Developmental trajectories of disordered eating from early adolescence to young adulthood: a longitudinal study.

OBJECTIVE: Research examining changes in eating disorder symptoms across adolescence suggests an increase in disordered eating from early to late adolescence. However, relevant studies have largely been cross-sectional in nature and most have not examined the changes in the attitudinal symptoms of eating disorders (e.g., weight concerns). This longitudinal study aimed to address gaps in the available data by examining the developmental trajectories of disordered eating in females from preadolescence into young adulthood. METHOD: Participants were 745 same-sex female twins from the Minnesota Twin Family Study. Disordered eating was assessed using the Total Score, Body Dissatisfaction subscale, Weight Preoccupation subscale, and a combined Binge Eating and Compensatory Behavior subscale from the Minnesota Eating Behavior Survey assessed at the ages of 11, 14, 18, 21, and 25. Several latent growth models were fit to the data to identify the trajectory that most accurately captures the changes in disordered eating symptoms from 11 to 25 years. RESULTS: The best-fitting models for overall levels of disordered eating, body dissatisfaction, and weight preoccupation showed an increase in from 11 through 25 years. In contrast, bulimic behaviors increased to age of 18 and then stabilized to age of 25. DISCUSSION: The findings expanded upon extant research by investigating longitudinal, symptom specific, within-person changes and showing an increase in cognitive symptoms into young adulthood and the stability of disordered eating behaviors past late adolescence.

Genetic and environmental factors underlying comorbid bulimic behaviours and alcohol use disorders: a moderating role for the dysregulated personality cluster?

Women with bulimia nervosa (BN) frequently have co-occurring alcohol use disorders (AUDs). Studies of shared genetic transmission of these disorders have been mixed. Personality heterogeneity among individuals with BN may explain discrepant findings. Cluster analysis has characterized women with BN in groups on the basis of personality profiles. One group, the Dysregulated cluster, characterized largely by behavioural disinhibition and emotional dysregulation may be more closely linked etiologically to AUDs. This study examined whether genetic associations between BN and AUDs are the strongest among the Dysregulated cluster. Symptoms of BN and AUDs were assessed in female twins at ages 17 and 25 years from the Minnesota Twin Family Study. Personality clusters were defined using the Multidimensional Personality Questionnaire. Twin moderation models suggested small-to-moderate common genetic transmission between BN and AUDs. However, shared genetic effects did not differ by personality cluster. Findings suggest that personality clusters are unlikely to account for inconsistent findings regarding their shared aetiology.

Bulimic behaviors and alcohol use: shared genetic influences.

Bulimic behaviors are frequently associated with alcohol use disorders. However, extant family and twin study findings have been inconsistent with regard to whether these behaviors share etiologic influences. A sample of 292 young adult, female twins was used to examine genetic and environmental factors underlying the association between binge eating and compensatory behaviors (e.g., vomiting)and alcohol use. Binge eating and compensatory behaviors were assessed using the Minnesota Eating Behavior Survey.Alcohol use was measured using the Alcohol Use Disorders Identification Test. Univariate models indicated that the heritability of binge eating, compensatory behaviors, and alcohol use was 41, 28, and 78%, respectively, with the remaining variance due to nonshared environmental effects.Bivariate models indicated that there was a moderate-to-large degree of overlap (genetic correlation = 0.31­0.61) in additive genetic factors between alcohol use and binge eating and compensatory behaviors, and no overlap in environmental effects. Findings suggest that these phenotypes co-aggregate in families and that similar genes or heritable traits may be contributing to their co-occurrence.

Etiologic relationships between anxiety and dimensions of maladaptive perfectionism in young adult female twins.

BACKGROUND: Theory and research suggest that maladaptive perfectionism, specifically, concerns about mistakes (CM) and doubts about actions (DA), may be important etiologic and maintenance mechanisms for anxiety and its disorders. However, no studies speaking directly to the origins of the relationship, i.e. what etiologic factors underlie the phenotypic association between anxiety and maladaptive perfectionism, exist. The current study aimed to address this gap in the literature by exploring genetic and environmental relationships between anxiety symptoms and maladaptive perfectionism. METHODS: The sample consisted of 292 young adult same-sex female twins from the Michigan State University Twin Registry. Anxiety symptoms were assessed by the State Trait Anxiety Inventory-Trait version and an anxiety problems scale derived from the Young Adult Self Report. Maladaptive perfectionism was measured using the CM and DA subscales of the Frost Multidimensional Perfectionism Scale. RESULTS: Anxiety and maladaptive perfectionism were both moderately heritable, with estimates ranging from. 45 to .66. Moreover, multivariate analyses revealed that genetic factors were primarily responsible for associations between anxiety and maladaptive perfectionism (r(g) =.59-.88). CONCLUSION: This is the first study to demonstrate the role of genetic factors in the relationship between anxiety and maladaptive perfectionism. Future studies are needed to uncover the specific biologic and genetic factors that contribute to this relationship and to evaluate whether maladaptive perfectionism represents an intermediate trait or risk factor for anxiety.

