Eating disorders in men: current features and childhood factors.

BACKGROUND: Disturbed interactions with one's body and with other persons are two major features in eating disorders. This study was designed to assess current and childhood characteristics of eating-disordered men. METHODS: The authors interviewed 32 men with eating disorders (anorexia nervosa: N=9, bulimia nervosa: N=15, eating disorders not otherwise specified: N=8) and 43 control participants with no such history similar in age and educational status. The Structured Clinical Interview for DSM-IV was used to assess Axis I disorders and a self-designed interview to assess actual social and sexual characteristics and childhood body-focused and social behaviors including sexual and physical abuse. RESULTS: The two groups differed significantly with regard to clinical, sexual and social features, with a three times higher rate of psychiatric disorders, fewer sexual and social relationships in the index group than in the controls. Eating-disordered men differed significantly from controls on most measures of body-focused and social behaviors, displaying higher rates of thumb sucking, nail biting, auto-aggressive behavior, and nudity as a familial taboo during childhood, as well as less parental bodily caressing than did controls. The index group reported significantly poorer relationships to their parents, fewer friends and persons of trust, and more often had adjustment problems at school than did their counterparts. CONCLUSIONS: Our data show that disturbed interactions with one's body and with other persons in eating-disordered men are associated with a body-denying and distant family climate and an auto-aggressive, anxious and inhibited social behavior during childhood.

[Burnout and stress disorders in intensive care doctors]. / Burnout und Belastungsstörungen bei Intensivmedizinern.

BACKGROUND AND OBJECTIVE: The various acute and chronic demands and burdens put ICU staff at greater risk for developing psychological and stress disorders. It was the aim of this study to assess the prevalence rates of burnout-syndrome in anesthetists, and to evaluate the contribution of working conditions to the development of burnout. METHODS: Self-reporting questionnaires were used to assess emotional well-being and physical health, burnout-syndrome (Maslach Burnout Inventory), and working conditions (Instrument for Stress-Oriented Task Analysis) in 89 anaesthetists (56 males, 33 females). RESULTS: One quarter of the anaesthetists show high values on the subscales "emotional exhaustion" or "depersonalization", and one fifth low values on the subscale "lack of personal accomplishment". About one quarter of the probands may be seen as "at risk for burnout". Feelings of ill-health are relatively frequent in both sexes. Long working hours and night duties, the cooperation with members of different occupational groups, and small working place resources are seen as particular stresses. CONCLUSION: Burnout-syndrome and psychosomatic symptoms are frequent in intensive care doctors. But preventive measures such as adequate resources at the work place and supervision can influence personal behavior and working conditions, and thus reduce the risk of burnout.

Therapeutic outcome of adjustable gastric banding in morbid obese patients.

We examined 77 obese patients treated with bariatric surgery in order to analyse treatment success, and compare those with a good or a poor outcome. The subjects, who were recruited one year after undergoing adjustable gastric banding, were asked questions concerning their sociodemographic status, postoperative course, past and present weight status, eating behaviours and difficulties in changing eating habits. Furthermore, we also used two body image questionnaires, and considered the patients' evaluations of positive and negative changes, as well as their wishes for the future. There were no preoperative differences between the 71% of patients in the good outcome group and the 29% in the poor outcome group. With regard to the postoperative course, the poor outcome group had more problems in adapting to new eating behaviours, experienced significantly more post-surgical complications, and had a persistently negative body evaluation. Both groups were satisfied with their achieved weight loss achieved, and their improved self-esteem and mobility. Adjustable gastric banding seems to be successful in inducing weight loss and allowing a better quality of life. However, factors such as postoperative complications, the ability and willingness to adopt new eating attitudes, and an improved body image seem to be crucial for therapeutic outcome.

Psychosocial consequences of weight loss following gastric banding for morbid obesity.

BACKGROUND: This study was performed to determine what consequences surgery for morbid obesity has on weight loss, problems in eating behavior, quality of life, physical appearance and mental state. METHOD: After a minimum follow-up of > 8 months (median follow-up 21 months, range 8-48 months), a questionnaire concerning extent of, satisfaction with and consequences of weight loss was mailed to 250 morbidly obese patients after laparoscopic Swedish adjustable gastric banding (SAGB). In addition, the partner's opinion regarding the operation was evaluated as well as the consequences of weight loss for partnership and sexual relationship. RESULTS: 160 patients (64%) completed and returned the questionnaire. Most patients (87%) were happy with the extent of weight loss. Weight loss, however, was connected with negative consequences for the body such as flabby skin (53%), abdominal skin overhang (47%) and pendulous breasts (42%). Patients who were satisfied with their postoperative physical appearance showed significantly less weight loss than did patients who were unhappy with their appearance (38 vs 54 kg). Most of the partners (91%) believed that the decision for SAGB was right. An improvement in partnership was reported by more than half of the partners (59%), and an improved sexual relationship by 45%. CONCLUSION: Laparoscopic SAGB is an effective surgical treatment for morbid obesity. However, the consequences of excess and rapid weight loss for physical appearance are negative in many cases. Well-directed information about the consequences of excess weight loss before SAGB and the possibilities and limits of plastic surgery must be given preoperatively to offset high and often unrealistic expectations.

