Physical fitness, bone mineral density and associations with physical activity in females with longstanding eating disorders and non-clinical controls.

AIM: To examine (i) aerobic fitness, muscular strength, and bone mineral density (BMD) in female inpatients with longstanding eating disorders and non-clinical controls, and (ii) associated and explanatory factors for BMD among the inpatients. METHODS: Adult females with DSM-IV anorexia nervosa (AN), bulimia nervosa (BN) or eating disorders not otherwise specified (EDNOS) (n=59, mean(SD) age 30.1(8.5) yrs and ED duration 14.3 yrs) and non-clinical age-matched controls (n=53, mean(SD) age 31.3(8.3) yrs) accepted participation in this cross-sectional study. Measurements included accelerometer assessed and self reported amount of different types of physical activities, VO2max on treadmill, 1RM in leg and chest press, and BMD in lumbar spine (L2-L4), femur neck and total body analyzed by DXA. RESULTS: Muscular strength and BMD were lower in patients with AN, not in patients with BN or EDNOS, compared to controls. Aerobic fitness did not differ between patients and controls. BMD in the patients was positively associated with body weight, muscular strength and self reported high impact PA (min.w-1), not self reported general weight-bearing PA (min.w-1) or accelerometer assessed PA (counts.min). History of AN (28%) and muscular strength (9%) contributed significantly to explain the variance in total body BMD. CONCLUSION: Muscular strength and only high impact PA are associated with BMD in patients with longstanding ED. An implication of this is the need for more specific guidelines regarding types of PA recommended for this patient population. Special considerations should be made for severely malnourished patients, and for patients with osteoporosis.

Physical activity in treatment units for eating disorders: clinical practice and attitudes.

OBJECTIVE: Physical activity (PA) in eating disorders (ED) may be harmful, but in a therapeutic setting also beneficial. The purpose of this survey was to examine these contradictory aspects of PA in ED specialist treatment settings. We examined whether 1) PA is assessed by the unit, 2) the units have guidelines for managing excessive PA, 3) the units have staff with higher education and special competence in PA and exercise science, 4) how units regard PA in ED, 5) whether regular PA is integrated in the treatment programs, and 6) how the units rate the role of PA in the treatment of ED compared with other mental disorders. METHODS: Of the 49 units located in Scandinavia and the United Kingdom, 41 (84%) responded to a questionnaire. RESULTS: In 28 units (68%) PA was assessed regularly. Excessive PA was considered a harmful symptom in ED, and most units reported guidelines to manage excessive PA. Thirty-two units included PA in their treatment programmes. Clinicians found PA most relevant in the treatment of obesity and, except for binge eating, less for ED. CONCLUSION: PA was more commonly integrated in treatment compared to previous studies. Future research should address how to manage excessive PA, and the potential beneficial role of PA in the treatment of ED.

Prevalence of eating disorders and the predictive power of risk models in female elite athletes: a controlled study.

The purposes of this study were to examine the percentage of female elite athletes and controls with disordered eating (DE) behavior and clinical eating disorders (EDs), to investigate what characterize the athletes with EDs, and to evaluate whether a proposed method of screening for EDs in elite athletes does not falsely classify sport-specific behaviors as indicators of EDs. All athletes representing the national teams at the junior or senior level, aged 13-39 years (n=938), and age-group matched, randomly selected population-based controls (n=900) were invited to participate. From the screening data, a random sample of athletes (n=186) and controls (n=145) were subjects for a clinical interview. More athletes in leanness sports (46.7%) had clinical EDs than athletes in non-leanness sports (19.8%) and controls (21.4%) (P<0.001). Variables predicting clinical EDs, and thus candidates for valid screening procedures, were menstrual dysfunction in leanness athletes, self-reported EDs in non-leanness athletes, and self-reported use of pathogenic weight control methods in controls. Hence, statistically based risk factors are not universally valid, but specifically related to athletes and non-athletes, respectively.

Short-term follow-up of adults with long standing anorexia nervosa or non-specified eating disorder after inpatient treatment.

