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INTRODUCTION: Eating disorders (ED) represent a group of very complex and serious diagnoses characterized by emotional dysregulation and impulsivity. New approaches are necessary to achieve effective diagnosis and treatments. Shifting biomarker research away from the constraints of diagnostic categories may effectively contribute to a dimensional differentiation across disorders according to neurobiology (e.g., inflammatory biomarkers). Thus, the aim of our study was to identify inflammatory profiles in patients with ED. METHODS: A sample of 100 women with an ED (23.4 ± 8.55 years) and 59 healthy controls (HC) (20.22 ± 4.18 years) was used. K-means cluster analysis was followed to identify inflammatory clusters considering seven blood biomarkers (iNOS, TNFα, COX2, p38, ERK, TBARS and PPARγ). Moreover, a wide assessment of clinical features was conducted. RESULTS: Two distinct clusters were identified. Cluster 1 patients were characterized by higher inflammatory levels of TNF-α, COX2, p38, and ERK, and had more restrictive anorexia diagnosis than cluster 2. Cluster 2 participants showed higher inflammatory levels of iNOS and were older than cluster 1 and controls and had lower BMI than HC. In addition, they had higher levels of bulimic symptoms than those from the cluster 1 and HC, and higher impulsivity than HC. All ED patients (regardless of cluster) showed higher ED symptoms and more trauma than HC. CONCLUSIONS: Our study revealed that inflammatory dysfunction may be linked with clinical endophenotypes in ED, one more restrictive (cluster 1) with an inflammation/oxidative endophenotype more cytokine and MAPK/ERK mediated, and the other more impulsive, with more bulimic symptoms (cluster 2) with NO free radical high output source iNOS. Trauma seems to be a vulnerability factor for both endophenotypes.
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Bulimia , Trastornos de Alimentación y de la Ingestión de Alimentos , Humanos , Femenino , Bulimia/diagnóstico , Bulimia/psicología , Ciclooxigenasa 2 , Biomarcadores , FenotipoRESUMEN
WHAT IS KNOWN ON THE SUBJECT?: Bulimia nervosa is characterized by recurrent episodes of binge eating, inappropriate compensatory behaviours to prevent weight gain and excessive mental preoccupation with body weight and shape. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: In this paper, the feelings, thoughts and experiences of an individual with bulimia nervosa are explained, and the positive and negative effects of their experiences during the treatment process are emphasized. This paper offers advice to patients, relatives and healthcare professionals in recognizing and treating bulimia nervosa. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses should organize training, seminars and conferences to raise awareness of society against bulimia nervosa, which is defined as a mannequin disease and therefore creates a positive perception. Mental health nurses, an essential part of the health system, should raise awareness of individuals and families about recognizing, monitoring and supporting the early symptoms of bulimia nervosa. ABSTRACT: INTRODUCTION: Bulimia nervosa is one of the areas where mental health professionals have difficulties due to its nature and course. It is important to understand the factors related to this problem in-depth to discover the dynamics unique to the individual that causes the difficulty, identify new perspectives on these dynamics and identify alternative behaviours, stop stubborn binge-eating attacks and prevent relapse. AIM: It is aimed to provide an in-depth insight into the nature, course and treatment processes of bulimia nervosa through the narrative of the lived experience of an individual living with this problem. IMPLICATION FOR PRACTICE: The perception of beauty seriously impacts the onset and later course of bulimia nervosa and draws attention to the fact that mental health professionals and media workers have important duties to change the concept of beauty equals being skinny, created in society and the media. Quality of perceived social support is very important in preventing, treating and rehabilitating bulimia nervosa. Adopting a more objective approach, which will prevent the positive or negative stigmatization of the disease in explaining bulimia nervosa to the public, should be adopted.