Psychotherapeutic treatment of morbidly obese patients after gastric banding.

BACKGROUND: Surgery is the most effective therapeutic option for weight reduction in carefully selected patients with morbid obesity resistant to conventional treatment. However, surgical treatment is not the solution but an important precondition for successful management of morbid obesity. METHODS: All patients undergo a psychiatric examination before laparoscopic gastric banding. At the first examination we inform all patients about the various forms of psychological support offered before and especially after gastric banding. RESULTS: A majority of the obese individuals are interested in psychological support postoperatively, but only a minority of this patient group (about one-quarter) ultimately enlists psychological support on a regular or irregular basis. Some specific psychological topics have proved to be particularly important such as change of self-esteem as a consequence of weight loss, problems in adopting new eating behaviors and the risk for developing a new eating disordered behavior, and problems involving adequate problem-solving. CONCLUSIONS: In many cases, some form of psychological support is necessary in order to cope with the new postoperative demands and to find more adequate coping strategies for underlying psychological, psychosocial and environmental problems. The different kinds of psychological support and psychotherapeutic treatment available at Innsbruck University Hospital for obese patients after gastric banding are discussed here.

Partnership, sexuality, and sexual disorders in morbidly obese women: consequences of weight loss after gastric banding.

BACKGROUND: A study was performed to determine what consequences surgery for morbid obesity has on sexual attitudes and partnership in obese female patients. METHOD: Semi-structured interviews concerning sociodemographic data, sexuality and relationship were conducted on 82 female patients preoperatively and at least 1 year postoperatively. RESULTS: Physical appearance played the main role in the decision to undergo weight reduction surgery in only 17% of the study patients. Postoperatively, half of the patients were satisfied with their physical appearance 1 year after surgery, the other half not. Preoperatively, 44% of the patients stated that sexuality with their partners was satisfying and the frequency of sexual intercourse was regular. Postoperatively, 63% of the patients stated that they enjoyed sex more, compared with 12% of the patients who enjoyed sex less than before surgery. Postoperatively, 20% of the patients reported that partnership had changed positively, 10% negatively. CONCLUSIONS: The results indicate that many of the sexual problems in obese individuals are the result of an underlying lack of self-esteem, unsatisfactory relationships, or collective stigmatization of obese individuals. Binge eating, often found in morbidly obese patients, seems to be less the result of or compensation for sexual problems but is more likely to stem from other psychosocial or psychological problems.

[Quality of life of patients with eating disorders. A catamnestic study]. / Lebensqualität essgestörter Patientinnen. Eine Katamneseerhebung.

OBJECTIVE: To assess the eating behaviour, quality of life and changes in life style in 46 female patients with eating disorders, discharged from our psychosomatic unit at least six month ago. METHODS: Patients meeting the criteria for DSM-IV anorexia nervosa or bulimia nervosa completed the "Lancashire Quality of Life Profile" [16] and a questionnaire covering demographic aspects, eating behaviour and changes in life style. RESULTS: Positive changes in eating behaviour correlated with higher quality of life scores in many of the domains assessed, including leisure, financial situation and perceived mental health. These changes also correlated with positive changes in life style in several domains, in particular family situation and leisure activities. CONCLUSIONS: Results show that various connections between eating behaviour and quality of life as well as life style exist, suggesting a treatment concept that emphasizes both clinical symptoms and psycho-social conflicts.

Body image and psychopathology in male bodybuilders.

BACKGROUND: To compare male bodybuilders to men with eating disorders and control men regarding body image, psychopathology and sexual history. METHOD: We compared 28 male bodybuilders, 30 men with eating disorders (anorexia nervosa, bulimia or binge eating disorder defined by DSM-IV), and 30 controls, using a battery of questionnaires covering weight history, eating behavior, body image, lifetime history of psychiatric disorders, and sexuality. Eating-disordered and control men were recruited from a college student population and studied during the course of an earlier investigation. RESULTS: Bodybuilders exhibited a pattern of eating and exercising as obsessive as that of subjects with eating disorders, but with a 'reverse' focus of gaining muscle as opposed to losing fat. Bodybuilders displayed rates of psychiatric disorders intermediate between men with eating disorders and control men. In measures of body image, the bodybuilders closely resembled the men with eating disorders, but significantly differed from the control men, with the former two groups consistently displaying greater dissatisfaction than the latter. Sexual functioning did not distinguish the three groups except for the item 'lack of sexual desire' which was reported significantly more often by both bodybuilders and men with eating disorders. CONCLUSION: On measures of body image and eating behavior, bodybuilders share many features of individuals with eating disorders.

