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1.
Eat Disord ; 23(1): 15-30, 2015.
Article in English | MEDLINE | ID: mdl-24983483

ABSTRACT

Binge episodes involve "definitely large" amounts of food, yet limited data exist regarding the upper limits of food consumption in non-binge eating episodes. Study 1 examined the concurrent validity of a self-report measure developed to measure "usual" food consumption. Results support good concurrent validity for most items across response versions. Study 2 identified the upper limits of normal food consumption (i.e., 85(th) percentile of participants' largest reported usual servings). Thresholds differed across types of foods, and men reported higher thresholds than women for several foods. Type of food and gender should be considered when assessing for "definitely large" amounts of food.


Subject(s)
Bulimia/classification , Eating , Self-Assessment , Surveys and Questionnaires , Adolescent , Bulimia/psychology , Female , Humans , Male , Sex Factors , Young Adult
2.
Int J Eat Disord ; 47(3): 231-8, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24282157

ABSTRACT

OBJECTIVE: DSM-5 has dropped subtyping of bulimia nervosa (BN), opting to continue inclusion of the somewhat contentious diagnosis of BN-nonpurging subtype (BN-NP) within a broad BN category. Some contend however that BN-NP is more like binge eating disorder (BED) than BN-P. This study examines clinical characteristics, eating disorder symptomatology, and Axis I comorbidity in BN-NP, BN-P, and BED groups to establish whether BN-NP more closely resembles BN-P or BED. METHOD: Women with BN-P (n = 29), BN-NP (n = 29), and BED (n = 54) were assessed at baseline in an outpatient psychotherapy trial for those with binge eating. Measures included the Structured Clinical Interviews for DSM-IV, Eating Disorder Examination, and Eating Disorder Inventory-2. RESULTS: The BN-NP subtype had BMIs between those with BN-P and BED. Both BN subtypes had higher Restraint and Drive for Thinness scores than BED. Body Dissatisfaction was highest in BN-NP and predicted BN-NP compared to BN-P. Higher Restraint and lower BMI predicted BN-NP relative to BED. BN-NP resembled BED with higher lifetime BMIs; and weight-loss clinic than eating disorder clinic attendances relative to the BN-P subtype. Psychiatric comorbidity was comparable except for higher lifetime cannabis use disorder in the BN-NP than BN-P subtype DISCUSSION: These results suggest that BN-NP sits between BN-P and BED however the high distress driving inappropriate compensatory behaviors in BN-P requires specialist eating disorder treatment. These results support retaining the BN-NP group within the BN category. Further research is needed to determine whether there are meaningful differences in outcome over follow-up.


Subject(s)
Binge-Eating Disorder/classification , Bulimia Nervosa/classification , Bulimia/classification , Adolescent , Adult , Age of Onset , Binge-Eating Disorder/diagnosis , Binge-Eating Disorder/psychology , Body Image/psychology , Body Mass Index , Bulimia/diagnosis , Bulimia/psychology , Bulimia Nervosa/diagnosis , Bulimia Nervosa/psychology , Cognitive Behavioral Therapy , Comorbidity , Data Interpretation, Statistical , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Interviews as Topic , New Zealand , Psychiatric Status Rating Scales , Psychometrics , Socioeconomic Factors , Thinness/classification , Young Adult
3.
Int J Eat Disord ; 46(8): 849-54, 2013 Dec.
Article in English | MEDLINE | ID: mdl-23868197

ABSTRACT

OBJECTIVE: The purpose of this study was to compare the type and frequency of restrictive eating behaviors across the two subtypes of anorexia nervosa (AN; restricting [ANr] and binge eating/purging [ANbp]) using ecological momentary assessment (EMA) and to determine whether subtype differences in restrictive eating behaviors were attributable to severity of the disorder or the frequency of binge eating. METHOD: Participants (N = 118) were women at least 18 years of age with full (n = 59) or subthreshold (n = 59) AN who participated in a two week (EMA) protocol. RESULTS: General estimating equations revealed that individuals with ANbp generally reported more frequent restrictive eating behaviors than individuals with ANr. These differences were mostly accounted for by greater severity of eating psychopathology, indicating that the presence and frequency of restrictive eating behaviors in AN may be nonweight-based markers of severity. Binge eating frequency did not account for these findings. DISCUSSION: The present findings are especially interesting in light of the weight-based severity rating in the DSM-5.