Genetic and environmental influences on disordered eating and depressive symptoms.

OBJECTIVE: Research suggests that shared genetic factors underlie relationships between eating disorder and depression diagnoses, but no studies to date have examined these associations using dimensional symptom measures. This study examined whether genetic associations observed between eating disorder and depression diagnoses extend to continuous measures of these phenotypes. METHOD: The sample consisted of 292 young adult female twins from the Michigan State University Twin Registry. Disordered eating was measured using the Minnesota Eating Behavior Survey. Depressive symptoms were assessed using the Beck Depression Inventory. RESULTS: Univariate twin models indicated that genetic factors accounted for 55% to 60% of the variance in disordered eating and depressive symptoms, with the remaining variance accounted for by nonshared environmental effects. Bivariate models indicated that genetic factors primarily accounted for associations between disordered eating and depressive symptoms (r(a) = .70). DISCUSSION: Phenotypic associations between disordered eating and depressive symptoms appear to be due to common genetic factors.

The road less traveled: Associations between externalizing behaviors and eating pathology.

OBJECTIVE: Few studies have examined associations between externalizing behaviors and eating disorders in either sex. The current study investigated sex differences in associations between internalizing and externalizing symptoms and disordered eating. METHOD: A sample of 541 men and women completed self-reported measures of disordered eating (e.g., binge eating), internalizing symptoms (e.g., anxiety), and externalizing behaviors (e.g., delinquency). Hierarchical linear modeling was used to examine sex differences in associations between these symptoms and disordered eating. RESULTS: Internalizing symptoms showed the strongest associations with disordered eating in both sexes. Hyperactivity and aggression were more strongly associated with disordered eating in men, whereas alcohol use was more strongly associated with disordered eating in women. DISCUSSION: Results indicated several sex similarities in associations between internalizing symptoms and disordered eating, but some important sex differences among externalizing behaviors. Externalizing behaviors may play a significant role in the development of disordered eating uniquely within men and women.

Negative affect as a mediator of the relationship between weight-based teasing and binge eating in adolescent girls.

Previous research has established a link between weight-based teasing and binge eating, though the precise mechanisms that drive this relationship remain unknown. This study examined negative affect as a mediator of the relationship between weight-based teasing and binge eating. Participants included 265 adolescent female twins (aged 10-15 years). Self-report measures assessed binge eating, weight-based teasing, and negative affect. Mediation was tested within hierarchical linear models to control for the non-independence of the twin data. Significant positive associations were observed between binge eating, teasing, and negative affect. In the regression analyses, negative affect partially mediated associations between weight-based teasing and binge eating. Results suggest that increases in negative affect are one way in which weight-based teasing leads to binge eating in girls. Future studies should examine additional mediators and assess possible clinical applications of these findings.

Eating Behaviors: Prevalence, Psychiatric Comorbidity, and Associations With Body Mass Index Among Male and Female Iraq and Afghanistan Veterans.

OBJECTIVE: There is a dearth of research examining eating behaviors, such as binge eating, among male and female veterans. The present study evaluated the prevalence of self-reported eating problems as well as associations with body mass index and psychiatric disorders among male and female Iraq and Afghanistan veterans. METHODS: Participants were 298 male and 364 female veterans (M = 33.3 ± 10.6 years old) from the Women Veterans Cohort Study, a study of male and female veterans enrolled for Veterans Affairs care in New England or Indiana. Veterans self-reported on emotion- and stress-related eating, eating disorder diagnoses, and disordered eating behaviors. Diagnoses of post-traumatic stress disorder, major depressive disorder, and alcohol abuse were obtained from administrative records. RESULTS: Female veterans reported higher rates of eating problems than did their male counterparts. Women and men who engage in disordered eating had higher rates of post-traumatic stress disorder and major depressive disorder, and women who engage in disordered eating had greater rates of alcohol abuse than did female veterans without eating disordered behaviors. CONCLUSIONS: Disordered eating may be a significant issue among Iraq and Afghanistan veterans, and veterans with eating problems are more likely to have comorbid mental health conditions that further increase their health risks.

