Predicting the restrictive eating, exercise, and weight monitoring compulsions of anorexia nervosa.

PURPOSE: Compulsions surrounding restrictive eating, exercise, and weight monitoring are thought to maintain abnormal eating behaviour in individuals with anorexia nervosa (AN). This study aimed to determine if AN psychopathology and trait anxiety explain the presence of restrictive eating, exercise, and weight monitoring compulsions in a mixed sample. METHODS: Participants were 31 females with AN and 31 age and gender-matched healthy individuals (HC). Restrictive eating, exercise and weight monitoring compulsion presence was compared between AN and HC groups. Multivariable poisson regression analyses, adjusted for diagnostic status, were conducted to assess the association of both AN psychopathology and trait anxiety with compulsions across the mixed group. RESULTS: Individuals with AN endorsed a greater number of restrictive eating, exercise and weight monitoring compulsions compared to HC. In adjusted poisson regression analyses neither AN psychopathology nor trait anxiety predicted compulsion presence: incidence rate ratio (IRR) for AN psychopathology = 1.15 [95% CI 0.84, 1.57], p = 0.39; IRR for trait anxiety = 1.01 [95% CI 0.97, 1.06], p = 0.50. CONCLUSIONS: Greater presence of restrictive eating, exercise and weight monitoring compulsions was reported by individuals with AN, supporting the conceptualisation of disorder behaviours as compulsive. The study was underpowered to robustly evaluate the association between predictors of interest and the compulsions outcome, largely owing to the small sample size. Further investigation is required, ideally using methods able to identify causal and mediation effects. LEVEL OF EVIDENCE: Level V, cross-sectional study.

Is overestimation of body size associated with neuropsychological weaknesses in anorexia nervosa?

BACKGROUND: Recent research indicates some evidence of neuropsychological weaknesses in visuospatial memory, central coherence and set-shifting in adults with anorexia nervosa (AN). The growing interest in neuropsychological functioning of patients with AN is based upon the assumption that neuropsychological weaknesses contribute to the clinical features of the illness. However, due to a paucity of research on the connection between neuropsychological difficulties and the clinical features of AN, this link remains hypothetical. The main objective of this study was to explore the association between specific areas of neuropsychological functioning and body size estimation in patients with AN and healthy controls. METHODS: The sample consisted of 36 women diagnosed with AN and 34 healthy female controls. Participants were administered the continuous visual memory test and the recall trials of Rey Complex Figure Test to assess visual memory. Central coherence was assessed using the copy trial of Rey Complex Figure Test, and the Wisconsin Card Sorting Test was used to assess set-shifting. Body size estimation was assessed with a computerized morphing programme. RESULTS: The analyses showed no significant correlations between any of the neuropsychological measures and body size estimation. CONCLUSION: The results suggest that there is no association between these areas of neuropsychological difficulties and body size estimation among patients with AN. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Are poor set-shifting abilities associated with a higher frequency of body checking in anorexia nervosa?

BACKGROUND: The rigid and obsessional features of anorexia nervosa (AN) have led researchers to explore possible underlying neuropsychological difficulties. Numerous studies have demonstrated poorer set-shifting in patients with AN. However, due to a paucity of research on the connection between neuropsychological difficulties and the clinical features of AN, the link remains hypothetical. The main objective of this study was to explore the association between set-shifting and body checking. METHODS: The sample consisted of 30 females diagnosed with AN and 45 healthy females. Set-shifting was assessed using the Wisconsin Card Sorting Test (WCST) and frequency of body checking was assessed using the Body Checking Questionnaire (BCQ). RESULTS: The analysis showed no significant correlations between any of the WCST scores and the BCQ. CONCLUSION: The results suggest that there is no association between set-shifting difficulties and frequency of body checking among patients with AN. An alternative explanation could be that the neuropsychological measure included in this study is not sensitive to the set-shifting difficulties observed in clinical settings. We recommend that future studies include more ecologically valid measures of set-shifting in addition to standard neuropsychological tests.

Validation of the Norwegian short version of the Body Shape Questionnaire (BSQ-14).