Subject(s)
Anorexia Nervosa/pathology , Bulimia/pathology , Feeding Behavior , Adolescent , Adult , Anorexia Nervosa/classification , Body Mass Index , Bulimia/classification , Diagnostic and Statistical Manual of Mental Disorders , Diet, Reducing , Female , Humans , Interview, Psychological , Severity of Illness Index , Social Class , Social Environment , Young Adult
4.
Eur Eat Disord Rev ; 21(3): 175-83, 2013 May.
Article in English | MEDLINE | ID: mdl-23440765

ABSTRACT

BACKGROUND: Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for eating disorders (EDs) are problematic and due to be revised. One area of debate concerns binge eating. AIMS: We investigated the impact of four aspects of binge eating (binge size, loss of control, frequency of objective and subjective binge eating) assessed by questionnaire and interview in adult ED patients on concurrent and follow-up symptoms. METHOD: Data came from two independent naturalistic Swedish ED databases (N = 2354, with 12-month follow-up; and N = 597, with 36-month follow-up). RESULTS: We found fair concurrent validity of criteria assessed using questionnaire, but poor concurrent validity for interview assessment, and no prognostic validity regardless of assessment method. CONCLUSIONS: The findings give support to some planned DSM-5 revisions, but challenge the assumption of binge eating as a useful diagnostic criterion, as well as having implications for measurement.


Subject(s)
Binge-Eating Disorder/diagnosis , Bulimia/diagnosis , Adolescent , Adult , Bulimia/classification , Databases, Factual , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Longitudinal Studies , Male , Middle Aged , Surveys and Questionnaires
5.
Eur Eat Disord Rev ; 21(4): 308-14, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23674268

ABSTRACT

OBJECTIVE: Anorexia nervosa (AN) has been associated with weak central coherence (CC) and weak set shifting (SS). The main aim of this study was to examine possible differences between restrictive AN (AN-R) and bingeing/purging AN (AN-BP) on these features. METHODS: A total of 31 patients with AN-R, 20 patients with AN-BP and 26 healthy controls (HC) completed five neuropsychological tests (Block Design, Object Assembly, an adapted task-switching paradigm, Wisconsin Card Sorting Test and Trail Making Test). RESULTS: Using Block Design and Object Assembly, indicative for CC, AN-R patients performed significantly worse than AN-BP patients and HC, without any difference between AN-BP and HC. On SS measures, no group differences were observed. DISCUSSION: The results suggest that cognitive profiles of AN-R and AN-BP patients differ significantly on CC and not on SS. Our current findings support the idea that the two subtypes of AN have a distinctive underlying nature and might need a different approach in cognitive remediation.


Subject(s)
Anorexia Nervosa/classification , Bulimia/classification , Sense of Coherence , Set, Psychology , Vomiting/classification , Adolescent , Adult , Anorexia Nervosa/psychology , Bulimia/psychology , Female , Humans , Male , Neuropsychological Tests , Vomiting/psychology
6.
Annu Rev Clin Psychol ; 8: 381-404, 2012.
Article in English | MEDLINE | ID: mdl-22136228

ABSTRACT

Current diagnostic criteria for anorexia nervosa (AN) and bulimia nervosa (BN) account for a minority of individuals with clinically significant disorders of eating, raising concerns about the clinical utility of current definitions. This review examines evidence for the validity of current and alternative approaches to defining eating disorders and implications for draft criteria for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Although this review largely supports the predictive validity of distinctions among AN, BN, and the newly proposed binge eating disorder (BED), it also highlights that our tendency to "study what we define" has created a gap between the problems that people have and what we know about those problems. Future research on the causes and consequences of eating disorders should include more heterogeneous groups to enable identification of meaningful boundaries that distinguish between disorders based on etiological and predictive validity.