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Trastorno por Atracón , Bulimia Nerviosa , Bulimia , Humanos , Bulimia Nerviosa/terapia , Bulimia Nerviosa/diagnóstico , Bulimia Nerviosa/psicología , Maniquíes , Bulimia/diagnóstico , Bulimia/psicología , Trastorno por Atracón/diagnóstico , Trastorno por Atracón/psicologíaRESUMEN
In recent years, the diagnostic definitions of eating disorders (EDs) have undergone dramatic changes. The Eating Attitudes Test-26 (EAT-26), which is considered an accepted instrument for community ED studies, has shown in its factorial structure to be inconsistent in different cultures and populations. The aim of the present study was to compare the factor structure of the EAT-26 among clinical and non-clinical populations. The clinical group included 207 female adolescents who were hospitalized with an ED (mean age 16.1). The non-clinical group included 155 female adolescents (mean age 16.1). Both groups completed the EAT-26. A series of factorial invariance models was conducted on the EAT-26. The results indicate that significant differences were found between the two groups regarding the original EAT-26 dimensions: dieting, bulimia and food preoccupation, and oral control. Additionally, the factorial structure of the EAT-26 was found to be significantly different in both groups compared to the original version. In the clinical group, the factorial structure of the EAT-26 consisted of four factors, whereas in the non-clinical sample, five factors were identified. Additionally, a 19-item version of the EAT-26 was found to be considerably more stable and well suited to capture ED symptoms in both groups, and a cutoff point of 22 (not 20) better differentiated clinical samples from non-clinical samples. The proposed shortening of the EAT from 40 to 26 and now to 19 items should be examined in future studies. That said, the shortened scale seems more suited for use among both clinical and non-clinical populations. These results reflect changes that have taken place in ED psychopathology over recent decades.
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Bulimia Nerviosa , Bulimia , Trastornos de Alimentación y de la Ingestión de Alimentos , Humanos , Femenino , Adolescente , Israel , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Pruebas Psicológicas , Bulimia/diagnósticoRESUMEN
OBJECTIVES: People with bipolar disorder who also report binge eating have increased psychopathology and greater impairment than those without binge eating. Whether this co-occurrence is related to binge eating as a symptom or presents differently across full-syndrome eating disorders with binge eating is unclear. METHODS: We first compared networks of 13 lifetime mania symptoms in 34,226 participants from the United Kingdom's National Institute for Health and Care Research BioResource with (n = 12,104) and without (n = 22,122) lifetime binge eating. Second, in the subsample with binge eating, we compared networks of mania symptoms in participants with lifetime anorexia nervosa binge-eating/purging (n = 825), bulimia nervosa (n = 3737), and binge-eating disorder (n = 3648). RESULTS: People with binge eating endorsed every mania symptom significantly more often than those without binge eating. Within the subsample, people with bulimia nervosa most often had the highest endorsement rate of each mania symptom. We found significant differences in network parameter statistics, including network structure (M = 0.25, p = 0.001) and global strength (S = 1.84, p = 0.002) when comparing the binge eating with no binge-eating participants. However, network structure differences were sensitive to reductions in sample size and the greater density of the latter network was explained by the large proportion of participants (34%) without mania symptoms. The structure of the anorexia nervosa binge-eating/purging network differed from the bulimia nervosa network (M = 0.66, p = 0.001), but the result was unstable. CONCLUSIONS: Our results suggest that the presence and structure of mania symptoms may be more associated with binge eating as a symptom rather than any specific binge-type eating disorder. Further research with larger sample sizes is required to confirm our findings.
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Anorexia Nerviosa , Trastorno por Atracón , Trastorno Bipolar , Bulimia , Humanos , Trastorno por Atracón/complicaciones , Trastorno por Atracón/diagnóstico , Manía , Anorexia Nerviosa/diagnóstico , Bulimia/diagnósticoRESUMEN
OBJECTIVE: This study compared the macronutrient profiles of subjective binge-eating episodes (SBEs), objective binge-eating episodes (OBEs), and typical eating episodes. METHOD: Twenty-one adults with binge eating completed ecological momentary assessment of all eating episodes for 2 weeks, including detailed monitoring of food types and portions. Binge-eating episodes (N = 237) were coded as OBEs (n = 76) or SBEs (n = 161). Calories and macronutrients were computed using manufacturer information and USDA Food and Nutrient Database for Dietary Studies. Multilevel regression models compared the eating episode types on caloric and macronutrient content. RESULTS: OBEs contained an average of 121.5 (95.1) g fat, 363.7 (289.1) g carbohydrates, 65.2 (38.2) g protein, 20.9 (16.4) g fiber, and 2856.2 (1869.2) calories. SBEs contained 31.6 (30.5) g fat, 76.5 (54.0) g carbohydrates, 20.5 (21.6) g protein, 5.3 (5.9) g fiber, and 695.1 (505.9) calories. Although OBEs contained significantly more calories and grams of all macronutrients than SBEs (p < .001), the macronutrient proportions of OBEs and SBEs did not differ. The proportions of carbohydrates (p = .005) and protein (p < .001) in SBEs significantly differed from typical eating episodes. DISCUSSION: Our findings offer preliminary evidence that OBEs and SBEs are more comparable in macronutrient profile than typical eating episodes. PUBLIC SIGNIFICANCE STATEMENT: The present study compared the calories and grams of macronutrients in objectively large binge-eating episodes, subjectively large binge-eating episodes, and typical meals and snacks. Results suggest that objectively and subjectively large binge-eating episodes demonstrate similar profiles of macronutrients, which are different from the macronutrient profile of meals and snacks. These results may help the eating disorder field better study the impact of subjectively large binge-eating episodes.
