Anorexia Nervosa Subtypes Research Articles

Perceived family cohesion, adaptability and communication in eating disorders

Objective: The aim of this study was to investigate the differences in perceived family cohesion, flexibility and communication in patients with eating disorder and their mothers. Method: Seventy-six patients with eating disorders, fifty matched female controls and seventy-nine female medical students completed Family Adaptability and Cohesion Evaluation Scale (FACES II)and Parent-Adolescent Communication Form. Mothers of twenty-nine patients with eating disorders and mothers of matched control subjects completed the same questionnaires. Results: Eating disorder patients perceived their families as less cohesive and less flexible and communication with their mothers as less open and more troubled. Perception of family characteristics differed by subtype of anorexia nervosa. Mothers of eating disorder patients tend to perceive their families as less cohesive and less flexible than mothers in the control group. Mothers in both groups perceived thair families more favourably than their daughters. Conclusions:The results suggest that restrictive anorectic patients perception of families as no different from those in the control group may be due to conflict avoidance and denial. The results confirm significant differences between the subtypes of anorexia nervosa and similarities between bulimic form of anorexia nervosa and bulimia. The daughters regardless od psychological status are more critical of their families than mothers, probably due to their age, fragility, frustrated expectations or separation issues.

Association study of cannabinoid receptor gene (CNR1) alleles and anorexia nervosa: differences between restricting and binging/purging subtypes.

Anorexia nervosa (AN) is a severe and disabling psychiatric disorder, characterized by profound weight loss and body image disturbance. Family and twin studies indicate a significant genetic contribution to this disorder although no genetic mutation has yet been identified. The endocannabinoid system has recently been implicated in many physiological functions including appetite regulation. We, therefore, undertook a family based study to test the hypothesis whether a polymorphism of the CNR1 gene, which encodes human CB1 receptor, a subclass of the central cannabinoid receptor, contributes to the susceptibility to AN. Fifty two families (parents with one or two affected siblings) were genotyped for the (AAT) trinucleotide repeat of CNR1 gene. Using the haplotype relative risk (HRR) method, the distribution of alleles transmitted to the patients was not found to be significantly different from the non-transmitted parental alleles. However, upon dividing the samples to restricting and binging/purging subtypes of AN, the extended transmission disequilibrium test (ETDT) revealed that there is preferential transmission of different alleles in each of the subtypes. The 14 repeat allele was preferentially transmitted in the binging/purging AN group (P = 0.05) but not in the restricting AN group, whereas the 13 repeat allele was preferentially transmitted in the restricting AN group (almost significant, P = 0.07) but not in the binging/purging AN group. Our study suggests that restricting AN and binging/purging AN may be associated with different alleles of the CNR1 gene.

Personality, perfectionism, and attitudes toward eating in parents of individuals with eating disorders.

This study compares personality and eating-related traits in parents of probands with eating disorders, with age-band matched healthy normal controls. Data were abstracted from an international genetic study of anorexia nervosa. Information was available for the Multidimensional Perfectionism Scale (MPS), the Eating Disorders Inventory (EDI), and the Temperament and Character Inventory (TCI). Comparisons were done by multivariate analysis of variance. Mothers of probands showed elevated levels of perfectionism on the MPS and more concerns about weight and shape on the EDI compared with controls. Mothers who had daughters with diagnoses other than the restricting subtype of anorexia nervosa showed elevated levels of perfectionism on the MPS. These data are compatible with the notion that some personality traits, such as perfectionism, and weight and shape concerns may cluster in families of probands with eating disorders.

Evidence for a Susceptibility Gene for Anorexia Nervosa on Chromosome 1

Eating disorders, such as anorexia nervosa (AN), have a significant genetic component. In the current study, a genomewide linkage analysis of 192 families with at least one affected relative pair with AN and related eating disorders, including bulimia nervosa, was performed, resulting in only modest evidence for linkage, with the highest nonparametric linkage (NPL) score, 1.80, at marker D4S2367 on chromosome 4. Since the reduction of sample heterogeneity would increase power to detect linkage, we performed linkage analysis in a subset (n=37) of families in which at least two affected relatives had diagnoses of restricting AN, a clinically defined subtype of AN characterized by severe limitation of food intake without the presence of binge-eating or purging behavior. When we limited the linkage analysis to this clinically more homogeneous subgroup, the highest multipoint NPL score observed was 3.03, at marker D1S3721 on chromosome 1p. The genotyping of additional markers in this region led to a peak multipoint NPL score of 3.45, thereby providing suggestive evidence for the presence of an AN-susceptibility locus on chromosome 1p.