OBJECTIVE: There are few follow-up studies on outcome for patients with long standing anorexia nervosa (AN) or non-specified eating disorder with several comorbid psychiatric disorders. Inpatient treatment is one option for these patients. The aim of this prospective study was to report one-year follow-up for a consecutive sample of these patients after an inpatient treatment program. METHOD: All 24 patients with a mean age of 28 years and mean duration of an eating disorder of 11 years were treated in a 23-week inpatient group treatment program for AN. Patients were assessed using Eating Disorder Examination interview (EDE), Eating Disorder Inventory (EDI) and Symptom Check List (SCL-90-R) at pre-treatment, post-treatment and at one year after start of treatment. At the follow-up 24 patients were personally interviewed. On admission 12 (50%) had AN, 8 (33%) non-specified eating disorder (EDNOS) and 4 (17%) bulimia nervosa (BN). All had previously suffered from AN and were clinically evaluated to have mostly anorectic psychopathology. RESULTS: Ten (42%) patients had improved at follow-up and 14 (58%) had a poor outcome. There was a moderate but significant improvement on the EDE, EDI and GSI from pre-treatment to follow-up. The improvement occurred during inpatient treatment, and no significant differences from post-treatment to follow-up were found. Patients with low weight on admission showed a significant mean weight increase of about 4 kg at the follow-up. CONCLUSIONS: At one-year follow-up there was a moderate reduction of eating disorder symptoms and general psychiatric symptoms for patients with long standing anorexic symptoms. The improvement occurred during inpatient treatment. Inpatient treatment may be a treatment option in long-time rehabilitation for some of these patients.

Body dissatisfaction and dieting in 4,952 Norwegian children aged 11-15 years: less evidence for gender and age differences.

A number of studies have shown that dieting and body dissatisfaction are highly frequent among adolescents. We here describe the relationship between dieting and body dissatisfaction in 4,952 children selected from the 11, 13 and 15 year age cohorts of the Norwegian national sample in the multinational WHO survey "Health Behavior in School Children". Body dissatisfaction was defined as the subjective experience of being a bit or much too fat and, using this definition, about 20% of the boys reported body dissatisfaction and 7% that they were on a diet. About 37% of the girls reported body dissatisfaction and 15% that they were on a diet. Within the age cohorts, respectively 22%, 30% and 32% reported body dissatisfaction, whereas about 40% overall indicated no body dissatisfaction. Being on a diet was reported by 8% of the 11-year olds, and subsequently increased to 10% (13 years) and 14% (15 years). Multiple regression analysis showed that body dissatisfaction explained 33% of the variance in dieting behaviour, and that the overall effect of gender and age was small. Dieting and body dissatisfaction should therefore be recognised as being equally important among boys, and be counteracted within the framework of a health promotion strategy aimed at the general adolescent population.

[Can psychological treatment help patients with cancer?]. / Kan psykologisk behandling hjelpe kreftpasienter?

BACKGROUND: A number of studies have shown that psychological interventions may supplement the medical treatment of cancer patients by reducing psychological morbidity and increasing their quality of life. However, previous literature reviews point to methodological flaws limiting the specific and definite conclusions that can be drawn with respect to intervention effects. MATERIAL AND METHODS: Through searches in Medline, Embase and PsycINFO, the present study aims to review recent controlled studies from 1992-2000. RESULTS: Of the ten studies identified, seven reported effects of cognitive, psycho-educational and supportive treatment of various forms of cancer. INTERPRETATION: As found in the previous literature reviews, methodological shortcomings limit what firm conclusions may be drawn in order to guide clinicians as to what kind of interventions will be cost-effective for specific cancer patient groups. Nevertheless, the present as well as the previous reviews indicate that psychological treatment of cancer patients should be continued and that more well-controlled studies should be conducted.

Seasonal eating patterns in Norway: a non-clinical population study.

Seasonal deviations in normal eating habits have been associated with seasonal affective disorder (SAD) and bulimia nervosa (BN). Two studies on seasonal variation in eating habits are reported in this paper. In Study 1, seasonal patterns of eating disturbances were measured cross-sectionally in 6313 participants using an eating disturbance scale (EDS-5) and a modified version of the Seasonal Pattern Assessment Questionnaire (SPAQ). Eating disturbance scores were predicted by seasonal sensitivity scores from the SPAQ, gender, age, and light. Study 2 used a longitudinal design in which 908 participants were given the EDS-5 every month from November 1993 to January 1995. Scores on the EDS-5 fluctuated with the season of the year, with higher EDS-5 scores in winter and lower in summer. The results suggest that seasonal fluctuations affect only a subset of the total population.