Subject(s)
Feeding and Eating Disorders/classification , Feeding and Eating Disorders/diagnosis , Anorexia Nervosa/classification , Anorexia Nervosa/diagnosis , Binge-Eating Disorder/classification , Binge-Eating Disorder/diagnosis , Bulimia/classification , Bulimia/diagnosis , Diagnostic and Statistical Manual of Mental Disorders , Humans , Reproducibility of Results
7.
Int J Eat Disord ; 44(7): 625-9, 2011 Nov.
Article in English | MEDLINE | ID: mdl-21997426

ABSTRACT

OBJECTIVE: This study evaluated whether the Broad Categories for the Diagnosis of Eating Disorders (BCD-ED) proposal (Walsh and Sysko, Int J Eat Disord, 42, 754-764, 2009) reduces the number of individuals who receive a DSM-IV eating disorder not otherwise specified (EDNOS) diagnosis. METHOD: Individuals calling a tertiary care facility completed a brief telephone interview and were classified into a DSM-IV eating disorder category (anorexia nervosa, bulimia nervosa, EDNOS). Subsequently, the proposed DSM-5 criteria for eating disorders and the BCD-ED scheme were also applied. RESULTS: A total of 247 individuals with telephone interview data met criteria for an eating disorder, including 97 (39.3%) with an EDNOS. Of patients with an EDNOS diagnosis, 97.6% were reclassified using the BCD-ED scheme. DISCUSSION: The BCD-ED scheme has the potential to virtually eliminate the use of DSM-IV EDNOS; however, additional data are needed to document its validity and clinical utility.


Subject(s)
Bulimia/diagnosis , Feeding and Eating Disorders/diagnosis , Adolescent , Adult , Bulimia/classification , Diagnostic and Statistical Manual of Mental Disorders , Feeding and Eating Disorders/classification , Female , Humans , Interviews as Topic , Male
8.
Int J Eat Disord ; 42(7): 595-602, 2009 Nov.
Article in English | MEDLINE | ID: mdl-19621467

ABSTRACT

OBJECTIVE: To review the evidence for the validity and utility of subtyping bulimia nervosa (BN) into a purging (BN-P) and a nonpurging subtype (BN-NP), and of distinguishing BN-NP from binge eating disorder (BED), by comparing course, complications, and treatment. METHOD: A literature search of psychiatry databases for studies published in peer-reviewed journals that used the DSM-definitions of BN and BED, and included both individuals with BN-NP and individuals with BN-P and/or BED. RESULTS: Twenty-three studies compared individuals with BN-NP (N = 671) to individuals with BN-P (N = 1795) and/or individuals with BED (N = 1921), two of which reported on course, 12 on comorbidity and none on treatment response-the indicators for validity and clinical utility. The differences found were mainly quantitative rather than qualitative, suggesting a gradual difference in severity from BN-P (most severe) through BN-NP to BED (least severe). DISCUSSION: None of the comparisons provided convincing evidence for the validity or utility of the BN-NP diagnosis. Three options for the position of BN-NP in DSM-V were suggested: (1) maintaining the BN-NP subtype, (2) dropping nonpurging compensatory behavior as a criterion for BN, so that individuals currently designated as having BN-NP would be designated as having BED, and (3) including BN-NP in a broad BN category.


Subject(s)
Bulimia Nervosa/classification , Bulimia/classification , Bulimia/diagnosis , Bulimia Nervosa/diagnosis , Diagnostic and Statistical Manual of Mental Disorders , Humans , Vomiting/psychology
9.
Int J Eat Disord ; 42(8): 674-86, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19610126

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.


Subject(s)
Bulimia Nervosa/diagnosis , Bulimia/diagnosis , Binge-Eating Disorder/classification , Binge-Eating Disorder/diagnosis , Bulimia/classification , Bulimia Nervosa/classification , Diagnostic and Statistical Manual of Mental Disorders , Feeding Behavior/classification , Humans , Surveys and Questionnaires
10.
Int J Eat Disord ; 42(8): 687-705, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19621466

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.