Regional Osteoporosis in Anorexia Nervosa

Letters6 November 2001Regional Osteoporosis in Anorexia NervosaSteven Grinspoon, MD and Anne Klibanski, MDSteven Grinspoon, MDHarvard Medical School; Boston, MA 02114 (Grinspoon, Klibanski)Search for more papers by this author and Anne Klibanski, MDHarvard Medical School; Boston, MA 02114 (Grinspoon, Klibanski)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-9-200111060-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree with Dr. Mehler's comments. We have previously shown that leptin levels are tightly regulated by adipose tissue in women with the restricting subtype of anorexia nervosa (1). Recently, Ducy and colleagues (2) demonstrated that leptin itself may inhibit bone formation through central mechanisms in leptin-deficient and wild-type mice. In women with anorexia nervosa, we have found that low leptin levels are associated with osteopenia and osteoporosis (1). Therefore, we believe that in this population, leptin is more likely to be a marker of fat loss and generalized undernutrition than a determinant of bone density. We agree ...

In search of predictors of dropout from inpatient treatment for anorexia nervosa.

The purpose of the present study was to investigate risk factors associated with premature dropout in the treatment of anorexia nervosa (AN). Eighty-one women who received free inpatient treatment for AN on a clinical research unit at a university-based psychiatric facility participated in this study. Demographic, lifetime, and baseline clinical characteristics as well as self-report measures of eating disorder symptomatology and associated psychopathology were assessed upon admission. Results indicated that AN subtype was [corrected] modestly predictive of treatment dropout. With the exception of AN subtype [corrected], successful completion of inpatient treatment may be unrelated to the severity of eating disorder symptomatology and associated psychopathology. Continued empirical research into factors that influence treatment dropout is clearly needed.

Plasma concentrations of interleukin-1-beta, interleukin-6 and tumor necrosis factor-alpha, and of their soluble receptors and receptor antagonist in anorexia nervosa

Interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) induce anorexia, and multiple behavioral and biochemical alterations that mimic those of anorexia nervosa. Reports in the literature, however, contain contrasting data on the pattern of secretion of the three cytokines and on the downstream activities of their receptors and receptor antagonists in anorexia nervosa. We measured plasma concentrations of IL-1β, IL-6, TNF-α, soluble IL-6 receptor (sIL-6-R), soluble TNF-α receptors I and II (s-TNF-α-R-I and II), and soluble IL-1β receptor antagonist (s-IL-1β-R-A) in 14 female patients with anorexia nervosa (nine restricters, five binge/purgers) and in 13 age- and sex-matched healthy control subjects to see whether the circulating cytokine concentrations and the downstream steps of cytokine activity were impaired, and if these alterations were correlated with some aspects of the disease. Concentrations of IL-1β, IL-6, TNF-α, s-TNF-α-R-I and -II and sIL-1β-RA in plasma did not differ significantly in patients with anorexia nervosa compared with control subjects. Concentrations of sIL-6-R were significantly lower in the patients than in the control subjects, but there were no differences between the two sub-types of anorexia nervosa. The etiopathogenetic significance of the sIL-6-R alteration is not clear, but together with recent data in the literature on cytokine function, the finding suggests that an impairment of the pro-inflammatory cytokine pathway might be involved in the development of anorexia nervosa.

