the Academy for Eating Disorders (AED) that anorexia nervosa and bulimia nervosa, along with their variants, are biologically based, serious mental illnesses (BBMI) that warrant the same level and breadth of health care coverage as conditions currently categorized in this way (e.g., schizophrenia, bipolar disorder, depression, obsessive-compulsive disorder). As set forth below, we advocate this position unequivocally based on an emerging science that affirms with a reasonable degree of medical and scientific certainty that eating disorders are significantly heritable; influenced by alterations of brain function; significantly impair cognitive function, judgment, and emotional stability; and restrict the life activities of persons afflicted with these illnesses. Accordingly, the denial or restriction of equitable and sufficient treatment necessary to avert serious health consequences and risk of death is untenable and should be vigorously protested. Commentary

Proposed diagnostic criteria for night eating syndrome.

Abstract: Objective: To propose criteria for diagnosis of the night eating syndrome (NES). Method: An international research meeting was held in April 2008, and consensus criteria for NES diagnosis were determined. Results: The core criterion is an abnormally increased food intake in the evening and nighttime, manifested by (1) consumption of at least 25% of intake after the evening meal, and/or (2) nocturnal awakenings with ingestions at least twice per week. Awareness of the eating episodes is required, as is distress or impairment in functioning. Three of five modifiers must also be endorsed. These criteria must be met for a minimum duration of 3 months. Discussion: These criteria help standardize the definition of NES. Additional aspects of the nosology of NES yet to be fully elaborated include its relationship to other eating and sleep disorders. Assessment and analytic tools are needed to assess these new criteria more accurately. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010

Meta-analysis of the effectiveness of psychological and pharmacological treatments for binge eating disorder.

Abstract: Objective: The aim of this study was to compute and compare mean effects of various treatments for binge eating disorder. Method: A total of 38 studies with 1973 participants fulfilled the defined inclusion criteria. Effect sizes, odds ratios, and simple rates were integrated in fixed and random (mixed) effects categorical models. Results: From randomized controlled trials, psychotherapy and structured self-help, both based on cognitive behavioral interventions, were found to have large effects on the reduction of binge eating. Regarding pharmacotherapy, mainly comprising antidepressants, randomized controlled trials revealed medium effects for the reduction of binge eating. Uncontrolled studies on weight-loss treatments demonstrated moderate reductions of binge eating. Combination treatments did not result in higher effects compared with single-treatment regimens. Except for weight-loss treatment, none of the interventions resulted in a considerable weight reduction. Discussion: Psychotherapy and structured self-help, both based on cognitive-behavioral interventions, should be recommended as the first-line treatments. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010

DSM-IV Psychiatric Disorder Comorbidity and Its Correlates in Binge Eating Disorder

Abstract: Objective: To assess DSM-IV lifetime and current psychiatric disorder comorbidity in patients with binge eating disorder (BED) and to examine associations of comorbidity with gender, selected historical obesity-related variables, and current eating disorder psychopathology. Method: A consecutive series of 404 patients with BED (310 women, 94 men) were reliably administered semistructured diagnostic and clinical interviews to assess DSM-IV psychiatric disorders and features of eating disorders. Results: Overall, 73.8% of patients with BED had at least one additional lifetime psychiatric disorder and 43.1% had at least one current psychiatric disorder. Lifetime-wise, mood (54.2%), anxiety (37.1%), and substance use (24.8%) disorders were most common. In terms of current comorbidity, mood (26.0%) and anxiety (24.5%) were most common. Few gender differences were observed; men had higher lifetime rates of substance use disorders and current rates of obsessive compulsive disorder. Patients with BED with current psychiatric comorbidity reported earlier age at first diet and higher “lifetime-high” BMI. Patients with current comorbidity also had significantly higher levels of current eating disorder psychopathology and negative affect and lower self-esteem relative to patients with BED with either lifetime (noncurrent) or no psychiatric histories. Discussion: Among treatment-seeking patients with BED, the presence of current psychiatric comorbidity is associated with greater eating disorder psychopathology and associated distress. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2009