Subject(s)
Binge-Eating Disorder/diagnosis , Bulimia/diagnosis , Binge-Eating Disorder/classification , Binge-Eating Disorder/complications , Body Image , Bulimia/classification , Bulimia/complications , Diagnostic and Statistical Manual of Mental Disorders , Feeding Behavior/classification , Humans , Obesity/complications , Quality of Life , Self Concept
11.
Int J Eat Disord ; 42(6): 540-5, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19189405

ABSTRACT

OBJECTIVE: This article provides an analysis of the use of artificial sweeteners, caffeine, and excess fluids in patients diagnosed with anorexia nervosa (AN). METHOD: Seventy participants with AN were recruited to participate in an ecologic momentary assessment study which included nutritional analysis using the Nutrition Data Systems for Research, a computer based dietary recall system. RESULTS: When subtypes were compared, participants with AN-restricting subtype (AN-R) and participants with AN-Binge-Purge (AN-B/P) did not differ in quantity of aspartame, caffeine, or water consumed. Daily water consumption was related to daily vomiting frequency in AN-B/P but not to daily exercise frequency in either participants with AN-R or AN-B/P. DISCUSSION: Caffeine, water, and aspartame consumption can be variable in patients with AN and the consumption of these substances seems to be only modestly related to purging behavior.


Subject(s)
Anorexia Nervosa/psychology , Aspartame/administration & dosage , Caffeine/administration & dosage , Drinking , Sweetening Agents/administration & dosage , Adult , Anorexia Nervosa/classification , Body Mass Index , Bulimia/classification , Bulimia/psychology , Exercise/psychology , Female , Humans , Minnesota , Nutrition Surveys , Vomiting/psychology , Young Adult
12.
Surg Obes Relat Dis ; 15(10): 1829-1835, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31494065

ABSTRACT

BACKGROUND: Assessing the complexities of eating behaviors in patients who undergo bariatric surgery is challenging. The Eating Loss of Control Scale (ELOCS), a measure of loss-of-control (LOC) eating, has not yet been evaluated psychometrically among bariatric surgery patients. OBJECTIVE: This study presents a psychometric examination of the ELOCS in postoperative bariatric surgery patients. SETTING: Academic medical center in the United States. METHODS: One hundred seventy-one postbariatric treatment-seeking adults (82.5% female, 52.4% white) with LOC eating completed the ELOCS and measures assessing eating psychopathology and mood. Confirmatory factor analysis (CFA) was used to test fit for a 1-factor solution. Exploratory factor analysis (EFA) examined alternative factor structures. RESULTS: CFA revealed poor fit for a 1-factor structure (χ2 = 220.375, degrees of freedom = 135, P < .001, comparative fit index = .917, Tucker-Lewis index = .906, root mean square error of approximation = .067). EFA data suggested an alternative factor solution (χ2 = 157.76, degrees of freedom = 118, P = .009, comparative fit index = .965, Tucker-Lewis index = .955, root mean square error of approximation = .047). Factor 1 (α = .88) reflected behavioral aspects and factor 2 (α = .92) reflected cognitive/emotional aspects of LOC eating. Bivariate correlations with measures of eating and other psychopathology suggested good construct validity for factors. CONCLUSIONS: Findings suggest possible differences in the construct validity of the ELOCS among postbariatric patients. The 1-factor solution previously supported in clinical and nonclinical groups demonstrated poor fit. EFA revealed a possible alternative 2-factor solution that aligns with emerging literature, suggesting that LOC eating presents differently in postbariatric patients. Researchers interested in LOC eating among bariatric patients should consider use of the ELOCS and testing the proposed alternative factor structure.