Association between 5HT2A receptor gene promoter region polymorphism and eating disorders in Japanese patients

Background: Evidence from family and twin studies suggests a genetic contribution to the etiology of eating disorders (EDs). Recently, researchers have reported genetic associations between the MspI polymorphism (-1438A/G) of the promoter region of the 5HT2A receptor gene and EDs; however, reports of evidence against these findings make the association controversial. Methods: The authors examined the prevalence of the -1438A/G polymorphism of the 5HT2A receptor gene among 182 Japanese patients with EDs and 374 normal control subjects. Interactions of the association of this polymorphism with subtypes of anorexia nervosa (AN), bulimia nervosa (BN), and various clinical characteristics were also assessed. Results: In contrast to previous studies reporting elevated A allele frequencies in patients with AN, the G allele had a significantly higher frequency in patients with BN but not in patients with AN, than in control subjects. Examination of the interactions revealed that the presence of the binge eating and/or purging behavior and comorbid borderline personality disorder (BPD) tended to be associated with increased frequency of the G allele. Conclusions: Though preliminary, these results can be interpreted as suggesting that the G allele of the 5HT2A receptor gene -1438A/G polymorphism may be associated with pathological features that EDs and BPD have in common, especially disinhibition in eating behavior and personality trait.

The validity of a short version of the Body Shape Questionnaire

This study investigated the ‘construct validity’ (which includes the extent to which a test conforms to predictions from previous observations) of a 14-item version of the Body Shape Questionnaire (BSQ) in 75 patients with psychogenic low weight and a history of full or partial anorexia nervosa (AN). Various predictions were confirmed, i.e. ratings on the BSQ (designed to measure concern about body image) were significantly correlated with ratings for the Eating Attitudes Test, the Bulimia Investigatory Test and the Beck Depression Inventory, and with the body mass index at referral. Also, the binge eating/purging subtype of AN was associated with increased body-image psychopathology. In contrast to a previous report using another questionnaire, this association was independent of body weight. The findings indicate that this shorter version of the BSQ can be used to assess body image psychopathology in patients with psychogenic low weight and to confirm an increased concern about body-image in the binge-eating/purging subtype of AN.

The prevalence and psychological correlates of anorexia nervosa, bulimia nervosa and binge eating among 15-year-old students: a controlled epidemiological study

The present study reports on the prevalence of adolescent anorexia nervosa, bulimia nervosa and binge eating disorders. Also, the hypothesis by Slade (1982) suggesting ‘perfectionism’ and ‘general dissatisfaction’ as setting conditions for eating disorders was tested. A total of 678 15-year-old adolescents were screened, and those who scored above 10 on the ‘drive for thinness’ subscale on the Eating Disorder Inventory (EDI) were interviewed for suspected eating disorders. A gender- and age-matched control group of low scores were also clinically interviewed. The interviewers were blind to whether individuals were suspected of having eating disorders or not. The Setting Conditions for Anorexia Nervosa Scale (SCANS) was used to test the setting condition hypothesis. Other variables included were the EDI subscales ‘Bulimia’ and ‘Body dissatisfaction’. Weight was calculated using the Body Mass Index. For the total material, we found 1.0 per cent with a binge eating disorder, 0.7 per cent with bulimia nervosa, 0.3 per cent with a bulimic subtype of anorexia nervosa and 0.7 per cent with subclinical bulimia nervosa. All subjects were girls. In addition, 3.5 per cent were considered ‘at risk’, of whom we identified 22 girls (3.2 per cent) and two boys (0.3 per cent). High scores on ‘perfectionism’ were unrelated to the presence of eating disorders. Controlling for ‘body dissatisfaction’, ‘general dissatisfaction’, on the other hand, was related to eating disorders and an ‘at-risk’ condition. The prevalence figures in this age cohort equal those for older age groups. The weak support to the setting condition hypothesis may point to an inadequate instrument and not necessarily to a theoretically blind alley. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association.

Binge/purge symptoms and comorbidity in adolescents with eating disorders.