The validity and clinical utility of binge eating disorder

Abstract: Objective: This review attempted to examine the validity and clinical utility of the DSM-IV binge eating disorder (BED) diagnosis across a wide range of validating strategies. Method: Various electronic databases (Pub Med, Psych Info) were searched for terms relevant to the diagnosis of BED (e.g., binge eating disorder, binge eating) in order to identify papers. Additionally, published papers were reviewed in order to locate additional manuscripts and papers that were presented at meetings. Results: The validity and utility of BED varied substantially according to the validator chosen. There is reasonable evidence that BED can be differentiated from other existing eating disorders and is associated with significant impairment and clinical levels of eating disorder psychopathology. The relationship of BED to obesity is complex, and in spite of some positive findings, further research examining the predictive power of BED, beyond the simple presence of obesity and associated psychopathology, in relationship to clinically relevant outcomes is needed. Discussion: Binge eating disorder is being considered for inclusion in the DSM-V and various options regarding this decision are reviewed based upon the empirical findings in the paper. © 2009 American Psychiatric Association.

Academy for eating disorders position paper: The role of the family in eating disorders

Abstract: Position It is the position of the Academy for Eating Disorders (AED) that whereas family factors can play a role in the genesis and maintenance of eating disorders, current knowledge refutes the idea that they are either the exclusive or even the primary mechanisms that underlie risk. Thus, the AED stands firmly against any etiologic model of eating disorders in which family influences are seen as the primary cause of anorexia nervosa or bulimia nervosa, and condemns generalizing statements that imply families are to blame for their child’s illness. The AED recommends that families be included in the treatment of younger patients, unless doing so is clearly ill advised on clinical grounds. The position articulated in this article is in line with the World Wide Charter for Action on Eating Disorders.

A prospective study of loss of control eating for body weight gain in children at high risk for adult obesity.

Abstract: Objective Limited data suggest that disordered-eating may predispose children to excessive weight gain. We investigated the relationship between baseline responses to the Eating Disorder Examination adapted for Children (ChEDE) and change in BMI (kg/m2) in children at high risk for adult obesity. Method Children (6–12 years) were administered the ChEDE to assess loss of control (LOC) eating, dietary restraint, and eating, shape, and weight concern. Height and weight were measured at baseline and annually. Results Between July, 1999, and August, 2007, 772 measurements were obtained from 143 children over 4.5 ± 1.9 years. LOC eating predicted an increased rate of BMI growth over time (p = .02). Compared with children without LOC, those reporting LOC gained an additional mean 2.4 kg of weight per year. Conclusion LOC is a salient predictor of weight gain during middle childhood. Interventions that decrease LOC eating should be evaluated for their ability to prevent excessive pediatric weight gain. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2009

Validity and utility of the current definition of binge eating

Abstract: Objective Binge eating, a cardinal symptom of bulimia nervosa (BN) and binge eating disorder (BED), continues to pose challenges in terms of its definition and thus construct validity and clinical utility. This article reviews the available empirical data that support or refute the current DSM-IV-TR defined characteristics of a binge episode. Method A systematic literature review was conducted using Medline/PubMed electronic database on DSM-IV-TR defined binge characteristics and associated attributes. Results Data support the current DSM guidelines indicating that binge episodes typically occur in less than 2 h. Size of binge episodes has variability across BN and BED diagnostic groups. Loss of control (LOC) continues to be a core feature of binge eating. Negative affect is the most widely reported antecedent. Strikingly, little is known about binge episodes among individuals with anorexia nervosa-binge/purge subtype. Discussion Available empirical evidence supports the current DSM duration and LOC attributes of a binge episode in BN and BED. However, a more controversial issues is the extent to which size is important in the definition of a binge episode (e.g., subjective vs. objective episodes) across diagnostic categories and the extent to which binge size informs prognosis, treatment, and clinical outcomes. Further study of binge eating attributes in AN is needed. © 2009 American Psychiatric Association. Int J Eat Disord 2009

SCOFF, the development of an eating disorder screening questionnaire.