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Trastorno por Atracón , Bulimia , Adulto , Humanos , Trastorno por Atracón/diagnóstico , Evaluación Ecológica Momentánea , Bulimia/diagnóstico , Carbohidratos , Proteínas de Unión al GTPRESUMEN
This study used cluster analysis to explore clinically relevant subgroups of adult patients with anorexia nervosa (AN). Patients were clustered based on their body mass index (BMI), eating disorder symptomatology, anxiety and depression symptoms and autistic characteristics. The difference between clusters in work and social functioning, duration of illness, bingeing and purging behaviour, previous hospitalisations and number of comorbidities was also investigated. Two meaningful clusters emerged: a higher symptoms cluster with more severe eating pathology, anxiety, depression, and more autistic traits, and a second cluster with lower symptoms. BMI did not make major contributions to cluster formation. The higher symptoms cluster also reported lower self-efficacy to change, more previous hospitalisations, comorbid diagnoses, binge eating and purging behaviours and use of psychotropic medication. Our findings suggest that weight alone may not be a significant severity indicator amongst inpatients with AN, and targeted treatment of AN should consider a broader range of symptom severity indicators.
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Anorexia Nerviosa , Trastorno por Atracón , Bulimia , Trastornos de Alimentación y de la Ingestión de Alimentos , Adulto , Humanos , Anorexia Nerviosa/complicaciones , Anorexia Nerviosa/epidemiología , Anorexia Nerviosa/diagnóstico , Síndrome , Bulimia/diagnóstico , Trastorno por Atracón/diagnósticoRESUMEN
Recent advances in developing and screening candidate pharmacotherapies for psychiatric disorders have depended on rodent models. Eating disorders are a set of psychiatric disorders that have traditionally relied on behavioral therapies for effective long-term treatment. However, the clinical use of Lisdexamfatamine for binge eating disorder (BED) has furthered the notion of using pharmacotherapies for treating binge eating pathologies. While there are several binge eating rodent models, there is not a consensus on how to define pharmacological effectiveness within these models. Our purpose is to provide an overview of the potential pharmacotherapies or compounds tested in established rodent models of binge eating behavior. These findings will help provide guidance for determining pharmacological effectiveness for potential novel or repurposed pharmacotherapies.
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Trastorno por Atracón , Bulimia Nerviosa , Bulimia , Terapia Cognitivo-Conductual , Humanos , Trastorno por Atracón/tratamiento farmacológico , Trastorno por Atracón/diagnóstico , Trastorno por Atracón/psicología , Bulimia/diagnóstico , Bulimia/psicología , Bulimia/terapia , Bulimia Nerviosa/diagnóstico , Bulimia Nerviosa/psicología , Bulimia Nerviosa/terapiaRESUMEN
The prevalence of binge eating spectrum conditions (BESC) are increasing globally. However, there is a lack of data from general population samples in low- and middle-income countries. Thus, this study described the food consumption during objective binge eating episodes (OBE) in people with BESC from a metropolitan city in Brazil. Participants comprised 136 adults (18 years old-60 years old) with Binge Eating Disorder (BED), Bulimia Nervosa (BN), or recurrent binge eating (RBE) from a two-phase epidemiological survey. They were interviewed in their homes by trained lay interviewers using the Questionnaire on Eating and Weight Patterns updated for the DSM-5 to assess BESC diagnosis and food consumption during a typical OBE. Overall, participants consumed a mean of 1067 kcal during the episodes. For the most part, these calories were derived from carbohydrates (58%) and lipids (30%), irrespective of the diagnosis. Regarding food item consumption, individuals with BED and RBE consumed staple foods (mainly rice and beans) more frequently than those with BN. Conversely, participants with BN ingested sugar-sweetened beverages more frequently than the BED group. In conclusion, there were differences in the eating patterns of individuals with BESC in Brazil. BED and RBE participants consumed more typical foods, whereas those with BN preferred foods with a high content of energy during their OBE.