[A pilot study of fathers on parental leave in Tirol.]. / Une étude pilote sur le congé parental de pères au Tirol.

The current study examines fathers in parental leave in Tirol. The authors have come to realise that systematic reflections concerning fathers on leave of their work are rare. The authors attempt to answer the following question: does parental leave have implications on child/father attachment? The pilot study examines a small sample of 15 father/child couples. The description and analysis of father/child interactions was elaborated with the Child Adult Relationship Index (CARE-Index) designed by Crittenden (1988, 2000).

The weeping behavior in anorexic and bulimic females.

BACKGROUND: The aim of the study was to examine the proneness, the functions and triggering situations of weeping in anorexic and bulimic women. METHODS: Participants were 36 anorexic and 31 bulimic female patients and 56 age-matched female controls. All women completed the Questionnaire on Adult Crying. We limited our study to results on 'crying proneness', 'functions of crying' and 'determining factors of crying'. RESULTS: Bulimic patients reported to have cried significantly more often in the last 4 weeks, to be more likely to cry in situations of distress and to have used weeping significantly more often as a manipulative behavior than control women. Anorexic patients rated their tendency to cry significantly lower and experienced weeping as significantly more negative than controls. CONCLUSIONS: Compared to control women, anorexic patients associated weeping with negative feelings as opposed to bulimic patients who appeared to use weeping on an intentional basis. These deviations from control women seem to mirror the introvert character of anorexic patients and the extrovert impulsive personality of patients with bulimia nervosa, respectively.

Binge eating disorder in females: a population-based investigation.

OBJECTIVE: The authors investigated the prevalence of binge eating behavior in a general female Austrian population. METHOD: A random sample of 1,000 women (age range 15a to 85a) was interviewed by dieticians over the phone. Some screening instruments were used to detect binge eating behavior. RESULTS: Of the entire sample, 122 met the diagnostic criteria for binge eating, 84 for binge eating syndrome, and 33 for binge eating disorder (BED). The point prevalence of bulimia nervosa was 1.5%. Women with binge eating episodes carried out more frequently one or more diets within the previous year, and more frequently exhibited a restrained eating behavior than did women without binge eating behavior. Underweight women more often met the diagnostic criteria for bulimia nervosa nonpurging type than did normal weight, overweight, and obese women, while overweight and obese women more frequently met the diagnostic criteria for BED. DISCUSSION: Our findings indicate that binge eating appears to be a fairly common behavior in women. Dieting, chronic restrained eating, and excessive exercise may be important triggers for BED and bulimia nervosa.

Knowledge of calories and its effect on eating behavior in overweight, normal weight, and underweight individuals.

BACKGROUND: To assess changes in the eating behavior of overweight, normal weight, and underweight individuals in response to knowledge about the caloric content of their food. METHODS: Anonymous self-report questionnaires were completed by 1041 staff members attending the Innsbruck University Hospital cafeteria shortly after it started to display the caloric content of all meals. The questions covered the subjects' weight history, body image, eating behavior, and response to knowledge of caloric content. RESULTS: Among the respondents, 141 were classified as overweight, 728 as normal weight, and 118 as underweight. Overweight individuals reported a significantly more frequent change in eating behavior in response to the information, and were also significantly more distressed about weight and eating and dissatisfied with their bodies and their weight than normal and underweight individuals. CONCLUSIONS: Overweight individuals were more likely to report that they had modified their eating in response to information about calories. Whether this reflects an actual change in eating behavior, or merely a wish to give socially desirable responses, remains uncertain.

Binge eating disorder in males: a population-based investigation.

The authors investigated the prevalence of binge eating behavior in a general male Austrian population. A randomly selected sample of 1000 male adults aged 18 to 88 was interviewed by dieticians over the phone. Some screening instruments were used to detect binge eating behavior. The results showed a total prevalence of eating disorders of 14.9%. Eight subjects (0.8%) met the full diagnostic criteria for binge eating disorder (BED), 42 (4.2%) exhibited a partial binge eating syndrome, 94 (9.4%) an Eating Disorder Not Otherwise Specified, and five subjects (0.5%) a bulimia nervosa. Most subjects with a eating disorder were overweight or obese, particularly those with a full BED syndrome. Our findings indicate that full BED syndromes are very rare in a nonclinical male sample, whereas partial syndromes are fairly common in males.

[Eating disorders in women: a representative study]. / Essstörungen bei Frauen: Eine Repräsentativerhebung.