[Is the Internet of any help for persons with serious mental disorders?]. / Er Internett til hjelp for personer med alvorlige psykiske lidelser?

BACKGROUND: Information and communication technology may represent unique opportunities as well as challenges for persons who are socially isolated due to serious mental disorders. MATERIAL AND METHODS: In order to explore how such persons use and experience Internet technology, a pilot project was conducted in collaboration with eight subjects. These accepted a PC with Internet access in their homes for a period of one year. The experiences reported are based on self-reports, and observations made by clinical and project personnel. RESULTS: Three of the eight subjects reported little or no use of the Internet. For the five active users, Internet opened up for social contact and support without provoking the same degree of social anxiety as face-to-face interaction. Four of the five subjects wish to use e-mail contact as a supplement to face-to-face contact with their therapist. INTERPRETATION: Internet can represent a lifeline to society for persons isolated due to mental disorders. Electronic based interaction between patients and health care professionals will provide unique opportunities as well as challenges in efforts towards improving the quality of and access to health care services.

The comorbidity of eating disorders and personality disorders: a meta-analytic review of studies published between 1983 and 1998.

Comorbid personality disorders in eating disordered patients may seriously affect the treatment and course of their illness. Several studies show such a comorbidity, though with inconsistent findings. Qualitative reviews attribute this to methodological shortcomings, but the qualitative method may itself create new shortcomings. To circumvent this, the present, more extensive review applies a meta-analytic approach. Using the databases MEDLINE and PSYCHLIT, the 28 articles published between 1983 and 1998 that presented empirical evidence for an eating disorder and personality disorder comorbidity suitable for meta-analysis were included. We found a higher proportion of eating disordered patients with any personality disorder (average proportion = 0.58) related to comparison groups (average proportion = 0.28). Compared with anorexia nervosa patients, a higher proportion of patients with bulimia nervosa had a concurrent cluster B personality (average proportion = 0.44) and a borderline personality disorder (average proportion = 0.31). However, no differences between anorexia nervosa and bulimia nervosa patients in proportions of cluster C were found (average proportion = 0.45 and 0.44 respectively). Patients with eating disorders and patients with bulimia nervosa in particular, should be routinely assessed for a concurrent personality disorder using structured clinical interviews. In future research, more stringent assessment procedures are highly recommended to address the question of causality between eating disorders and personality disorders, and how eating disorder symptoms and personality disorder symptoms are related to treatment effects.

[Eating disorders--how is treatment organized?]. / Spiseforstyrrelser--hvordan er behandlingen organisert?

A nation-wide survey of the organisation and efficiency of public health care services for Norwegian patients with eating disorders was conducted among the heads of medical and psychiatric units (N = 261). Only the number of patients treated predicted special clinical routines or measures to increase the clinical competence, and not geographical location of institutions or the national health authorities' distribution of treatment recommendations. To improve the quality of the health care services, the informants stressed the importance of increased clinical competence, more resources enabling more patients to be treated, as well as improved cooperation between the medical and psychiatric treatment units.

Eating pattern and self-esteem in overweight women.

Recent studies have shown that the relationship between poor self-esteem and disturbed eating patterns may be more fully understood when the self-esteem concept is divided into an affective domain ('self-liking') and a cognitive domain ('self-competence'). In the present study 38 overweight women between the ages of 21 and 68 participated in an 8-week weight reduction program whereby the Self-Liking and Competence Scale [SLCS] and the Eating Disorder Scale [EDS-5] were used in order to measure self-esteem and eating patterns, respectively. An improvement in the eating patterns corresponded to an improvement in self-liking, but not in self-competence. Statistically significant weight reduction did occur, but on the average, the subjects still remained overweight. As in other studies on normal weight individuals in analogous test situations completing the same instruments, the results point only to a specific relationship between disturbed eating patterns and self-liking. The results suggest that an increased benefit from a weight reduction program could be expected if strategies for improving eating patterns and self-liking are included. This hypothesis warrants further controlled treatment studies.