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Trastorno por Atracón , Bulimia Nerviosa , Bulimia , Trastornos de Alimentación y de la Ingestión de Alimentos , Adulto , Humanos , Adolescente , Trastorno por Atracón/epidemiología , Trastorno por Atracón/diagnóstico , Brasil/epidemiología , Bulimia/epidemiología , Bulimia/diagnóstico , Bulimia Nerviosa/diagnóstico , Conducta AlimentariaRESUMEN
The dazzling characteristics of postmodernity in the form of social flexibility, economization and virtualization can be understood as an expression of a cultural configuration that is by no means natural and irreversible, but is particularly media-related. Bulimia seems, more than Anorexia, a prime example of this.With regard to the historicity of symptoms in their various forms and disorders over time, consideration is given to how anorexic and bulimic symptoms position themselves in it. If the development toward postmodernity is to be understood as the pathology of modernity, in the course of the social pervasion of visual media there is a sociocultural turnabout to the fragile self, in which the theoretical polarity of conflict and structure can no longer be displayed.
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Anorexia Nerviosa , Bulimia Nerviosa , Bulimia , Trastornos de Alimentación y de la Ingestión de Alimentos , Humanos , Anorexia Nerviosa/diagnóstico , Anorexia Nerviosa/terapia , Bulimia/diagnóstico , Bulimia Nerviosa/diagnóstico , Bulimia Nerviosa/terapiaRESUMEN
Baseline interpersonal problems have been associated with treatment outcome in eating disorders (ED) and are important for understanding ED maintenance and aetiology. Despite this evidence, little is known about trajectories of change in interpersonal problems in the context of treatment, particularly in intensive ED treatment. This study examined the trajectory of total interpersonal problems in residential ED treatment, as well as two subdomains previously highlighted in ED research of being overly Cold (interpersonally distant) or overly Domineering (interpersonally controlling), as a function of different primary presenting ED diagnoses: anorexia nervosa restricting subtype (AN-R), binge-purge subtype (AN-BP), and bulimia nervosa or binge eating (BN/BED). Interpersonal problem data were collected at admission, discharge, and 6-month follow-up. Trajectories were analysed with multilevel models. Results showed small-to-medium statistically significant reductions in interpersonal problems across diagnostic groups from admission to discharge for total interpersonal scores, and gains appeared to be maintained at follow-up for both AN groups. Patients diagnosed with primary AN experienced steeper declines in total interpersonal problems from admission to follow-up compared with patients diagnosed with BN/BED, with AN-R experiencing the steepest trajectory. Planned contrasts indicated anyone with relevant binge eating behaviours had higher average levels of both Cold, as well as Domineering problems. Exploratory contrasts suggested that patients who had more Domineering problems also exhibited more binge symptoms and were typically slower to improve. Overall, results suggest interpersonal problems are generally malleable in residential ED treatment, yet change patterns differ by presenting ED symptoms and interpersonal problem subdomain.