Subject(s)
Bariatric Surgery/psychology , Bulimia , Feeding Behavior , Adult , Bulimia/classification , Bulimia/psychology , Feeding Behavior/classification , Feeding Behavior/psychology , Feeding and Eating Disorders/classification , Feeding and Eating Disorders/psychology , Female , Humans , Male , Middle Aged , Psychometrics
13.
Nurs Forum ; 54(1): 60-67, 2019 Jan.
Article in English | MEDLINE | ID: mdl-30380136

ABSTRACT

AIM: The aim of this analysis is to develop a better understanding of the concept of binge-eating behavior among African American women (AAW). BACKGROUND: Obesity is a major public health concern that is disproportionately prevalent among AAW. Among the factors that contribute to obesity development, binge eating may be of significant concern to AAW. DESIGN: A critical analysis and synthesis of the empirical literature using Walker and Avant's model for concept analysis. The databases MEDLINE, Cumulative Index to Nursing Health Literature (CINAHL) Complete, PsycINFO, and PsycARTICLES were used. Keywords included binge eating AND African American women or Black women race or ethnicity or minority. RESULTS: Binge eating is a behavior that exists on a continuum that involves the overconsumption of food, with or without loss of control (LOC), whereas binge eating with LOC is related to increased impairment and severity. While the main attribute of binge eating involves the consumption of a large amount of food, the LOC component of binge eating definition may not be culturally relevant criteria to include as a requirement, as it may exclude AAW in diagnostics and subsequent treatment as well as overlook the health implications of binge eating regardless of LOC endorsement. CONCLUSION: Including LOC in defining binge-eating behavior among AAW is significant, but should not be necessitated. This concept analysis illustrates the complexities related to binge-eating behavior among AAW, enumerating the characteristics of binge eating that may be unique to certain populations. The definition for binge eating among AAW developed from this concept analysis needs to be further explored in future studies.


Subject(s)
Black or African American/psychology , Bulimia/classification , Concept Formation , Adult , Black or African American/ethnology , Body Mass Index , Bulimia/ethnology , Bulimia/psychology , Feeding Behavior/ethnology , Feeding Behavior/psychology , Female , Humans , Obesity/ethnology , Obesity/psychology , Prevalence , Psychometrics/instrumentation , Psychometrics/methods , Surveys and Questionnaires
14.
Eur Eat Disord Rev ; 16(2): 133-8, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18278827

ABSTRACT

OBJECTIVE: The aim of this study was to examine whether personality-related differences also exist in non-clinical adolescents with any given type of eating disorder (ED) and whether personality characteristics are associated with changes in the course of the diagnosis. METHOD: An initial sample of 1336 boys and girls (mean age: 11.37, SD = 0.62) was assessed in a two-phase long-term study. A total of 258 subjects were selected from the initial sample (T1) and contacted again 2 years later (T2) (n = 200). These subjects comprise the sample group of this study. Of these, 51 were diagnosed with ED (37 with diagnosis type anorexia (DTA) and 14 with diagnosis type bulimia (DTB)). An experimental version of the Junior Temperament and Character Inventory (JTCI) was applied. RESULTS: Subjects with DTA had significantly higher scores on Reward Dependence and Self-Directedness factors than subjects with no diagnosis or DTB, respectively. Subjects with DTB had higher scores on Novelty Seeking, Harm Avoidance and Spirituality factors than subjects with forms of anorexia or without diagnosed ED. Subjects with ED remission had significantly lower scores on Persistence and Self-Directedness scales. ED incident subjects had significantly higher scores on Harm Avoidance. CONCLUSIONS: Subjects without full-blown syndromes have similar temperament characteristics to subjects with full eating disorders. These results support the theory that non-full-blown syndromes differ from full syndromes only in pathological severity.