BACKGROUND: The Body Shape Questionnaire (BSQ) is a widely used self-report measure of body shape dissatisfaction. AIMS: We aimed to establish psychometric properties and report normative data for the Norwegian 14-item BSQ in a clinical and non-clinical sample. METHODS: A total of 423 female students, 267 male students and 49 female inpatients [anorexia nervosa (AN) and subthreshold AN] were administered the BSQ, the Body Checking Questionnaire (BCQ), and the Eating Disorder Examination Questionnaire (EDE-Q). RESULTS: On average, the male and female controls were aged (mean± standard deviation) 20.98 ± 5.68 years and 24.35 ± 9.89 years with mean body mass indexes (BMIs) of 23.34 ± 3.13 and 22.30 ± 3.62 kg/m(2), respectively. Patients were 19.04 ± 3.06 years with a mean BMI of 16.48 ± 1.81. Divergent validity was indicated by significantly (P < 0.001) different means between the patient group versus female controls, 56.80 ± 18.89 and 35.89 ± 15.19, respectively. Cronbach's alpha was satisfactory for all three groups (0.91-0.96), indicating excellent internal consistency. The BSQ correlated significantly (P < 0.001) with the BCQ and EDE-Q, indicating concurrent validity. BMI and BSQ scores did not correlate significantly within the population as a whole. However, when subdividing the sample, higher BMI was associated with higher BSQ scores among females and males within the non-clinical sample. CONCLUSIONS: Our study provides psychometric support for the Norwegian version of the BSQ-14 among a clinical and non-clinical sample of both young men and women.

Memory versus perception of body size in patients with anorexia nervosa and healthy controls.

The objective of this study was to compare body size estimation based on memory versus perception, in patients with anorexia nervosa (AN) and healthy controls, adjusting for possible confounders. Seventy-one women (AN: 37, controls: 35), aged 14-29 years, were assessed with a computerized body size estimation morphing program. Information was gathered on depression, anxiety, time since last meal, weight and height. Results showed that patients overestimated their body size significantly more than controls, both in the memory and perception condition. Further, patients overestimated their body size significantly more when estimation was based on perception than memory. When controlling for anxiety, the difference between patients and controls no longer reached significance. None of the other confounders contributed significantly to the model. The results suggest that anxiety plays a role in overestimation of body size in AN. This finding might inform treatment, suggesting that more focus should be aimed at the underlying anxiety.

Norms for the Eating Disorder Examination Questionnaire (EDE-Q) among high school and university men.

This study aimed to establish normative and reliability data for the Eating Disorder Examination-Questionnaire (EDE-Q) in a sample of high school and university men. A total of 250 men aged 15 to 30 years (mean = 19.7; SD = 2.3) with an average BMI of 23.1 (SD = 3.1) were administered the EDE-Q. Mean global EDE-Q was 0.44 (SD = 0.52), with subscale means ranging from 0.15 (SD = 0.38) for eating concern to 0.70 (SD = 0.81) for shape concern. EDE-Q scores among this non-clinical sample of normal-weight young men were significantly, and almost invariably, lower than similarly aged young women. The EDE-Q performed less reliably among men than women, and this is an important caveat. Owing to the overall pattern of low item endorsement, reliance upon this single instrument is unlikely to provide a comprehensive assessment of shape, weight, and eating concerns among normal-weight young men in the community.

Reliability and validity of the Norwegian translation of the Child Eating Disorder Examination (ChEDE).

The Child Eating Disorder Examination (ChEDE) is a valid and reliable semi-structured interview, which measures eating-disorder specific psychopathology in children and young adolescents. The instrument is an adaptation of version 12.0D of the original Eating Disorder Examination (EDE 12.0) for adults. The Norwegian translation of the ChEDE is currently the only instrument for assessing eating disorder psychopathology in Norwegian children and adolescents. This study aimed to investigate the psychometric properties of the Norwegian translation of the ChEDE 12.0. The Norwegian version of ChEDE 12.0 was administered to 15 Norwegian children with anorexia nervosa (AN), 15 children with diabetes mellitus type 1 (DM) and two groups of 15 age-matched controls. The groups were compared using a matched pairs design. The results showed that the subscale scores of the AN group were significantly higher than those of the other groups, and the DM comparison group did not differ from its control group. The current AN group scored significantly higher on the Shape Concern subscale than the previous UK sample, with implications for construct validity or cross-cultural effects worthy of further study. Inter-rater reliability was generally high (r=0.91 to 1.00), although there were significant differences between raters on specific items for individual participants. Alpha coefficients for each of the ChEDE subscales indicated a high degree of internal consistency. It was concluded that the Norwegian version of the ChEDE 12 has adequate psychometric properties and can be recommended for clinical and research use with young people with eating disorders in Norway.