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Anorexia Nerviosa , Trastorno por Atracón , Bulimia Nerviosa , Bulimia , Trastornos de Alimentación y de la Ingestión de Alimentos , Humanos , Bulimia Nerviosa/diagnóstico , Trastorno por Atracón/terapia , Bulimia/diagnósticoRESUMEN
The impact of family factors, particularly the sibling status, on the development and course of eating disorders has been rarely investigated.Therefore, the aimof the present study was to assess a putative association between sibling status and self-rated family dysfunctionality in a large sample of study participants with bulimia nervosa and anorexia nervosa. A total cohort of n = 568 outpatients aged twelve years and older, of whomhalf had the diagnosis of anorexia (n = 288, 50.7 %), was assessed for self-rated family dysfunctionality using the well-validated German General Family Questionnaire (FB-A), while the symptom level (Global Severity Index) was determined using the SCL-90-Rsymptomchecklist. Patientswith anorexiaweremore frequently only children compared to the bulimia group who had generallymore siblings (22.6%vs. 14.4%, p = 0.012). In patients with bulimia nervosa, bivariate analyses revealed a significant positive association between the presence of siblings and the degree of family dysfunctionality (only child: 33.6 ± 17.6, sibling child: 39.3 ± 15.5, p = 0.043). Linear regressionmodels adjusted for age, body-mass index, parents living in separation, and the Global Severity Index (GSI) confirmed a significant association between higher family dysfunctionality as a dependent variable and sibling status (beta = 0.163, 95%confidence interval [CI] = 1.431; 12.774, p = 0.014).No such relationship was found in the anorexia group (p = 0.418).The differential associations between sibling status and self-rated family dysfunctionality found for the two eating-disorder entities may indicate differences in the pathogenesis of anorexia and bulimia nervosa.
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Anorexia Nerviosa , Bulimia Nerviosa , Bulimia , Anciano , Anorexia , Anorexia Nerviosa/diagnóstico , Bulimia/diagnóstico , Bulimia Nerviosa/diagnóstico , Niño , Humanos , HermanosRESUMEN
INTRODUCTION: Specific characteristics of sleep (e.g., duration, quality, and fatigue) are positively associated with (ED) behaviors, specifically binge eating (BE) potentially through decreased self-regulation and increased appetite. However, prior work has been largely cross-sectional and has not examined temporal relationships between sleep characteristics and next-day ED behaviors. Thus, the present study examined daily relationships between sleep and ED behaviors among individuals with binge-spectrum EDs. METHOD: Participants (N = 96) completed 7 daily ecological momentary assessment (EMA) surveys over 7-14 days; morning surveys assessed sleep characteristics and 6 randomly timed surveys each day captured ED behaviors. Analyses examined within-subject and between-subject effects of sleep quality, duration, and fatigue on BE, compensatory purging behaviors, and maladaptive exercise. RESULTS: Within-subject sleep quality was significantly negatively associated with engagement in maladaptive exercise later that day. Additionally, between-subject sleep duration was significantly negatively associated with engagement in compensatory purging behaviors. DISCUSSION: Within- and between-subjects associations between sleep quality and duration and compensatory behavior engagement indicate that sleep plays an important role in ED behaviors. Future research should incorporate sensor-based measurement of sleep and examine how specific facets of sleep impact BE and treatment response. LEVEL OF EVIDENCE: Level II: Evidence obtained from controlled trial without randomization.
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Anorexia Nerviosa , Trastorno por Atracón , Bulimia , Trastornos de Alimentación y de la Ingestión de Alimentos , Humanos , Trastorno por Atracón/complicaciones , Estudios Transversales , Bulimia/diagnóstico , Sueño , FatigaRESUMEN
PURPOSE: Abnormalities in appetite hormones have been implicated in bulimia nervosa (BN). Orexigenic hormone asprosin has been reported to be associated with food intake and weight gain, but no relevant studies have yet been reported in BN. This study investigated asprosin concentrations and their association with eating disorder symptoms in patients with BN. METHODS: This study recruited a total of 26 BN patients and 23 healthy controls (HC). Symptom severity for eating disorders, depression, and anxiety was determined by the Eating Disorder Examination Questionnaire 6.0, Beck Depression Inventory, Version 2, and Beck Anxiety Inventory, respectively. In addition, the study employed sandwich enzyme-linked immunoassay technology to determine plasma asprosin and glucose concentrations in all participants. RESULTS: The results revealed that plasma asprosin concentrations were significantly higher in BN patients than in HC (P = 0.037), but the difference disappeared after adjusting for the covariate BMI (F = 2.685, P = 0.108). Correlation analysis showed that asprosin concentration was positively correlated with overeating (r = 0.451, P = 0.021) and eating loss of control (r = 0.483, P = 0.012) in BN patients. Linear regression analysis indicated that an increase in asprosin concentration was associated with an increase in the times of overeating (F = 6.303, P = 0.019, R2 = 0.208). Multiple linear regression showed that increases in asprosin concentration and BDI-II total score could explain the frequent eating loss of control (F = 5.766, P = 0.009, R2 = 0.334). CONCLUSIONS: The present study is the first report of plasma asprosin concentration in BN patients and found that overeating and eating loss of control increased with the increase of asprosin concentration. Additionally, asprosin level and degree of depression may explain the frequency of loss of control. LEVEL OF EVIDENCE: Level III: Evidence obtained from case-control studies.
