The Eating Disorder Inventory-III Maturity Fears Scale and Treatment Outcome in an Intensive Outpatient Eating Disorder Program

Eating disorders present a significant physical and psychological problem with a prevalence rate of approximately six percent in the United States. Despite the extensive literature, identifying the consistent risk factors for predicting the course of treatment in eating disorders remains difficult. The present study explores the use of a standardized assessment, using the consistently validated Eating Disorder Inventory-III (EDI-3), in predicting treatment outcome. Specifically, the study investigates the particular scale of Maturity Fears (MF) on the EDI-3, hypothesizing that higher scores on the MF scale would predict lower rates of recovery and treatment completion. The participants were 52 eating disorder patients (19 AN, 18 BN, and 15 EDNOS), consecutively admitted to a five-month long intensive outpatient program (IOP). The participants completed an EDI-3 self-report at pre and post treatment, and their score on the MF scale did not show a significant predictive relationship to treatment completion or change in symptoms, as measured by the Eating Disorder Risk Composite (EDRC) scale on the EDI-3. This finding primarily suggests that maturity fears are not a significant predictive factor in an outpatient setting with adults, as compared to previous studies that found a relationship between maturity fears and treatment outcome, primarily with adolescent and inpatient populations.

Therapeutic Assessment for an individual with Binge Eating Disorder: A single-case time-series design .

Therapeutic Assessment (TA) is a treatment approach that combines psychological assessment and psychotherapy. The study examines the efficacy of this approach with an individual with Binge Eating Disorder. A replicated single-case time-series design with daily measures is used to assess the effects of TA and to track the process of change during the TA. The individual experienced inconclusive benefits after participation in TA. Significant change occurred in all variables measured, though none of the changes occurred in the hypothesized direction. Further research is needed to determine if TA is an effective treatment for individuals diagnosed with Binge Eating Disorder.

Eating disorder attitudes and psychopathology in Caucasian Australian, Asian Australian and Thai university students

Objective: To examine eating disorder attitudes and psychopathology among female university students in Australia and Thailand. Method: Participants were 110 Caucasian Australians, 130 Asian Australians and 101 Thais in Thailand. The instruments included the Eating Attitudes Test (EAT) and the Eating Disorders Inventory (EDI). Results: Eating disorder attitudes and psychopathology scores in the Thai group were found to be highest. The Asian Australian group did not have significantly higher scores on the EAT-26 than the Caucasian Australian group, but had higher scores in some subscales of the EDI-2. That the Thai group had the highest scores in susceptibility to developing an eating disorder and eating disorder psychopathology may be partially explained in sociocultural terms, with pressure to be thin more extreme in Thailand than in Australia. The evidence suggested that unhealthy eating disorder psychopathology is not limited to Western societies but is already present in Thai and other Asian societies.

The influence of variations in eating disorder-related symptoms on processing of emotional faces in a non-clinical female sample:an eye-tracking study

This study aimed to: i) determine if the attention bias towards angry faces reported in eating disorders generalises to a non-clinical sample varying in eating disorder-related symptoms; ii) examine if the bias occurs during initial orientation or later strategic processing; and iii) confirm previous findings of impaired facial emotion recognition in non-clinical disordered eating. Fifty-two females viewed a series of face-pairs (happy or angry paired with neutral) whilst their attentional deployment was continuously monitored using an eye-tracker. They subsequently identified the emotion portrayed in a separate series of faces. The highest (n=18) and lowest scorers (n=17) on the Eating Disorders Inventory (EDI) were compared on the attention and facial emotion recognition tasks. Those with relatively high scores exhibited impaired facial emotion recognition, confirming previous findings in similar non-clinical samples. They also displayed biased attention away from emotional faces during later strategic processing, which is consistent with previously observed impairments in clinical samples. These differences were related to drive-for-thinness. Although we found no evidence of a bias towards angry faces, it is plausible that the observed impairments in emotion recognition and avoidance of emotional faces could disrupt social functioning and act as a risk factor for the development of eating disorders.

Middle school teachers' intentions to refer eating disorder students for professional counseling