Analyzing the relation between self-esteem and eating disorders: differential effects of self-liking and self-competence.

Research in the past has demonstrated an association between low self-esteem and eating disorders. Recent research on self-esteem has shown, however, that self-esteem is composed of two distinct factors--self-liking and self-competence. The present study examined the relation between these two self-esteem factors and both eating disorders and eating disturbed cognitions. A total of 51 female participants from a high-risk population were clinically interviewed to identify the eating disorder and administered a series of questionnaires that included a measure of self-liking and self-competence. A strong relationship was found between self-liking and eating disorders, but no relationship was found between self-competence and eating disorders.

Construction and validation of an anorexia nervosa scale on the MMPI.

The article describes the construction and validation of an anorexia nervosa subscale (ANOR) on the Minnesota Multiphasic Personality Inventory (MMPI). The female subjects included 42 anorexic patients, 56 normal controls and 56 patient controls. Using an empirical discrimination procedure, 60 items contribute to the total homogeneity of the scale and the Chronbach's alpha is 0.86. The five items common with the Hysteria scale represent the highest number of common items with the main MMPI clinical scales. Crossvalidation findings support the results. Content analyses indicate that the ANOR covers important features of anorexia nervosa like a fear of sexual matters, disturbed social relations, rigidity, a depressed mood, low self esteem and a dissatisfaction with appearance.

Early descriptions of eating disorders in the Norwegian medical literature.

By the end of the nineteenth century, anorexia nervosa had acquired a certain amount of recognition in the medical literature in many countries. In Norway, however, little attention had been paid to this eating disorder. Some anorexic-like conditions can be found in case reports on "hysteria" in children, of which the article by Selmer, from 1891, is quoted in extenso.

Insulin-dependent diabetes mellitus: a risk factor in anorexia nervosa or bulimia nervosa? An empirical study of 116 women.

A number of recent studies suggest that diabetes mellitus confers a high risk for the development of anorexia nervosa or bulimia nervosa. In order to test this hypothesis, 56 women with IDDM and 60 non-diabetic female controls were studied. All subjects completed the Eating Attitudes Test (EAT), and the Bulimic Investigatory Test, Edinburgh (BITE). The subjects were interviewed in order to obtain clinical and demographic information as well as to determine test validity. The DSM-III-R criteria of anorexia nervosa and bulimia nervosa were used. Four items were removed from the original EAT in order to eliminate possible bias related to IDDM. The results did not support the hypothesis that eating disturbances occur more frequently in IDDM-patients. Six criteria are proposed to improve the methodological standards of future studies in order to facilitate comparison of results.

Group therapy for anorexic and bulimic patients. Some aspects on the conduction of group therapy and a critical review of some recent studies.

Group psychotherapy for Anorexia Nervosa (AN) and Bulimia Nervosa (BN) patients may be a major therapeutic challenge. The cognitive-behavioural approach may seem promising and some important stages in the conduction of cognitive-behavioural group therapy in particular are discussed. Furthermore, some problems concerning inpatient versus outpatient groups are mentioned. Studies on group therapy that have appeared between 1984 and 1989 are briefly reviewed and some recommendations concerning the improvement of methodology for future studies are put forward.

Outcome and prognosis of anorexia nervosa. A retrospective study of 41 subjects.

An investigation was carried out in 1986 of 41 patients, 39 female and 2 male, who had been treated for anorexia nervosa in a psychiatric ward at a general hospital between 1958 and 1980. A follow-up analysis was carried out, in which 30 subjects participated. Using the scores on the 40-item version of the EAT as outcome criteria, validated by the Morgan-Hayward outcome scales, the outcome distribution and rate of mortality was in agreement with previous findings. Further data concerning weight, menstruation, and nutritional, social and psychiatric status were based on a semistructured interview as well as on the scores on the EAT, the GHQ, and the MMPI. Prognostic variables were analysed, indicating that duration of illness, poor motivation for treatment, social withdrawal, and poor family relations were significant as predictors of poor outcome.