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Anorexia Nerviosa , Bulimia Nerviosa , Bulimia , Bulimia/diagnóstico , Bulimia Nerviosa/diagnóstico , Glucosa , Hormonas , Humanos , HiperfagiaRESUMEN
Binge eating is characterised by the ingestion of large quantities of food in a short time. Cases in the literature deal exclusively with gastric perforation in people with a history of anorexia nervosa, binge eating disorder or bulimia nervosa.We report the case of a young woman with no previous diagnosis of mental illness and a history of only two binge-eating episodes that occurred a few years earlier. She died suddenly during a binge-eating episode from stomach rupture resulting from a single perforation of the stomach with leakage of food material within the abdominal cavity. There was no sign of gastric necrosis or peritonitis. The deceased died quickly.Our case, which appears unique in the literature, shows that there is a risk of death even in people with no diagnosis of eating disorders and a history of only few and isolated binge-eating episodes. Physicians should carefully investigate a patient's history to assess any risks.
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Trastorno por Atracón , Bulimia Nerviosa , Bulimia , Trastornos de Alimentación y de la Ingestión de Alimentos , Trastorno por Atracón/complicaciones , Trastorno por Atracón/diagnóstico , Bulimia/diagnóstico , Bulimia Nerviosa/complicaciones , Bulimia Nerviosa/diagnóstico , Causas de Muerte , Femenino , HumanosRESUMEN
OBJECTIVE: Sociocultural influences, including an increasing pressure for fashion models to maintain a thin body frame may be crucial in the development of eating disorders. The present study aimed to establish whether fashion models are more likely than non-models to develop eating disorders. METHODS: Female fashion models were selected by snowball sampling (n = 179, mean age: 25.9 SD = 4.70 years). They were compared with an age adjusted control group (n = 261, mean age: 25.0 SD = 4.97 years). Participants completed an online questionnaire containing the Eating Disorder Inventory. RESULTS: The average BMI of the fashion models was in the underweight range (mean BMI = 18.1 SD = 1.68). The BMI of the control group was significantly higher (mean = 22.1 SD = 4.23, p < 0.001). The frequency of simulated anorexia nervosa was 3.9% among the fashion models and 1.1% in the control group (p = 0.057). 14.6% of the models showed subclinical anorexia nervosa symptoms versus 2.7% in the control group (p < 0.001). The ratio of bulimia nervosa and subclinical bulimia nervosa showed no significant difference between the two groups. CONCLUSION: Female fashion models showed no significant difference from the control group in the frequency of anorexia nervosa and bulimia nervosa but had a significantly higher frequency of the subclinical form of anorexia nervosa.