Eating disorders can lead to a negative impact on students' academic growth, nutrition and can cause death (Claude-Pierre, 1997; Manley, Rickson, & Standeven, 2000; Romeo, 1996). Early intervention by referring students to professional counseling might help counter these negative consequences. The teacher is in the position to assist students by providing health information, identifying those with problems, and intervening for a variety of dysfunctions that may include the eating disorders called anorexia nervosa and bulimia nervosa (Myers-Clark & Christopher, 2000). However teachers are in a difficult position to know when to address student concerns and judge what action to take (Ransley, 1999). Teachers' engagement seems crucial (Smolak, Harris, Levine, & Shisslak, 2001) since eating disorders are being identified in younger children. The purpose of this study was to examine (a) the relationships of the theoretical constructs, attitude, subjective norm, and perceived behavioral control of the theory of planned behavior as predictors of behavioral intention (Ajzen & Fishbein, 1980) of middle school teachers to identify and refer suspected anorexia nervosa (AN) and/or bulimia nervosa (BN) students for professional help; and (b) the actual behavior of middle school teachers who reported having ever referred a student suspected of having AN and BN and those teachers who reported not having made such a referral. One hundred fourteen middle school teachers in Broward County, Florida volunteered to participate in the ex post facto research. Data were collected from a questionnaire. Multiple regression analysis revealed that the constructs of subjective norm (perception of what others think about one's performance of behavior combined with motivation to comply) and perceived behavioral control (perception regarding the extent of the difficulty of performing the behavior) were predictive of teachers' intent (likelihood of engaging in a behavior) to refer. However, the analysis revealed that attitude (overall positive or negative feeling with respect to performing the behavior) was not predictive of teachers' intent. Discriminant function analysis revealed that both intent and perceived behavioral control were predictive of group membership, either having referred a student suspected of having an eating disorder for counseling or not having made such a referral. Attitude and subjective norm were not predictive of group membership.

A preliminary examination of the relationship between compulsive exercise and shame in individuals with an eating disorder: and clinical research portfolio

Objective: To explore the relationship between compulsive exercise and shame in a clinical sample of eating disorder patients. Method: In a cross-sectional study, individuals with an eating disorder (n=21) completed self-report measures of compulsive exercise, internal shame, external shame, bodily shame, anxiety and depression. Results: Internal shame was moderately associated with compulsive exercise (r=.496, p<.05). No further variables were significantly related to compulsive exercise. Individuals with Anorexia-Nervosa and Bulimia-Nervosa did not significantly differ on any of the study variables. Discussion: Hypotheses regarding the possible nature of the relationship between compulsive exercise and shame are suggested. For instance, that compulsive exercise may serve a role in the regulation of internal shame. That compulsive exercise may act as a compensatory behaviour and be a consequence of high levels of shame. Or that internal shame may result as a response to negative perceptions of one’s exercise habits. The results are discussed in line with current literature.

Étude des liens entre l’intensité du trouble alimentaire et le niveau de motivation au changement chez des adolescentes atteintes d’anorexie

Essai doctoral présenté à la Faculté des Arts et des Sciences en vue de l’obtention du grade de Doctorat en Psychologie option clinique (D.Psy.)

Eating disorders in patients with obsessive-compulsive disorder: Prevalence and clinical correlates

Objective: The objective is to evaluate the prevalence and associated clinical characteristics of eating disorders (ED) in patients with obsessive-compulsive disorder (OCD). Method: This is a cross-sectional study comparing 815 patients with OCD. Participants were assessed with structured interviews and scales: SCID-I, Y-BOCS, (Int J Eat Disord 2010; 43:315-325) Dimensional Y-BOCS, BABS, Beck Depression and Anxiety Inventories. Results: Ninety-two patients (11.3%) presented the following EDs: binge-eating disorders [= 59 (7.2%)], bulimia nervosa [= 16 (2.0%)], or anorexia nervosa [= 17 (2.1%)]. Compared to OCD patients without ED (OCD-Non-ED), OCD-ED patients were more likely to be women with previous psychiatric treatment. Mean total scores in Y-BOCS, Dimensional Y-BOCS, and BABS were similar within groups. However, OCD-ED patients showed higher lifetime prevalence of comorbid conditions, higher anxiety and depression scores, and higher frequency of suicide attempts than did the OCD-Non-ED group. Primarily diagnosed OCD patients with comorbid ED may be associated with higher clinical severity. Discussion: Future longitudinal studies should investigate dimensional correlations between OCD and ED. © 2009 Wiley Periodicals, Inc.

Obsessive-compulsive disorder: Influence of age at onset on comorbidity patterns

Purpose: This study investigates the influence of age at onset of OCS on psychiatric comorbidities, and tries to establish a cut-off point for age at onset. Methods: Three hundred and thirty OCD patients were consecutively recruited and interviewed using the following structured interviews: Yale-Brown Obsessive Compulsive Scale; Yale Global Tic Severity Scale and the Structured Clinical Interview for DSM-IV. Data were analyzed with regression and cluster analysis. Results: Lower age at onset was associated with a higher probability of having comorbidity with tic, anxiety, somatoform, eating and impulse-control disorders. Longer illness duration was associated with lower chance of having tics. Female gender was associated with anxiety, eating and impulse-control disorders. Tic disorders were associated with anxiety disorders and attention-deficit/hyperactivity disorder. No cut-off age at onset was found to clearly divide the sample in homogeneous subgroups. However, cluster analyses revealed that differences started to emerge at the age of 10 and were more pronounced at the age of 17, suggesting that these were the best cut-off points on this sample. Conclusions: Age at onset is associated with specific comorbidity patterns in OCD patients. More prominent differences are obtained when analyzing age at onset as an absolute value. © 2008 Elsevier Masson SAS. All rights reserved.

