Overvaluation of body shape/weight and engagement in non-compensatory weight-control behaviors in eating disorders: is there a reciprocal relationship?

BACKGROUND: Overvaluation of body shape/weight is thought to be the core psychopathology underlying eating disorders, which propels engagement in non-compensatory weight-control behaviors. In turn, these behaviors lead to binge eating and/or maintenance of low weight thereby reinforcing overvaluation. The present study investigated the reciprocal relationship between overvaluation and engagement in non-compensatory weight-control behaviors (defined in two ways: restrictive eating and compulsive exercise) among women diagnosed with anorexia nervosa or bulimia nervosa (N = 237). METHOD: Participants completed clinical interviews in which weekly eating disorder symptoms and behaviors were assessed over 2 years. RESULTS: Overvaluation on a given week was associated with greater engagement in non-compensatory weight-control behaviors during the following week. Further, engagement in non-compensatory weight-control behaviors on a given week was associated with greater overvaluation during the following week. These findings held true regardless of participants' shape/weight concerns (feelings of fatness and fat phobia), and eating disorder diagnosis. CONCLUSIONS: Our data provide empirical support for key aspects of the transdiagnostic cognitive-behavioral model of eating disorders and suggest that targeting non-compensatory weight-control behaviors in treatment may help alleviate overvaluation and shape/weight concerns.

How should DSM-V classify eating disorder not otherwise specified (EDNOS) presentations in women with lifetime anorexia or bulimia nervosa?

OBJECTIVE: Anorexia nervosa (AN) and bulimia nervosa (BN) are marked by longitudinal symptom fluctuations. DSM-IV-TR does not address how to classify eating disorder (ED) presentations in individuals who no longer meet full criteria for these disorders. To consider this issue, we examined subthreshold presentations in women with initial diagnoses of AN and BN. METHOD: A total of 246 women with AN or BN were followed for a median of 9 years; weekly symptom data were collected at frequent intervals using the Longitudinal Interval Follow-up Evaluation of Eating Disorders (LIFE-EAT-II). Outcomes were ED presentations that were subthreshold for 3 months, including those narrowly missing full criteria for AN or BN, along with binge eating disorder (BED) and purging disorder. RESULTS: During follow-up, most women (77.6%) experienced a subthreshold presentation. Subthreshold presentation was related to intake diagnosis (Wald chi2=8.065, df=2, p=0.018). Individuals with AN most often developed subthreshold presentations resembling AN; those with BN were more likely to develop subthreshold BN. Purging disorder was experienced by half of those with BN and one-quarter of those with AN binge/purge type (ANBP); BED occurred in 20% with BN. Transition from AN or BN to most subthreshold types was associated with improved psychosocial functioning (p<0.001). CONCLUSIONS: Subthreshold presentations in women with lifetime AN and BN were common, resembled the initial diagnosis, and were associated with modest improvements in psychosocial functioning. For most with lifetime AN and BN, subthreshold presentations seem to represent part of the course of illness and to fit within the original AN or BN diagnosis.

The relationship between meal frequency and body mass index in black and white adolescent girls: more is less.

OBJECTIVE: To document meal frequency and its relationship to body mass index (BMI) in a longitudinal sample of black and white girls from ages 9-19 years. DESIGN: Ten-year longitudinal observational study. SUBJECTS: At baseline, 1209 Black girls (539 age nine years, 670 age 10 years) and 1,166 White girls (616 age nine years, 550 age 10 years) were enrolled in the National Heart, Lung and Blood Institute Growth and Health Study (NGHS). MEASUREMENTS: Three-day food diaries, measured height and weight and self-reported physical activity and television viewing were obtained at annual in-person visits. RESULTS: Over the course of the study, the percentage of girls eating 3+ meals on all 3 days was reduced by over half (15 vs 6%). Participants who ate 3+ meals on more days had lower BMI-for-age z-scores. Black girls, but not white girls, who ate 3+ meals on more days were less likely to meet criteria for overweight. CONCLUSION: Meal frequency was related to BMI and should be considered when developing guidelines to prevent childhood overweight.

What predicts suicide attempts in women with eating disorders?

BACKGROUND: Suicide is a common cause of death in anorexia nervosa and suicide attempts occur often in both anorexia nervosa and bulimia nervosa. No studies have examined predictors of suicide attempts in a longitudinal study of eating disorders with frequent follow-up intervals. The objective of this study was to determine predictors of serious suicide attempts in women with eating disorders. METHOD: In a prospective longitudinal study, women diagnosed with either DSM-IV anorexia nervosa (n = 136) or bulimia nervosa (n = 110) were interviewed and assessed for suicide attempts and suicidal intent every 6-12 months over 8.6 years. RESULTS: Fifteen percent of subjects reported at least one prospective suicide attempt over the course of the study. Significantly more anorexic (22.1%) than bulimic subjects (10.9%) made a suicide attempt. Multivariate analyses indicated that the unique predictors of suicide attempts for anorexia nervosa included the severity of both depressive symptoms and drug use over the course of the study. For bulimia nervosa, a history of drug use disorder at intake and the use of laxatives during the study significantly predicted suicide attempts. CONCLUSIONS: Women with anorexia nervosa or bulimia nervosa are at considerable risk to attempt suicide. Clinicians should be aware of this risk, particularly in anorexic patients with substantial co-morbidity.