Subject(s)
Anorexia Nervosa/psychology , Bulimia/psychology , Personality , Adolescent , Analysis of Variance , Anorexia Nervosa/classification , Bulimia/classification , Child , Female , Humans , Interview, Psychological , Longitudinal Studies , Male , Severity of Illness Index
15.
Psychiatr Pol ; 42(2): 179-93, 2008.
Article in Polish | MEDLINE | ID: mdl-19697524

ABSTRACT

AIM: The aim of the study was the adaptation and normalization of the Eating Disorder Inventory in the group of Polish schoolgirls and patients with eating disorders. METHOD: 297 healthy schoolgirls (14-22 y.o.) and 40 patients with anorexia nervosa and bulimia nervosa were examined using the EDI. RESULTS: A Polish version of EDI revealed a high reliability in most of the subscales. Percentile norms were established. Comparison of subgroups of patients with restrictive and bulimic type of eating disorder revealed differences in most of the subscales. CONCLUSIONS: The Polish version of EDI is a useful research instrument. Differences between bulimic and restrictive groups of patients indicates that in severe cases of restrictive type of anorexia nervosa, self-evaluation using self-report questionnaires may underestimate the severity of symptoms.


Subject(s)
Feeding and Eating Disorders/diagnosis , Feeding and Eating Disorders/psychology , Psychological Tests/standards , Self Concept , Surveys and Questionnaires/standards , Adolescent , Anorexia Nervosa/classification , Anorexia Nervosa/diagnosis , Anorexia Nervosa/psychology , Body Image , Bulimia/classification , Bulimia/diagnosis , Bulimia/psychology , Feeding and Eating Disorders/classification , Female , Humans , Interpersonal Relations , Mass Screening/standards , Sensitivity and Specificity , Severity of Illness Index , Social Perception , Women's Health , Young Adult
16.
Arch Gen Psychiatry ; 55(5): 425-32, 1998 May.
Article in English | MEDLINE | ID: mdl-9596045

ABSTRACT

BACKGROUND: Many risk factors have been implicated for eating disorders, although little is known about those for binge eating disorder. METHODS: A community-based, case-control design was used to compare 52 women with binge eating disorder, 104 without an eating disorder, 102 with other psychiatric disorders, and 102 with bulimia nervosa. RESULTS: The main risk factors identified from the comparison of subjects with binge eating disorder with healthy control subjects were certain adverse childhood experiences, parental depression, vulnerability to obesity, and repeated exposure to negative comments about shape, weight, and eating. Compared with the subjects with other psychiatric disorders, those with binge eating disorder reported more childhood obesity and more exposure to negative comments about shape, weight, and eating. Certain childhood traits and pronounced vulnerability to obesity distinguished the subjects with bulimia nervosa from those with binge eating disorder. CONCLUSIONS: Binge eating disorder appears to be associated with exposure to risk factors for psychiatric disorder and for obesity. When compared with the wide range of risk factors for bulimia nervosa, the risk factors for binge eating disorder are weaker and more circumscribed. Pre-morbid perfectionism, negative self-evaluation, and vulnerability to obesity appear especially to characterize those in whom bulimia nervosa subsequently develops.


Subject(s)
Feeding and Eating Disorders/diagnosis , Adult , Bulimia/classification , Bulimia/diagnosis , Bulimia/epidemiology , Case-Control Studies , Comorbidity , Data Collection , Diagnosis, Differential , Diet, Reducing , Disease Susceptibility , Feeding and Eating Disorders/classification , Feeding and Eating Disorders/epidemiology , Female , Humans , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Obesity/diagnosis , Obesity/epidemiology , Obesity/psychology , Parents/psychology , Regression Analysis , Risk Factors , Social Environment
17.
Psychiatry Res ; 134(1): 75-84, 2005 Mar 30.
Article in English | MEDLINE | ID: mdl-15808292

ABSTRACT

Assessments of the severity of vomiting (weekly frequency), depressive and eating-related psychopathology, anger level and management, and personality dimensions were used to characterize patients with bulimia nervosa binge purging type (BN-BP). The sample comprised 130 outpatients with BN and 130 control women. The Eating Disorder Inventory-2 (EDI-2), the State-Trait Anger Expression Inventory, the Beck Depression Inventory, and the Temperament and Character Inventory (TCI) were administered to all patients. The Self-Directedness dimension of the TCI and the Bulimia subscale of the EDI-2 were the strongest predictors of the severity of bulimic behavior; anger levels and anger expression were not so strongly related to illness severity. A more severe form of bulimic symptomatology probably has substrata in specific character deficits (low Self-Directedness on the TCI) and particular psychopathological features (high bulimia on the EDI-2). Patients with a high frequency of vomiting need specific therapeutic interventions to enhance the character dimension of Self-Directedness.