Early onset obsessive-compulsive disorder with and without tics

Introduction: Research suggests that obsessive-compulsive disorder (OCD) is not a unitary entity, but rather a highly heterogeneous condition, with complex and variable clinical manifestations. Objective: The aims of this study were to compare clinical and demographic characteristics of OCD patients with early and late age of onset of obsessive-compulsive symptoms (OCS); and to compare the same features in early onset OCD with and without tics. The independent impact of age at onset and presence of tics on comorbidity patterns was investigated. Methods: Three hundred and thirty consecutive outpatients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD were evaluated: 160 patients belonged to the early onset group (EOG): before 11 years of age, 75 patients had an intermediate onset (IOG), and 95 patients were from the late onset group (LOG): after 18 years of age. From the 160 EOG, 60 had comorbidity with tic disorders. The diagnostic instruments used were: the Yale-Brown Obsessive Compulsive Scale and the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS), Yale Global Tics Severity Scale; and Structured Clinical Interview for DSM-IV Axis I Disorders-patient edition. Statistical tests used were: Mann-Whitney, full Bayesian significance test, and logistic regression. © MBL Communications Inc.

Occurrence of bipolar spectrum disorder and comorbidities in women with eating disorders

Abstract Background Eating disorder (ED) patients often have comorbidities with other psychiatric disorders, especially with mood disorders. Although recent studies suggest an intimate relationship between ED and bipolar disorder (BD), the study on a broader bipolar spectrum definition has not been done in this population. We aimed to study the occurrence of bipolar spectrum (BS) and comorbidities in eating disorder patients of a tertiary service provider. Methods Sixty-nine female patients diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified were evaluated. The assessment comprised the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), clinical criteria for diagnosis of the Zurich bipolar spectrum. Mann–Whitney tests compared means of continuous variables. The association between categorical variables and the groups was described using contingency tables and analyzed using the chi-square or Fisher's exact test. The level of significance alpha was set at 5%. Results The results showed that 68.1% of patients had comorbidity with bipolar spectrum, and this was associated with higher family income, proportion of married people, and comorbidity with substance use. The ED with BS group showed higher rates of substance use comorbidity (40.4%) than the ED without BS group (13.6%). Discussion These results showed that the bipolar spectrum is a common comorbidity in patients with eating disorders and is associated with correlates of clinical importance, notably the comorbidity with substance use. Due to the pattern of similarity between the groups with and without comorbid bipolar spectrum in relation to various outcomes evaluated, the identification of comorbidity can be difficult. However, the precise diagnosis and careful identification of clinical correlates may contribute to future advances in treating these conditions. Further studies are necessary to evaluate the association of other clinical correlates and its possible causal association.

Measurement of disordered eating in Latina college women

The Eating Disorder Risk Composite (EDRC) comprises the Drive for Thinness, Bulimia, and Body Dissatisfaction subscales of the Eating Disorder Inventory, Third Edition (EDI-3, Garner, 2004). Past research conducted with Latina college women (LCW) has found older versions of the EDRC subscales to be reliable, but the EDI-3's EDRC factor structure has yet to be studied among LCW. The present study investigated the pattern of responses to and the factor structure of the EDRC in LCW. It was hypothesized that eating pathology would be present and that a factor analysiswould find some discrepancies between the original factor structure of the EDRC and the factor structure from LCW. Analyses of data on a 6-point Likert scale indicate that drive for thinness and body dissatisfaction are far more prevalent than is bulimic symptomology in LCW. Principal Axis Factoring with promax rotation was used to extract three factors very similar to the original EDRC. Some discrepancies in the item loadings were observed, most notably that half of the items from the original Body Dissatisfaction subscale did not load together on one factor. Overall, the EDRC appears to be a goodmeasurement of eating- and body-related phenomena among LCW. Implications, limitations, and future directions are discussed.

Male eating disorders and related traits : Genetic epidemiological study in Finnish twins