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Anorexia Nerviosa , Bulimia Nerviosa , Bulimia , Trastornos de Alimentación y de la Ingestión de Alimentos , Adulto , Anorexia Nerviosa/diagnóstico , Anorexia Nerviosa/epidemiología , Bulimia/diagnóstico , Bulimia Nerviosa/epidemiología , Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Femenino , Hábitos , HumanosRESUMEN
PURPOSE: The imposition of the thin body as an ideal of beauty and the changes that occur in adolescence lead to a constant concern with adolescents' body weight, putting them at risk for eating disorders. Thus, the study sought to investigate associations between eating disorders and salivary cortisol concentrations, nutritional status and depressive symptoms in female adolescents with bulimia. METHODS: A cross-sectional study was carried out with 1435 adolescents aged 10-19 years. The Bulimic Investigatory Test of Edinburgh (BITE) and Body Shape Questionnaire (BSQ) questionnaires were used. A follow-up study was conducted from a random selection of female adolescents diagnosed with Bulimia Development and Well-Being Assessment-(DAWBA) to assess associations with salivary cortisol concentrations and nutritional status. RESULTS: The prevalence of body dissatisfaction among adolescents with symptoms of bulimia was 37%. There was a significant difference between salivary cortisol and bulimia (Risk Group = 0.33 ± 0.20 µg/100 ml, Diagnostic Group = 0.44 ± 0.21 µg/100 ml p = 0.040), and correlation positive between the risk of bulimia with symptoms of depression (0.355 p = 0.002) and with Body Mass Index (0.259 p = 0.028). High concentrations of salivary cortisol in bulimic adolescents may be associated with hyperactivity of the hypothalamic-pituitary-adrenal axis and depressive symptoms. CONCLUSIONS: Nutritional status indicators cannot be used alone for the diagnosis of bulimia, since cortisol levels seem to be a reliable parameter in the identification of bulimia, provided they are used with other diagnostic criteria. LEVEL III: Evidence obtained from cross-sectional study.
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Bulimia , Trastornos de Alimentación y de la Ingestión de Alimentos , Adolescente , Bulimia/diagnóstico , Estudios Transversales , Trastornos de Alimentación y de la Ingestión de Alimentos/complicaciones , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Hidrocortisona , Sistema Hipotálamo-Hipofisario , Estado Nutricional , Sistema Hipófiso-SuprarrenalRESUMEN
PURPOSE: Maladaptive exercise (i.e., exercise that is either driven or compensatory) is thought to momentarily down-regulate elevated fear of weight gain (FOWG). However, little research has examined associations between FOWG and exercise, and no research has measured FOWG at a momentary level or considered exercise type (i.e., maladaptive vs. adaptive). Thus, we examined both within- and between-subject associations between FOWG and exercise among individuals with trans-diagnostic binge eating. METHODS: We recruited treatment-seeking adults (N = 58, 82.9% female) to complete a 7-14-day ecological momentary assessment protocol which assessed levels of FOWG and exercise engagement and type. Mixed models and generalized estimating equations assessed within-subject associations, and linear regression assessed between-subject associations. RESULTS: There was no main effect of FOWG on exercise engagement at the next survey. However, unexpectedly, exercise type moderated this relationship such that the relationship between FOWG and exercise was strongest for episodes of adaptive exercise. Overall exercise frequency accounted for 10.4% of the variance in FOWG and exercise type explained an additional 1.7% of the variance in FOWG. CONCLUSION: The findings of the current study indicate that momentary levels of FOWG are associated with subsequent adaptive exercise episodes, while higher overall levels of maladaptive exercise were associated with higher levels of FOWG. Future treatments should place a greater emphasis on reducing the frequency of maladaptive exercise by providing strategies for reducing FOWG. LEVEL OF EVIDENCE: Level IV: Evidence obtained from multiple time series analysis such as case studies.
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Trastorno por Atracón , Bulimia Nerviosa , Bulimia , Ejercicio Físico , Adulto , Trastorno por Atracón/diagnóstico , Bulimia/diagnóstico , Bulimia Nerviosa/diagnóstico , Evaluación Ecológica Momentánea , Miedo , Femenino , Humanos , Masculino , Aumento de PesoRESUMEN
PURPOSE: Evidence suggests loss of control over eating may be the driving component of binge eating, a transdiagnostic symptom of eating disorders and highly comorbid with depressive symptoms. Prior studies have evaluated eating disorder and depressive symptoms across types of binge episodes among adolescent and young adult samples, yet no studies have focused on middle-aged women who may be particularly vulnerable to both binge eating and depressive symptoms. The goal of this study was to compare eating disorder symptoms and depressive symptoms across different types of binge eating episodes among middle-aged women. METHODS: Women (N = 347), ages 40-63, completed an online survey about both objective (OBE) and subjective binge episodes (SBE), eating disorder symptoms, and depressive symptoms. Participants were categorized as OBEs only, SBEs only, both OBEs and SBEs, and no binge eating. RESULTS: Controlling for group differences, results showed middle-aged women who experienced SBEs only reported greater levels of anorexia nervosa attitudes and behaviors compared to all other groups, and greater dietary restraint compared to those who experienced only OBEs and those with no binge eating. Middle-aged women who experienced any type of binge eating reported greater levels of body image concerns and depressive symptoms compared to those who reported no binge eating. CONCLUSIONS: Findings suggest that loss of control is more clinically relevant in terms of associations with eating disorder and depressive symptoms in middle-aged women. LEVEL OF EVIDENCE: Level V based on descriptive studies.