To identify the diagnostic subtypes of eating disorders (EDs), the psychiatric comorbid diagnoses, and associated specific and nonspecific psychopathology in a series of 120 adolescents undergoing standardized assessment for an ED. Consecutive patients referred to our large pediatric hospital for ED assessment completed a semistructured diagnostic interview for children and adolescents. The following self-report scales were administered to assess specific and nonspecific psychopathology: the Children's Depression Inventory (CDI), the Brief Symptom Inventory (BSI), the Eating Disorder Inventory 2 (EDI-2), and the Family Assessment Measure (FAM-III) of family functioning. Female subjects with a mean age of 14.5 years and a mean body mass index (BMI) of 18.1 comprised 93% of the sample. The restrictive subtypes of anorexia nervosa (AN) (43%) and eating disorder not otherwise specified (EDNOS) (16%) were the most common diagnoses. Patients with restricting symptoms (R) could be grouped together because they were more similar to each other with respect to self-report symptoms of psychopathology than they were to patients with binge/purge (B/P) symptoms and vice versa. Patients with R endorsed significantly fewer subjective symptoms, both ED-specific and nonspecific, and rated their families functioning better than did B/P patients. Comorbid, current major depressive disorders and dysthymic disorders occurred in 66% of subjects, but depressive, dysthymic, and oppositional disorders occurred in 96% of those with B/P symptoms. Severity of the CDI was the best single discriminator between R and B/P subjects. Adolescents with EDs in the early stage of their illness are similar to adults with EDs in the following ways: they meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for subtypes of EDs (excluding amenorrhea) and commonly have comorbid psychiatric disorders, especially depressive disorders. Patients with B/P symptoms can be distinguished from restricting subjects because they endorse significantly more ED-specific and nonspecific psychopathology and have a higher frequency of comorbid Axis I diagnoses (especially depressive disorders) than restricting patients. Oppositional defiant disorder (ODD) occurs more commonly in adolescents with EDs associated with B/P symptoms.

5-HT 2A promoter polymorphism in anorexia nervosa

A study 1 Collier DA Arranz MJ Li T Mupita D Brown N Treasure J Association between the 5-HT2A gene promoter polymorphism and anorexia nervosa. Lancet. 1997; 350: 412 Summary Full Text Full Text PDF PubMed Scopus (200) Google Scholar has shown an association between a polymorphism (−1438G/A) in the promoter region of the 5-HT2A gene and anorexia nervosa: Two independent groups failed to replicate these data. 2 Hinney A Ziegler A Nothen MA Remschmidt H Hebebrand J 5-HT2A receptor gene polymorphism, anorexia nervosa, and obesity. Lancet. 1997; 350: 1324-1325 Summary Full Text Full Text PDF PubMed Scopus (77) Google Scholar , 3 Campbell DA Sundaramurthy D Markham AF Pieri LF Lack of association between 5-HT2A gene promoter polymorphism and susceptibility to anorexia nervosa. Lancet. 1998; 351: 499 Summary Full Text Full Text PDF PubMed Scopus (75) Google Scholar We studied this polymorphism in two clinical subtypes of anorexia nervosa and in controls. We analysed the segregation of this polymorphism in 77 female patients with anorexia nervosa, according to DSM-IV criteria (43 restricting-type, body-mass index [BMI] 14·9 [SD 2·6] kg/m 2 Hinney A Ziegler A Nothen MA Remschmidt H Hebebrand J 5-HT2A receptor gene polymorphism, anorexia nervosa, and obesity. Lancet. 1997; 350: 1324-1325 Summary Full Text Full Text PDF PubMed Scopus (77) Google Scholar , and 34 purging type, BMI 16·0 [1·9· kg/m 2 Hinney A Ziegler A Nothen MA Remschmidt H Hebebrand J 5-HT2A receptor gene polymorphism, anorexia nervosa, and obesity. Lancet. 1997; 350: 1324-1325 Summary Full Text Full Text PDF PubMed Scopus (77) Google Scholar , 15–34 years (mean age 24·58 [5·75] years). All patients or their parents gave their informed written consent. We also studied 107 normal female age-matched controls (age 15–36 years, mean age 25·33 [5·57] years), obtained from the DNA bank of the CNR (National Research Council, Florence, Italy). All controls were carefully assessed to exclude any neurological or psychiatric disorders. DNA from affected and non-affected individuals was extracted from transformed lymphoblasts or peripheral blood samples with the phenol-chloroform procedure. Amplification from 200 ng of genomic DNA was done with a Thermal Cycler 9600 (Perkin Elmer). The − 1438G/A polymorphism was analysed as previously described. 1 Collier DA Arranz MJ Li T Mupita D Brown N Treasure J Association between the 5-HT2A gene promoter polymorphism and anorexia nervosa. Lancet. 1997; 350: 412 Summary Full Text Full Text PDF PubMed Scopus (200) Google Scholar The frequencies of 1438G/A alleles were estimated by gene counting. Statistical analysis was done with the χ2 test.