The aim of this study was to deepen the understanding of eating disorders, body image dissatisfaction and related traits in males by examining the epidemiology and genetic epidemiology of these conditions in representative population-based twin samples. The sample of Study I included adolescent twins from FinnTwin12 cohorts born 1983 87 and assessed by a questionnaire at ages 14 y (N=2070 boys, N=2062 girls) and 17 y (N=1857 boys, N=1984 girls). Samples of Studies II-V consisted of young adult twins born 1974-79 from FinnTwin16 cohorts (Study II N=1245 men, Study III N=724 men, Study IV N=2122 men, Study V N=2426 women and N=1962 men), who were assessed by a questionnaire at the age 22-28 y. In addition, 49 men and 526 women were assessed by a diagnostic interview. The overall response rates for both twin cohorts in all studies were 80-90%. In boys, mainly genetic factors (82%, 95% confidence interval [CI] 72-92) explained the covariation of self-esteem between the ages 14 y and 17 y, whereas in girls, environmental factors (69%, 95% CI 43-93) were the largest contributors. Of young men, 30% experienced high muscle dissatisfaction, while 12% used or had used muscle building supplements and/or anabolic steroids on a regular basis. Muscle dissatisfaction exhibited a robust association with the indicators of mental distress and a genetic component (42%, 95% CI 23-59) for its liability in this population was found. The variation of muscle-building substance use was primarily explained by the environmental factors. The incidence rate of anorexia nervosa in males for the age of 10-24 y was 15.7 (95% CI 6.6-37.8) per 100 000 person-years, and its lifetime prevalence by the young adulthood was 0.24% (95% CI 0.03-0.44). All detected probands with anorexia nervosa had recovered from eating disorders, but suffered from substantial psychiatric comorbidity, which manifested also in their co-twins. Additionally, male co-twins of the probands displayed significant dissatisfaction with body musculature, a male-specific feature of body dysmorphic disorder. All probands were from twin pairs discordant for eating disorders. Of the five male probands with anorexia nervosa, only one was from an opposite-sex twin pair. Among women from the opposite-sex pairs, the prevalence of DSM-IV or broad anorexia nervosa was no significantly different compared to that of the women from monozygotic pairs or from dizygotic same-sex pairs. The prevalence of DSM-IV or broad bulimia nervosa did not differ in opposite- versus same-sex female twin individuals either. In both sexes, the overall profile of indicators on eating disorders was rather similar between individuals from opposite-sex and same-sex pairs. In adolescence, development of self-esteem was differently regulated in boys compared to girls: this finding may have far-reaching implications on the etiology of sex discrepancy of internalizing and externalizing disorders. In young men, muscle dissatisfaction and muscle building supplement/steroid use were relatively common. Muscle dissatisfaction was associated with marked psychological distress such as symptoms of depression and disordered eating. Both genetic and environmental factors explained muscle dissatisfaction in the population, but environmental factors appeared to best explain the use of muscle-building substances. In this study, anorexia nervosa in boys and young men from the general population was more common, transient and accompanied by more substantial co-morbidity than previously thought. Co-twins of the probands with anorexia nervosa displayed significant psychopathology such as male specific symptoms of body dysmorphic disorder, but none of them had had an eating disorder: taken together, these traits are suggestive for an endophenotype of anorexia nervosa in males. Little evidence was found on that the risk for anorexia nervosa, bulimia nervosa, disordered eating or body dissatisfaction were associated with twin zygosity. Thus, it is unlikely that in utero femininization, masculinization or postnatal socialization according to the sex of the co-twin have a major influence on the later development of eating disorders or related traits.

As relações entre estilos de apego e habilidades sociais em indivíduos com transtornos alimentares

Os Transtornos Alimentares são caracterizados por graves perturbações no comportamento alimentar. Entre eles, incluímos a anorexia nervosa, a bulimia nervosa e o transtorno da compulsão alimentar periódica. Sua etiologia é multifatorial, estando envolvidos no seu desenvolvimento aspectos biológicos, psicológicos, familiares e sociais. Além das complicações clínicas associadas ao transtorno, encontramos também graves dificuldades interpessoais. Esses déficits contribuem para ocorrência de baixa auto-estima, ansiedade, depressão, retraimento social, e insegurança, dificultando também o desenvolvimento de relações afetivas satisfatórias. O objetivo desse estudo foi investigar as relações entre habilidades sociais, estilos de apego e transtornos alimentares A amostra foi composta por 14 indivíduos com anorexia nervosa (AN), 33 indivíduos com bulimia nervosa (BN), 31 indivíduos obesos com transtorno da compulsão alimentar periódica (TCAP), 31 obesos sem transtorno alimentar, comparados a um grupo controle sem transtornos alimentares, pareados por idade, sexo e anos de estudo. Os instrumentos utilizados foram: Teste de atitude alimentares; Teste de investigação bulímica de Endiburgo, Escala de Compulsão Alimentar Periódica, Inventário de Empatia (IE), o Inventário de Habilidades Sociais (IHS) e a Escala de Apego Adulto (EAA). A avaliação dos dados foi feita através de estatísticas descritivas e inferenciais (Teste T, ANOVA e correlação de Pearson). Os resultados encontrados confirmaram algumas hipóteses desse estudo e corroboraram dados da literatura que sugerem que indivíduos com TA apresentam déficits em habilidades sociais e estilos de apego inseguro, que podem afetar os relacionamentos interpessoais. Ainda foi possível observar que tais deficiências estariam relacionadas a maior gravidade do TA.