Abstract: Objective: This article describes the three-stage development of the SCOFF, a screening tool for eating disorders. Method: Study 1 details questionnaire development and testing on cases and controls. Study 2 examines reliability of verbal versus written administration in a student population. Study 3 validates the test as a screening tool in primary care. Results: The SCOFF demonstrates good validity compared with DSM-IV diagnosis on clinical interview. In the primary care setting it had a sensitivity of 84.6% and a specificity of 89.6%, detecting all true cases of anorexia nervosa and bulimia nervosa and seven of nine cases of EDNOS. Reliability between written and verbal versions of the SCOFF was high, with a kappa statistic of 0.82. Discussion: The SCOFF, which has been adapted for use in diverse languages, appears highly effective as a screening instrument and has been widely adopted to raise the index of suspicion of an eating disorder. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010

Psychosocial predictors of weight loss and psychological adjustment following bariatric surgery and a weight-loss program: the mediating role of emotional eating.

Abstract: Objective: To examine a structural equation model of the effects of personal and interpersonal factors on treatment outcome of bariatric surgery and weight-loss program. Method: Forty-four participants of the surgery group and 47 participants of the diet group completed questionnaires before treatment and 1 year afterward. Predictor measures are as follows: social support, motivation for control, sense of control, self-esteem, neuroticism, fear of intimacy, and emotional eating (EE). Outcome measures: Weight loss, qual-ity of life, and mental health. Results: Neurotic predisposition (NP), a latent variable indicated by neuroticism, low self-esteem, and fear of intimacy, had an effect on weight loss that was fully mediated by EE. NP also had an effect on quality of life improvement that was fully mediated by EE and weight loss in both treatment groups. Discussion: Both NP and EE predict outcome of obesity treatments, but EE is the more proximal variable that mediates the effect of NP. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2009

Contribution of emotion regulation difficulties to disordered eating and body dissatisfaction in college men.

Abstract: Objective: Affect regulation models of disordered eating propose that disordered eating behaviors function as maladaptive efforts to modulate or escape from aversive emotional states. Prior studies have shown both negative affect and emotion regulation factors to be significantly associated with disordered eating and body dissatisfaction in women. The purpose of the current investigation was to evaluate whether emotion regulation difficulties contribute to disordered eating and body dissatisfaction in men. Method: Two hundred and ninety-six undergraduate men completed a series of questionnaires assessing negative affect, difficulties in emotion regulation, disordered eating, and body dissatisfaction. Results: A series of hierarchical regression analyses revealed that emotion regulation difficulties accounted for unique variance in both outcome measures after accounting for the variance associated with BMI and negative affect. Discussion: Results are discussed in terms of the role of emotion regulation difficulties in the etiology and maintenance of body dissatisfaction and disordered eating in men.

Should amenorrhea be a diagnostic criterion for anorexia nervosa

Abstract: Objective: The removal of the amenorrhea criterion for anorexia nervosa (AN) is being considered for the fifth edition of The Diagnostic and Statistical Manual (DSM-V). This article presents and discusses the arguments for maintaining as well as those for removing the criterion. Method: The psychological and biological literatures on the utility of amenorrhea as a distinguishing diagnostic criterion for AN and as an indicator of illness severity are reviewed. Results: The findings suggest that the majority of differences among patients with AN who do and do not meet the amenorrhea criterion appear largely to reflect nutritional status. Overall, the two groups have few psychological differences. There are mixed findings regarding biological differences between those with AN who do and do not menstruate and the relationship between amenorrhea and bone health among patients with AN. Discussion: Based on these findings, one option is to describe amenorrhea in DSM-V as a frequent occurrence among individuals with AN that may provide important information about clinical severity, but should not be maintained as a core diagnostic feature. The possibilities of retaining the criterion or eliminating it altogether are discussed. V C 2009 American Psychiatric Association.

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

Abstract: 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. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2009

An evaluation of a body image intervention based on risk factors for body dissatisfaction: a controlled study with adolescent girls.

Abstract: Objective: In this research we aimed to evaluate the efficacy of a theoretically derived school-based body image intervention for young adolescent girls. Method: Participants were 194, female Grade 7 students from two Catholic Secondary Schools in Melbourne, Australia. One school was allocated to the intervention group and the other school was allocated to the control group. The intervention group participated in three 50-min body image intervention sessions, while the control group received their usual classes. All participants completed baseline, post-intervention and 3-month follow-up questionnaires. Results: The intervention group reported significantly more positive outcomes than the control group on measures of intervention topic knowledge, risk factors for body dissatisfaction, body image, dietary restraint and self-esteem, at post-intervention and follow-up. Discussion: This study provides support for the efficacy of a theoretically derived school-based body image intervention with adolescent girls. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010

Obesity: Is it a mental disorder?