Case Study: An Infection-Triggered, Autoimmune Subtype of Anorexia Nervosa

Certain cases of anorexia nervosa (AN) may be similar to the recently described subtype of childhood-onset obsessive-compulsive disorder hypothesized to be one of the pediatric infection-triggered autoimmune neuropsychiatric disorders (PITANDs). Three clinical cases are reported. The first patient is a 12-year-old boy whose AN worsened acutely after a group A beta-hemolytic streptococcal (GABHS) infection. His symptoms were alleviated after antibiotic treatment. Two other patients with possible PITANDs-related AN are described. An infection-triggered process may contribute to the pathogenesis of a subtype of AN. Future research is needed to explore the nature of PITANDs and their relationship with AN.

Exposure with response prevention treatment of anorexia nervosa-bulimic subtype and bulimia nervosa

Binge exposure with response-prevention of bingeing (ERP-B) was evaluated in 20 female Ss within an inpatient eating disorders unit over 9 sessions as an adjunct to standard milieu therapy. Subjects met DSM-III-R criteria for either bulimia nervosa (BN) (n = 13) or the bulimic subtype of anorexia nervosa (AN-B) (n = 7). The average age of the Ss in each group was 26.5 (±8.8) and 24.1 (±6.0) yr, respectively. Results indicate significant within-session and pre-post treatment effects in self-report measures ‘urge to binge’, ‘lack of control’, ‘feelings of guilt’ and ‘tension’. Further analysis revealed that the AN-B subgroup had significantly greater reduction in ‘depression’ and ‘urge to vomit’ compared to the BN group. This study provides preliminary evidence that ERP-B deserves further investigation with long-term follow-up in both BN and AN-B patients and may be particularly advantageous in the AN-B subpopulation.

Associations between self‐induced vomiting and personality disorder in patients with a history of anorexia nervosa

Fifty-five patients of an eating disorders service with a history of anorexia nervosa (AN), defined by a history of refusal to maintain body weight above a level of 15% below that expected, completed a modified version of the revised Personality Diagnostic Questionnaire (PDQ-R) based on DSM-III-R personality disorders (PD). The subjects were divided into 2 groups based on AN subtypes: vomiters, defined by a history of self-induced vomiting, and non-vomiters, who had maintained low weight mainly or only by diet +/- excessive exercise. Vomiters showed significantly higher scores on self-report measures of borderline and antisocial PD criteria. Discriminant analysis based on PD scores for all 13 DSM-III-R PD categories correctly predicted AN subtype membership based on vomiting history in 85.5% of patients. The implications of PD comorbidity for the development and management of eating disorders are discussed.

Gonadotropin response to LH-RH in anorexia nervosa and bulimia.

Serum LH and FSH levels before and after stimulation with LH-RH were measured in 9 patients with bulimia, 7 with a restricting subtype and 6 with a bulimic subtype of anorexia nervosa. All patients with anorexia nervosa and 5 (56%) patients with bulimia showed amenorrhea for at least 5 months, while 4 (44%) of the bulimic patients showed oligomenorrhea. Mean basal levels of LH and FSH were low in patients with restricting and bulimic anorexia nervosa, but were normal in patients with bulimia. The response of LH and FSH to LH-RH was impaired in approximately half of the patients with the two subtypes of anorexia nervosa, whereas it was normal in all but one patient with bulimia. These results suggest that bulimic patients with amenorrhea or oligomenorrhea have hypothalamic dysfunctions, which do not appear to be due solely to low weight or to metabolic changes resulting from binge eating, vomiting or purgative use.

Outcome Prediction by MMPI in Subtypes of Anorexia Nervosa

Sixty-seven discharged, chronically anorectic inpatients were followed eight to 60 months after discharge at normal weight: 39 with anorexia nervosa, restricting subtype (ANR), and 27 with anorexia nervosa, bulimic subtype (ANB). The groups did not differ demographically. ANB patients produced more elevated MMPI profiles; they were distinguished by profile type as well as by discriminant function analysis, which identified ANB patients as higher in both depression and impulsivity. Outcome criteria, i.e., follow-up weight, bulimic behavior, social functioning, revealed that 39% of all patients maintained treatment gains while 61% relapsed. Forty-nine percent of ANR patients maintained improvement, compared with only 22% of ANB. Minnesota Multiphasic Personality Inventory (MMPI) profiles did not predict outcome across all patients, but did within each subtype. Successful ANR patients were more distressed and dramatic, while greater distress and impulsivity predicted failure among ANB. Prediction of ability to maintain improvement after inpatient treatment was markedly enhanced by first classifying anorectics into clinical subtypes. Higher subjective distress predicted negative outcome in one group and positive outcome in the other. These results may clarify apparent contradictions in the literature and contribute to more focused treatment.