The authors examined the prevalence rates of binge-eating behavior, binge-eating disorder (BED), and bulimia nervosa in a female representative random sample in Tyrol. The data were collected ba telephone. Of the 1,000 women, 3 (0.3%) met the DSM-IV diagnostic criteria for anorexia nervosa, 15 (1.5%) for bulimia nervosa, and 33 (3.3%) for binge-eating disorder. While bulimics were young and found in all weight groups, women with BED were mostly overweight or obese and found in all age groups. The findings show that restrained eating, dieting, and/or excessive exercise are risk factors for developing eating disorders.

[Eating disorders in males: a representative survey]. / Essstörungen bei Männern: Eine Repräsentativerhebung.

The present study examined the prevalence of eating disorders in a male representative random sample in Tyrol. The data were collected by telephone. Of the 1000 men, 8 (0.8%) met the DSM-IV diagnostic criteria for binge eating disorder. An additional 42 subjects (4.2%) exhibited a partial binge eating syndrome. These two otherwise widely identical groups of binge eaters were separated only by the DSM-IV frequency criterion. Five subjects (0.5%) met the DSM-IV criteria for the diagnosis of bulimia nervosa, and 94 men (9.4%) reported recurrent overeating. Men with any eating disorder were mostly overweight or obese. The findings show that there is a significant difference in eating disorders between men and women, but certain eating disorders are frequent not only in women but also in men.

Eating-disordered behavior in males: the impact of adverse childhood experiences.

OBJECTIVE: The authors examined the possible relationship of childhood sexual abuse, physical abuse, and dysfunctional family background and the risk for developing an eating disorder in adult males. METHOD: Several anonymous questionnaires were distributed to male university students. RESULTS: Of the 301 men, 12 (4.0%) had experienced childhood sexual abuse, 11 (3.6%) had been victims of physical abuse, 79 (26.2%) reported an adverse family background, and 14 (4.6%) had an increased risk for developing an eating disorder. There were no significant differences in the risk for developing an eating disorder and in total EDI between victims and nonvictims, but a significantly increased risk for eating disorders in men with an adverse family background. DISCUSSION: The findings suggest that long-lasting negative familial relationships, particularly in connection with physically abusive experiences, may increase the risk for eating disorders.

Drug use and lifestyle among college students in Austria and the United States.

Using an anonymous questionnaire, we assessed the prevalence of alcohol use and illicit drug use among 545 college students in Innsbruck, Austria in 1995. The questionnaire also assessed various aspects of students' lifestyles, including academic performance, college activities, career plans, visits to a psychiatrist, and sexual activity. We compared these results with those obtained using the same questionnaire at a similar American college in 1989. We found that the prevalence of virtually all forms of illicit substance use was much higher among the American students. In both Austria and the United States, however, we found few differences between drug users and nonusers on most measures of lifestyle, with the exception of hetero-sexual activity.

[Sexual dysfunctions in men and women: significance of a dysfunctional family climate and sexual abuse]. / Sexuelle Funktionsstörungen bei Männern und Frauen: Bedeutung eines dysfunktionalen Familienklimas und sexuellen Missbrauchs.

The authors examined by questionnaire the prevalence and the possible relationship of childhood sexual abuse and dysfunctional family background to the later sexual dysfunctions in a nonclinical male and female student sample. Of the 202 females, 44 (21.8%) reported a narrowly defined childhood sexual abuse, of the 301 men who completed the questionnaires 29 (9.6%) reported any kind of a sexually abusive experience, and 17 (5.6%) were victims of a marked childhood sexual victimization. 66 (32.6%) females and 79 (26%) males reported an adverse family background. Long-lasting adverse familial relationship to attachment figures were significant to later sexual dysfunctions in both sexes. Women, who reported repeated childhood sexual abuse, reported significantly more frequently sexual desire disorder and orgasm disorder. However, males who experienced-in most cases single-childhood sexual abuse, showed not more frequently sexual dysfunctions than nonvictims.

Eating disorders in Austrian men: an intracultural and crosscultural comparison study.

BACKGROUND: We compared 30 male university students with eating disorders and 30 male comparison subjects without eating disorders recruited by advertisement at Innsbruck University, Austria. METHODS: Subjects were interviewed using instruments that we had previously used in a controlled study of college men with eating disorders in the United States. RESULTS: The Austrian men with eating disorders differed sharply from Austrian comparison subjects, but closely resembled their American counterparts, on prevalence of personal and familial psychopathology, adverse family experiences, and scores on rating scales for eating disorder. Interestingly, dissatisfaction with body image was consistently greater among American subjects regardless of eating disorder status. CONCLUSIONS: Our data suggest a weak association between eating disorders and homosexual or bisexual orientation in men and no consistent association between eating disorders and childhood sexual abuse.