Abstract: Objective: Using Wakefield's conceptualization of mental disorder as “harmful mental dysfunction” (Wakefield, Am Psychol, 47, 373–388, 1992), we examined the evidence for including obesity as a mental disorder in DSM-V. Method: We searched computer databases and examined reference lists from review articles published in the last 10 years to identify empirical papers relevant to the present review. Results: Obesity is a condition of heterogeneous etiology that is harmful for most individuals. However, there is scant evidence that obesity, in general, is caused by mental dysfunction. Although recent work examining the neurocircuitry of energy balance has suggested that mental dysfunction may be involved in the etiology of specific obesity phenotypes, findings are too preliminary to support classification of obesity as a mental disorder. Nevertheless, there is evidence that obesity is related to mental disorder and many of the medications used to treat psychiatric illness. Discussion: There is little evidence for including obesity as a mental disorder in DSM-V. However, results confirm the importance of monitoring adiposity routinely among patients with psychiatric illness. © 2009 American Psychiatric Association. (Int J Eat Disord 2009)

Should non-fat-phobic anorexia nervosa be included in DSM-V?

Abstract: Objective: Cross-cultural data suggest that rationales for food refusal vary in anorexia nervosa (AN), and a variant, termed non-fat-phobic AN (NFP-AN), has been described. This review evaluates whether data support modification of the requirement for intense fear of weight gain to meet AN criterion B in DSM-V. Method: We performed a systematic search of the Medline and PsychInfo literature and evaluated the relevant publications by Robins and Guze’s (Am J Psychiatry 126, 983‐987, 1970) criteria as a standard for diagnostic validity. We also performed a meta-analysis comparing the severity of eating pathology in AN to (a) NFP-AN and (b) AN with low drive for thinness (low-DT-AN). Results: A modest literature indicates that NFP-AN has wide geographic distribution and occurs in both Western and non-Western populations alongside cases of typical AN. Aggregating across eligible studies, patients with NFP-AN or low-DTAN score at least 2/3 of a standard deviation lower on measures of eating pathology than patients with conventional AN. Transcultural comparison of drive for thinness suggests significantly lower norms in non-Western cultures. Discussion: NFP-AN occurs with wide distribution. Further research is necessary on the course and outcomes of NFPAN to characterize its congruence with, or distinction from, conventional AN. We discuss several options for including a description of NFP-AN in DSM-V. V C 2009

Emotion regulation and binge eating in children.

Abstract: Objective: To examine the ability to regulate emotions in children with binge eating. Method: A community sample of 60 children ages 8–13 with at least one episode of loss of control (LOC) eating during the past 3 months and a matched control group without LOC (n = 60) underwent a clinical interview (Eating Disorder Examination adapted for Children) and completed self-report questionnaires assessing emotion regulation strategies, eating pathology, and depressive symptoms. Results: Children with LOC eating made a significantly higher use of dysfunctional emotion regulation strategies (p < .01), especially for the regulation of anxiety (p < .01). Maladaptive strategies were associated with greater depressiveness (p < .001). Use of adaptive emotion regulation strategies did not differ between children with and without LOC eating. Discussion: Results document an association between LOC eating and difficulties in regulating negative emotions in children. Interventions targeting LOC eating in children should include training for coping with negative emotions. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2009

Physical activity and exercise dependence during inpatient treatment of longstanding eating disorders: an exploratory study of excessive and non-excessive exercisers.

Abstract: Objective: To describe changes in physical activity (PA) and exercise dependence score during treatment of eating disorders (ED), and to explore correlations among changes in PA, exercise motivation, exercise dependence score and ED psychopathology in excessive and non-excessive exercisers. Method: Thirty-eight adult females receiving inpatient treatment for anorexia nervosa, bulimia nervosa or ED not otherwise specified participated in this prospective study. Assessments included accelerometer assessed PA, Exercise Dependence Scale, Reasons for Exercise Inventory, ED Examination, and ED Inventory. Results: Amount of PA was significantly reduced in non-excessive exercisers during treatment, in excessive exercisers there was a trend towards reduced amount of PA from admission to discharge. In excessive exercisers, reduced ED psychopathology was correlated with reduction in exercise dependence score and perceived importance of exercise to regulate negative affects, but not with importance of exercise for weight/appearance. These associations were not found in non-excessive exercisers. Discussion: Excessive exercise is an important issue in longstanding ED, and the excessive exercising patients need help to develop alternative strategies to regulate negative affects. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010

Validity and utility of subtyping anorexia nervosa.