Subject(s)
Bulimia/psychology , Vomiting/psychology , Adolescent , Adult , Anger , Bulimia/classification , Character , Chronic Disease , Defense Mechanisms , Depression/diagnosis , Depression/psychology , Eating , Female , Humans , Internal-External Control , Personality Inventory/statistics & numerical data , Psychometrics/statistics & numerical data , Psychopathology , Reference Values , Statistics as Topic , Temperament , Vomiting/classification
19.
Diabetes Care ; 25(9): 1571-5, 2002 Sep.
Article in English | MEDLINE | ID: mdl-12196429

ABSTRACT

OBJECTIVE: To classify type 1 diabetic females with bulimia nervosa (BN) by type of inappropriate compensatory behavior in order to prevent weight gain (ICB) and to investigate the group differences. RESEARCH DESIGN AND METHODS: Type 1 diabetic females with BN, diagnosed by structured diagnostic interview based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) criteria, were classified by type of ICB as follows: 1) only severe insulin omission as an ICB (BN-I) (n = 22), 2) both severe insulin omission and self-induced vomiting and/or laxative abuse (BN-IP) (n = 22), or 3) no insulin omission but another ICB (BN-NI) (n = 11). The clinical characteristics of these three groups and a binge-eating disorder (BED) group (n = 24) were compared. RESULTS: The BN-IP and BN-I groups had the highest HbA(1c) levels. The BN-IP group had the highest rates of diabetic neuropathy, retinopathy, and nephropathy. The BN-NI group had the second highest rates of neuropathy and retinopathy. The BN-IP group had the highest frequencies of diabetes- and ketoacidosis-related hospital admissions, and the BN-I group had the second highest frequencies. The BN-NI group showed the highest scores on psychological tests related to depression, anxiety, eating disorder psychopathology, and perfectionism. The BN-NI group had the highest rate of history of visits to a psychiatrist, and the BN-IP group had the second highest history. CONCLUSIONS: Type 1 diabetic females with BN seem not to be homogenous and can be classified into three distinctive subgroups by type of ICB. Individuals with BN-IP had the most severe problems with both medical and psychological/behavioral aspects. Individuals with BN-NI manifested the highest psychological distress. The BN-I group had comparatively mild distress despite having the poorest metabolic control. Each BN group manifested more severe pathology than the BED group.


Subject(s)
Bulimia/classification , Bulimia/psychology , Diabetes Mellitus, Type 1/classification , Diabetes Mellitus, Type 1/psychology , Adolescent , Adult , Cathartics/administration & dosage , Diabetes Mellitus, Type 1/drug therapy , Diabetic Nephropathies/classification , Diabetic Nephropathies/drug therapy , Diabetic Nephropathies/psychology , Diabetic Neuropathies/classification , Diabetic Neuropathies/drug therapy , Diabetic Neuropathies/psychology , Diabetic Retinopathy/classification , Diabetic Retinopathy/drug therapy , Diabetic Retinopathy/psychology , Female , Humans , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Patient Compliance
20.
Am J Psychiatry ; 149(1): 123-4, 1992 Jan.
Article in English | MEDLINE | ID: mdl-1728161

ABSTRACT

Systematic examination of the use of the word "binge" by 243 young women revealed discrepancies between the lay and technical uses of the term; the young women placed great emphasis on loss of control and less on the quantity eaten. These discrepancies indicate that the term "binge" should be clearly defined in clinical practice.


Subject(s)
Eating , Feeding and Eating Disorders/diagnosis , Terminology as Topic , Bulimia/classification , Bulimia/diagnosis , Bulimia/psychology , Feeding and Eating Disorders/classification , Feeding and Eating Disorders/psychology , Female , Humans , Surveys and Questionnaires
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