Association of Restraint and Disinhibition to Gestational Weight Gain among Pregnant Former Smokers.

INTRODUCTION: Gaining excessive weight during pregnancy is associated with immediate maternal and fetal complications as well as longer term obesity. Prepregnancy body mass index, age, and smoking cessation have been related to gestational weight gain (GWG); however, less is known about how eating behaviors, that may be amenable to modification and have been related to weight gain outside of pregnancy, affect GWG. METHODS: The present study evaluated the relationship of dietary restraint and disinhibition to GWG in a sample of women (n=248) who quit smoking before or early in pregnancy. Women self-reported height and prepregnancy weight during their third trimester. GWG was calculated by subtracting prepregnancy weight from third trimester weight. The Three-Factor Eating Questionnaire assessed restraint and disinhibition. RESULTS: Average GWG was 14.60 (±7.64) kg and 47% of women had a GWG greater than the Institute of Medicine recommendations. Linear regression models were used to examine restraint and disinhibition as correlates of GWG, and multinomial logistic regressions were utilized to determine whether eating behaviors were associated with inadequate or excessive GWG. Restraint was associated positively with total GWG, but disinhibition was not associated with GWG. Thus, conscious attempts to restrict intake were associated with GWG beyond the influence of covariates. CONCLUSION: These findings highlight the potential influence of modifiable eating behaviors on GWG and demonstrate the need for additional research to determine how these behaviors relate to GWG over the course of pregnancy.

Sex differences in genetic and environmental influences on percent body fatness and physical activity.

BACKGROUND: Knowing the extent to which genetic and environmental factors influence percent body fatness (%Fat) and physical activity (PA) would be beneficial, since both are tightly correlated with future health outcomes. Thus, the purpose was to evaluate sex differences in genetic and environmental influences on %Fat and physical activity behavior in male and female adolescent twins. METHODS: Subjects were adolescent (age range 8.3 to 16.6 yr) twins. %Fat (n = 518 twins) was assessed by bioelectrical impedance analysis (BIA) and PA (n = 296 twins) was measured using 3-Day PA Recall. Each activity was converted to total MET-minutes. Univariate twin models were used to examine sex differences in genetic and environmental factors influencing %Fat and PA. RESULTS: %Fat was influenced by genetic effects in both boys and girls (88% and 90%, respectively), with slightly higher heritability estimates for girls. PA was influenced solely by environmental effects for both sexes with higher shared environmental influences in boys (66%) and higher nonshared effects in girls (67%). CONCLUSIONS: When developing interventions to increase PA in adolescents, it is important to consider the environment in which it takes place as it is the primary contributor to PA levels.

Interpersonal dysfunction and affect-regulation difficulties in disordered eating among men and women.

Although several studies suggest that negative affect and interpersonal problems serve as important contributors for eating-related problems, much of this research has been conducted among women and less is known about their roles in precipitating and maintaining eating problems among men. Previous studies with undergraduate men suggest that difficulties in emotion regulation are associated with disordered eating even after controlling for differences in body mass index (BMI) and negative affect. The present study sought to replicate these findings and extend them to assess any unique variance explained by problems in interpersonal functioning among both men and women. Participants were men (n=213) and women (n=521) undergraduates at a large Midwestern university who completed a demographic information form, the Eating Disorder Examination-Questionnaire (EDE-Q), the Difficulties in Emotion Regulation Scale (DERS), the Positive and Negative Affect Schedule, and the Inventory of Interpersonal Problems-Short Circumplex Form (IIP-SC). A series of hierarchical regression analyses indicated that DERS and IIP-SC significantly predicted EDE-Q global scores after controlling for variability in BMI and negative affect and that the results were similar for men and women. Our findings offer preliminary support for models that highlight emotional vulnerability and interpersonal problems for disordered eating for young adult men. Future research extending these findings among treatment-seeking samples and employing multi-method assessment would serve to further clarify the tenability of these theoretical models for both men and women.

Personality clusters and family relationships in women with disordered eating symptoms.