Eating disorders: implications for the 1990's.

In the past decade much has been learned about the clinical features, diagnosis and understanding of people with anorexia nervosa and bulimia nervosa. In order to provide the next level of improvement in our care for these patients, our understanding of certain problems must be addressed by empirical research. Areas which require further study include the definition of high risk groups, the refinement of diagnoses, understanding factors which result in chronicity, determining the complications of chronicity and comparative evaluations of different treatments. These five areas are outlined in this article. Populations at risk for anorexia nervosa and bulimia nervosa may be those who must be thin and achieve according to career choice, those with a particular family and personal psychiatric history; obesity and chronic medical illnesses may be further risks. Improved diagnostic understanding has occurred by the differentiation of bulimic from restricting subtypes of anorexia nervosa. Further work must determine the relationship between the bulimic subtype of anorexia nervosa and bulimia in normal weight women and to further clarify the relationship between eating disorders and affective disorders. A number of factors may result in a chronic illness. These have been described on a variety of levels. The consequences of starvation in altering an individual's thinking, feeling and behaviour do play a role. It is not clear what factors at a neurochemical level contribute to this. Elevated endogenous opiates decreased noradrenergic function and decreased serotonin may be important. Information about the chronic complications is required for clinicians to understand the broad range of difficulties that may develop over time so that clinicians may use this information in planning treatment strategies.(ABSTRACT TRUNCATED AT 250 WORDS)

Thyrotropin, prolactin, and growth hormone responses to thyrotropin-releasing hormone in anorexia nervosa and bulimia

Serum thyrotropin (TSH), prolactin (PRL), and growth hormone (GH) levels were measured before and after stimulation with thyrotropin-releasing hormone (TRH) in 10 patients with bulimia, 7 with features of the restricting subtype of anorexia nervosa, and 6 with bulimic subtype of anorexia nervosa. The mean basal levels of TSH, PRL, and GH did not differ among the three groups. A delayed TSH response was found in 86% of the restricting anorectics, 80% of the bulimic anorectics, and 22% of the bulimics. The PRL response was normal in all patients, with no significant difference among the three groups. Elevated basal GH levels were found in 29% of the restricting anorectics, 33% of the bulimic anorectics, and 33% of the bulimics. An abnormal GH increase after TRH stimulation was observed in 50% of the restricting anorectics, 20% of the bulimic anorectics, and 13% of the bulimics. These results suggest that some patients with bulimia, and some with anorexia nervosa, have a hypothalamic dysfunction. These neuroendocrine abnormalities do not appear to be due solely to low weight or to metabolic changes resulting from binge eating and are not associated with depressive symptoms.

Clinical and personality correlates of body size overestimation in anorexia nervosa and bulimia nervosa

A video camera technique was used to assess perceived actual and ideal size in patients with a restricting type of anorexia nervosa (n = 17), bulimia nervosa patients with previous anorexia (n = 23), bulimia nervosa patients with no previous anorexia (n = 24), phobic controls (n = 18), and normals (n = 33). Bulimic patients with previous anorexia demonstrated a significantly greater tendency to overestimate their actual body size (p <.05) than subjects in the restricting anorexic or control groups. Previously anorexic bulimics also demonstrated more overall clinical and personality disturbance than any of the other groups (p <.01). Body size overestimation and dissatisfaction were strongly associated with the duration and severity of the eating disturbance in previously anorexic bulimics but there were no clear relationships between clinical or personality disturbances and body size distortions in the restricting anorexic or never-anorexic bulimic groups. Results are discussed with respect to the importance of refining diagnostic criteria for subtypes of anorexia and bulimia nervosa. Multitrait-multimethod methodologies are recommended for purposes of elucidating “body image disturbance” and its importance in the etiology and maintenance of eating disorders.