Pregnancy complications and neonatal outcomes in women with eating disorders.

OBJECTIVE: This study reported pregnancy complications and neonatal outcomes for 49 live births in a group of women with eating disorders who were prospectively followed. METHOD: Subjects were recruited from 246 women participating in a longitudinal study of anorexia nervosa and bulimia nervosa, now in its 12th year. Subjects were interviewed by trained assistants and completed a brief self-report instrument that assessed both birth statistics and birth-related complications. Medical records and/or self-report data describing the neonates' birth status were obtained. RESULTS: The majority of the women with eating disorders had normal pregnancies, resulting in healthy babies. Across the group, the mean length of pregnancy was 38.7 weeks, the mean birth weight was 7.6 lb, and mean Apgar scores at 1 and 5 minutes after birth were 8.2 and 9.0, respectively. Most outcomes were positive; however, three babies (6.1%) had birth defects, and 17 (34.7%) of the women experienced postpartum depression. The mean number of obstetric complications in the group was 1.3, and 13 (26.5%) of the women delivered by cesarean section. Women who showed symptoms of either anorexia nervosa or bulimia nervosa during pregnancy had a higher frequency of birth by cesarean section and postpartum depression than did nonsymptomatic women. CONCLUSIONS: Pregnant women with active eating disorders appear to be at greater risk for delivery by cesarean section and for postpartum depression. Pregnant women with past or current eating disorders should be viewed as being at high risk and monitored closely both during and after pregnancy to optimize maternal and fetal outcomes.

Detection and management of eating disorders during pregnancy.

Eating disorders such as anorexia nervosa and bulimia nervosa are associated with potential negative consequences during pregnancy, including higher rates of miscarriage, low birth weight, obstetric complications, and postpartum depression. Women with eating disorders are reluctant to disclose symptoms to health care providers, so it is important for obstetric clinicians to be aware of warning signs and assessment techniques to identify them. Signs suggestive of eating disorders include lack of weight gain, hyperemesis gravidarum, and a history of eating disorders. Recent studies showed that the Eating Disorder Examination, a newly developed assessment tool, can ascertain whether someone has an eating disorder. Questions from the Eating Disorder Examination about body image, food avoidance, food rules, and dieting behaviors have successfully differentiated women with eating disorders from healthy controls. We offer an approach to the clinical care of individuals identified or suspected of having eating disorders. We recommend a team approach that emphasizes ongoing communication and clear goal setting for the care of pregnant women with eating disorders.

Subclinical eating disorders in adolescent women: a test of the continuity hypothesis and its psychological correlates.

Subclinical eating disorders are common in adolescent women. In this study the severity of disturbed eating and its psychological correlates were examined in 207 college freshmen. The results indicated that 9% fell into the probable bulimic or dieter at-risk categories, 23% were classified as intensive dieters, 17% as casual dieters, and over half (51%) of the sample was classified as non-dieters. Depression, dysfunctional thinking, and disturbed eating attitudes were found to correlate with the severity of eating pathology. Support was found for the continuity hypothesis of eating disorders.

Phagophobia: a form of psychogenic dysphagia. A new entity.

There is a group of patients presenting with either acute or chronic dysphagia secondary to fear of swallowing. We have termed this entity phagophobia. It is characterized by various significant swallowing complaints in the face of normal findings on head and neck examination, oropharyngeal swallowing videofluoroscopy, and standard barium swallow study. Ten patients who received diagnoses of phagophobia after a full evaluation at our swallowing disorders center are presented. Each patient was then evaluated by a psychologist, and an attempt at therapy was undertaken. We discuss the specific clinical features, assessment, and treatment of this frequently misdiagnosed disorder.

Retrospective perceptions of parents' child-rearing conduct by same-sex sibling trios in African American and European American families.

Adult (M = 33 years) trios of 20 sisters and 6 brothers from 15 African American and 11 European American intact families retrospectively described their parents' child-rearing conduct on the Parent-Child Relations Questionnaire II (Siegelman & Roe, 1979). Respondents' mean education (15.1 years) and family size exceeded U.S. averages. Fitting cultural stereotypes, mothers were depicted as more loving, more attentive, and less rejecting than fathers. African American parents were described as more demanding and less lenient than European American parents, although this finding was confounded with the latter's greater education (M = 14.4 years vs. 10.9 years). Daughter trios tended to differ more than son trios on their ratings of each parent, suggesting that daughters may be more attentive to intrafamilial events. The uniqueness of the sample and the small number of brother trios limit the generalizability of these findings.