Personality clusters in women with eating disorders predict important clinical variables (e.g., social functioning) better than eating disorder diagnoses. However, it is unknown whether these findings generalize to samples with subclinical pathology. Further, little is known about associations between personality clusters and family relationships. This study sought to address these limitations by replicating personality clusters in a college sample of women with disordered eating symptoms Based on reported symptoms, women were divided into a restricting, binging and purging, or control (i.e., symptom free) group. Participants completed measures of personality, social functioning, and family relationships. Cluster analyses suggested three personality groups (i.e., Adaptive, Rigid, Dysregulated) which corresponded to those identified previously in clinical samples. Personality clusters, and not disordered eating groups, significantly predicted social functioning, and these clusters were differentially associated with family conflict type. Meaningful personality clusters are present in subclinical populations and have clinical utility in predicting social functioning and family relationships.

The dysregulated cluster in personality profiling research: longitudinal stability and associations with bulimic behaviors and correlates.

Among cluster analytic studies of the personality profiles associated with bulimia nervosa, a group of individuals characterized by emotional lability and behavioral dysregulation (i.e., a dysregulated cluster) has emerged most consistently. However, previous studies have all been cross-sectional and mostly used clinical samples. This study aimed to replicate associations between the dysregulated personality cluster and bulimic symptoms and related characteristics using a longitudinal, population-based sample. Participants were females assessed at ages 17 and 25 from the Minnesota Twin Family Study, clustered based on their personality traits. The Dysregulated cluster was successfully identified at both time points and was more stable across time than either the Resilient or Sensation Seeking clusters. Rates of bulimic symptoms and related behaviors (e.g., alcohol use problems) were also highest in the dysregulated group. Findings suggest that the dysregulated cluster is a relatively stable and robust profile that is associated with bulimic symptoms.

Bupropion and cognitive behavioral therapy for weight-concerned women smokers.

BACKGROUND: We previously documented that cognitive behavioral therapy for smoking-related weight concerns (CONCERNS) improves cessation rates. However, the efficacy of combining CONCERNS with cessation medication is unknown. We sought to determine if the combination of CONCERNS and bupropion therapy would enhance abstinence for weight-concerned women smokers. METHODS: In a randomized, double-blind, placebo-controlled trial, weight-concerned women (n = 349; 86% white) received smoking cessation counseling and were randomized to 1 of 2 adjunctive counseling components: CONCERNS or STANDARD (standard cessation treatment with added discussion of smoking topics but no specific weight focus), and 1 of 2 medication conditions: bupropion hydrochloride sustained release (B) or placebo (P) for 6 months. Rates and duration of biochemically verified prolonged abstinence were the primary outcomes. Point-prevalent abstinence, postcessation weight gain, and changes in nicotine withdrawal, depressive symptoms, and weight concerns were evaluated. RESULTS: Women in the CONCERNS + B group had higher rates of abstinence (34.0%) and longer time to relapse than did those in the STANDARD + B (21%; P = .05) or CONCERNS + P (11.5%; P = .005) groups at 6 months, although rates of prolonged abstinence in the CONCERNS + B and STANDARD + B groups did not differ significantly at 12 months. Abstinence rates and duration did not differ in the STANDARD + B group (21% and 19%) compared with the STANDARD + P group (10% and 7%) at 6 and 12 months, respectively. There were no differences among abstinent women in postcessation weight gain or weight concerns, although STANDARD + B produced greater decreases in nicotine withdrawal and depressive symptoms than did STANDARD + P. CONCLUSIONS: Weight-concerned women smokers receiving the combination of CONCERNS + B were most likely to sustain abstinence. This effect was not related to differences in postcessation weight gain or changes in weight concerns. Trial Registration clinicaltrials.gov Identifier: NCT00006170.

Predictors of alcohol problems in college women: the role of depressive symptoms, disordered eating, and family history of alcoholism.

Disordered eating and depressive symptoms are established correlates of alcohol use in college women. Family history of alcoholism (FHA) is also related to problematic alcohol use, but there have been limited studies of how it relates to other established cofactors in women. Predictive associations between disordered eating (i.e., overall levels as well as binge eating), depressive symptoms, and alcohol problems were examined in a sample of 295 female twins. The direct and moderating effects of FHA on the relationships between alcohol problems, disordered eating, and depressive symptoms were investigated. Using hierarchical linear modeling depressive symptoms, but not disordered eating or FHA, significantly predicted alcohol problems. However, there was a significant interaction between disordered eating and FHA; disordered eating was associated with alcohol problems in those with a positive FHA. The implications for high-risk subgroups of college women are discussed.