Abstract: Objective The purpose of this paper is to review the available literature that addresses the predictive validity and utility of subtyping anorexia nervosa patients into binge/purge and restrictor subtypes.

Frequency of binge eating episodes in bulimia nervosa and binge eating disorder: Diagnostic considerations

Abstract: The frequency criterion in DSM-IV (1) for the diagnosis of Bulimia Nervosa (BN) is “at least twice a week,” on average, for three months (criterion C). Similarly, in the provisional criteria for Binge Eating Disorder (BED), the frequency criterion is the occurrence of “binge eating, on average, at least two days a week for 6 months” (criterion D). The DSM-IV Work Group voiced concern with this twice-a-week frequency criterion for BN that was introduced in DSM-III-R, noting unpublished data that indicated no difference between once a week or greater frequency (2). Unless there was substantial empirical evidence favoring change the operational philosophy guiding the development of DSM-IV was to make no alterations to DSM-III-R criteria. Research is now available, however, to document the limitations inherent in this criterion and the need for change in DSM-V. The purpose of this review was to examine the validity and utility of the frequency criterion for BN and BED and to consider possible options for change.

Birth outcomes in women with eating disorders in the Norwegian Mother and Child cohort study (MoBa).

Abstract: Objective We explored the impact of eating disorders on birth outcomes in the Norwegian Mother and Child Cohort Study. Method Of 35,929 pregnant women, 35 reported broad anorexia nervosa (AN), 304 bulimia nervosa (BN), 1,812 binge eating disorder (BED), and 36 EDNOS-purging type (EDNOS-P) in the six months before or during pregnancy. The referent comprised 33,742 women with no eating disorder. Results Pre-pregnancy body mass index (BMI) was lower in AN and higher in BED than the referent. AN, BN, and BED mothers reported greater gestational weight gain, and smoking was elevated in all eating disorder groups. BED mothers had higher birth weight babies, lower risk of small for gestational age, and higher risk of large for gestational age and cesarean section than the referent. Pre-pregnancy BMI and gestational weight gain attenuated the effects. Conclusion BED influences birth outcomes either directly or via higher maternal weight and gestational weight gain. The absence of differences in AN and EDNOS-P may reflect small numbers and lesser severity in population samples. Adequate gestational weight gain in AN may mitigate against adverse birth outcomes. Detecting eating disorders in pregnancy could identify modifiable factors (e.g., high gestational weight gain, binge eating, and smoking) that influence birth outcomes. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2009

Ecological momentary assessment of affect, stress, and binge-purge behaviors: day of week and time of day effects in the natural environment.

Abstract: Objective: The present study examined ecological momentary assessments of binge/vomit behavior, mood, and type and severity of stressors in a sample of 133 women with bulimia nervosa. Method: Participants completed an ecological momentary assessment protocol for a period of 2 weeks. Results: Mixed-effects and multilevel logistic models revealed significant variation across time of day and day of the week in the occurrence of binging, vomiting, positive and negative affect, and the severity and types of stressful events. Discussion: These findings explicate how momentary and daily experiences vary in the natural environments of women with bulimia nervosa, and document critical time periods for intervention.