Asunto(s)
Trastorno por Atracón , Bulimia , Trastornos de Alimentación y de la Ingestión de Alimentos , Adolescente , Adulto , Trastorno por Atracón/diagnóstico , Imagen Corporal , Bulimia/diagnóstico , Depresión , Femenino , Humanos , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
PURPOSE: The association of bulimic symptoms with sensation seeking is uncertain; however, both behaviors have been linked to alcohol problems. We assessed in a longitudinal, community-based setting whether sensation seeking in adolescence is associated with bulimic symptoms in early adulthood, also accounting for alcohol problems. METHODS: Finnish men (N = 2000) and women (N = 2467) born between 1974-1979 completed Zuckerman's sensation seeking scale (SSS) at age 18. Alcohol problems (Malmö-modified Michigan alcoholism screening test (Mm-MAST) and bulimic symptoms [eating disorder inventory-2, bulimia subscale (EDI-Bulimia), population and clinical scoring systems] were defined at age 22-27. We examined relationships between SSS, Mm-MAST, and EDI-Bulimia using Pearson's correlation coefficient (r) and linear regression. RESULTS: Alcohol problems were moderately correlated with sensation seeking and bulimic symptoms (population scoring) among women and men (r = 0.21-0.31). The correlation between sensation seeking and bulimic symptoms (population scoring) was weak among men (r = 0.06, p = 0.006) and even weaker and non-significant among women (r = 0.03, p = 0.214). Adjustment for alcohol problems removed the association between sensation seeking and bulimic symptoms among men. Furthermore, there were no significant correlations between sensation seeking and bulimic symptoms when assessing EDI-Bulimia clinical scoring. CONCLUSION: Sensation seeking and bulimic symptoms were not associated among women. The association between sensation seeking and bulimic symptoms among men was entirely attributable to increased alcohol problems among those with higher sensation seeking. While this association may be important on the population level, its clinical significance may be minor. LEVEL OF EVIDENCE: Level III, well-designed cohort study.
Asunto(s)
Trastornos Relacionados con Alcohol , Bulimia , Adolescente , Adulto , Trastornos Relacionados con Alcohol/complicaciones , Trastornos Relacionados con Alcohol/diagnóstico , Bulimia/diagnóstico , Bulimia/epidemiología , Estudios de Cohortes , Femenino , Humanos , Estudios Longitudinales , Masculino , Sensación , Adulto JovenRESUMEN
PURPOSE: To assess eating behavior and associated factors in male fitness-center attendees. METHODS: An anonymous questionnaire was administered to male fitness center members of Innsbruck (Austria), aged 18-80 years to assess socio-demographic features, weight history, sports activity, eating behavior including disordered eating based on the Eating Disorder Examination Questionnaire (EDE-Q) and DSM-5 key symptoms for eating disorders (anorexia nervosa, binge eating, bulimia nervosa, purging disorder) and body image. Three age groups (younger-middle-aged-older men) were compared regarding the variables described above. RESULTS: A total of 307 men included displayed high rates of disordered eating as described by EDE-Q cutoff scores (5-11%) as well as by DSM-5 eating disorder symptoms (10%). While EDE-Q cutoff scores did not differentiate between the groups, the prevalences of DSM-5 eating disorder symptoms yielded significant differences indicating a clear decrease with increasing age. Binge eating and bulimic symptoms with excessive exercising as the purging method were the most often reported symptoms. CONCLUSION: Although described as typically female, disordered eating does occur in male fitness-gym attendees across all ages. The older the men, the less prevalent are the symptoms. Awareness of disordered eating and possible negative effects need to be addressed for attendees and trainers of the gym. LEVEL OF EVIDENCE: V-descriptive survey study.