Sexual functioning in women with eating disorders

Abstract: Little empirical evidence exists concerning the extent to which women with eating disorders experience problems with intimacy and sexual functioning Extant research has not adequately examined the prevalence of sexual dysfunction across subtypes of eating disorders nor the degree to which psychological and physiological features associated with eating disorders influence sexual functioning1 Additionally, sexual functioning is rarely discussed as an important component of treatment except in the context of sexual abuse and trauma history2 Studies of sexual functioning in eating disorders point to considerable concerns in the area of sexuality3–6 The loss of sexual interest, especially in women with AN, may reflect physiological consequences of the hypogonadism of emaciation7 Increases in sexual drive accompany weight restoration in patients with AN, which is consistent with physiological causes of altered sexuality3–5 Sexual satisfaction in AN is inversely related to degree of caloric restriction;8 similarly, the greater the weight loss, the greater the loss of sexual enjoyment5 Even though malnutrition may affect libido, other central features of eating disorders such as distorted body image, body dissatisfaction, and shame can also compromise healthy sexual functioning and relationships among individuals who struggle with eating pathology9–11 Women with AN often report difficulties in their sexual relationships,6 and sexual discord with their partners12 The existing literature on sexual functioning does not adequately differentiate across AN subtypes, and few studies have examined these sexual dysfunction parameters in bulimia nervosa (BN), where hypogonadism associated with emaciation is typically not a factor Small studies have suggested that women with restricting AN are less likely to have a romantic partner or to have engaged in sexual intercourse than women with BN5, 8, 12 Consistent with these findings, women with BN symptomatology report an earlier age of sexual encounters and have more sex partners and higher sexual desire and fantasy compared with women with restricting AN8, 12–14 Mangweth-Matzek et al 15 showed that women with AN and BN were similar to healthy controls in age at menarche and achievement of most sexual milestones, but rated their sexual experiences significantly more negatively than both a psychiatric and a healthy control group, corroborating earlier findings14 Sexual concerns among women with AN are similar to concerns of women within other groups known to have sexual difficulties such as women with major depression and post-partum women16 Personality traits of individuals with eating disorders may also influence sexual functioning17, 18 In fact, personality variables may account for a greater proportion of variance in sexual attitudes and behaviors than eating disorders diagnoses and symptoms Individuals with eating disorders who are emotionally constricted and overcontrolled report restrictive sexual functioning, whereas those with personality profiles marked by emotional dysregulation and undercontrol report more impulsive and self-destructive sexuality profiles17, 18 The current study emerged from: (1) evidence that an eating disorder negatively affects sexual functioning and partner relationships; (2) scant literature examining sexual functioning in adult women with eating disorders, across well defined eating disorders subtypes; and (3) the need for improved understanding of the role of psychological variables and personality traits on sexual functioning To address these issues, we: (1) examined sexual functioning in a large, multinational sample of women with well-characterized eating disorders; (2) compared sexual functioning across eating disorder subtypes; (3) compared sexual functioning of women with eating disorders with normative data; and (4) determined the association between clinical and psychological variables and sexual functioning We hypothesized that sexual functioning would be particularly disturbed in individuals with clinical profiles marked by low body mass index (BMI)

The rising prevalence of comorbid obesity and eating disorder behaviors from 1995 to 2005

Abstract: Objective: To measure the cooccurrence of obesity and eating disorder (ED)behaviors in the South Australian population and assess the change in level from 1995 to 2005. Method: Two independent cross-sectional single stage interview based population surveys were conducted a decade apart. Self-reported height, weight, ED behaviors, and sociodemographics were assessed. Changes between the two time points were analyzed. Results: From 1995 to 2005 the population prevalence of comorbid obesity and ED behaviors increased from 1 to 3.5%. Comorbid obesity and ED behaviors increased more (prevalence odds ratio (POR) 5 4.5; 95% confidence interval (CI) 5 95% CI 5 [2.8, 7.4]; p\.001) than either obesity (POR 5 1.6; 95% CI 5 [1.3, 2.0]; p \ .001) or ED behaviors (POR 5 3.1; 95% CI 5 [2.3, 4.1]; p\.001) alone. Discussion: Comorbid obesity and ED behaviors are an increasing problem in our society. Prevention and treatments efforts for obesity and EDs must consider and address this increasing comorbidity.

Health-related quality of life and eating disorders: a review and update.

Abstract: Objective: The aim of this article is to provide a narrative review of empirical studies related to health-related quality of life (HRQOL) and eating disorders and to report recent changes in the measurement of HRQOL in eating disorders. Method: Twenty-five articles of central importance to the topic were identified in a systematic search of six databases. All articles were selected based on a consensus relevancy rating process. Key themes were extracted from the articles and validated by all authors. Results: We identify six themes in the extant empirical literature. Discussion: We discuss these six themes and review them in light of the fact that they are identified in studies using only generic measures of HRQOL. Four recently developed disease-specific HRQOL measures specific to patients with eating disorder are discussed. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2009

Body dissatisfaction and the effects of perceptual exposure on body norms and ideals.

Abstract: Objective: Body dissatisfaction is of high prevalence among women all over the Western world. It is often suggested that sociocultural processes are the main cause of such widespread dissatisfaction. Here, we consider how perceptual effects may influence ideas of body normality and body ideals. Method: Women who varied on a measure of body dissatisfaction rated a range of bodies for how normal and ideal they looked. They were exposed to either thin or fat bodies, and then they rerated the bodies. Results: Women’s perceptions of body normality and ideal were easily malleable by exposure. In addition, greater body dissatisfaction and internalization of the thin Western ideal were related to (i) a smaller most normal and ideal body, (ii) a greater discrepancy between the most normal and most ideal-rated body, and (iii) a reduced effect of exposure to fat bodies. Discussion: Reduced updating of perceptions of body normality and body ideals in response to experience may be one mechanism that maintains body dissatisfaction. V C 2008 by Wiley Periodicals,

Five-year longitudinal predictive factors for disordered eating in a population-based sample of overweight adolescents: Implications for prevention and treatment

Abstract: Objective: The objective of this study is to identify predictors of prevalence and incidence of disordered eating (binge eating and extreme weight control behaviors) among overweight adolescents. Five-year longitudinal associations were examined in 412 overweight adolescents who participated in Project EAT-I and II. Results: Among both overweight males and females, risk factors for disordered eating included exposure to weight loss magazine articles, higher weight importance, and unhealthy weight control behaviors, while family connectedness, body satisfaction, and regular meals were protective factors, although there were some differences in predictors of prevalence (total cases) versus incidence (new cases) of disordered eating. Among males, poor eating patterns, including fast food and sweetened beverage intake, increased risk for disordered eating, and the use of healthy weight control behaviors was protective. Discussion: Attention should be directed toward decreasing disordered eating among overweight adolescents. Findings suggest the importance of promoting positive family relationships, psychological health, and regular meals, and steering adolescents away from overemphasizing weight and using unhealthy weight control behaviors. V C 2009 by

Rate of inpatient weight restoration predicts outcome in anorexia nervosa.

Abstract: Objective: To examine weight restoration parameters during inpatient treatment as predictors of outcome in anorexia nervosa (AN). Method: Adolescent and adult females admitted for inpatient eating disorder treatment were recruited for an ongoing longitudinal study. This analysis examined several weight restoration parameters as predictors of clinical deterioration after discharge among participants with AN. Results: Rate of weight gain was the only restoration parameter that predicted year 1 outcome. Clinical deterioration occurred significantly less often among participants who gained ≥0.8 kg/week (12/41, 29%) than those below this threshold (20/38, 53%) (χ2 = 4.37, df = 1, p = .037) and remained significant after adjustment for potential confounders. Discussion: Weight gain rate during inpatient treatment for AN was a significant predictor of short-term clinical outcome after discharge. It is unclear whether weight gain rate exerts a causal effect or is rather a marker for readiness to tolerate weight restoration and engage in the recovery process. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2009

Female emotional eaters show abnormalities in consummatory and anticipatory food reward: a functional magnetic resonance imaging study.

Abstract: Objective: To test the hypothesis that emotional eaters show greater neural activation in response to food intake and anticipated food intake than nonemotional eaters and whether these differences are amplified during a negative versus neutral mood state. Method: Female emotional eaters and nonemotional eaters (N = 21) underwent functional magnetic resonance imaging (fMRI) during receipt and anticipated receipt of chocolate milkshake and a tasteless control solution while in a negative and neutral mood. Results: Emotional eaters showed greater activation in the parahippocampal gyrus and anterior cingulate (ACC) in response to anticipated receipt of milkshake and greater activation in the pallidum, thalamus, and ACC in response to receipt of milkshake during a negative relative to a neutral mood. In contrast, nonemotional eaters showed decreased activation in reward regions during a negative versus a neutral mood. Discussion: Results suggest that emotional eating is related to increased anticipatory and consummatory food reward, but only during negative mood. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2009