Bulimic Behaviors Research Articles

Effects of an antiandrogenic oral contraceptive on appetite and eating behavior in bulimic women

High androgen levels in women with bulimia nervosa may promote bulimic behavior. The aim of the present study was to investigate the effects of an antiandrogenic oral contraceptive (OC) on appetite and eating behavior in women with bulimia nervosa compared to healthy controls. Twenty-one women with bulimia nervosa and 17 healthy controls matched for age and body mass index participated in the study. Basal and meal-related appetite and secretions of the satiety peptide cholecystokinin (CCK) and the appetite-stimulating peptide ghrelin were studied before and after 3 months of treatment with an antiandrogenic OC (30 microg ethinyl estradiol combined with 3 mg drospirenone). Bulimic behavior was evaluated in relation to changes in hormone levels. Before treatment, bulimic women had higher frequency of menstrual disturbances, acne and hirsutism and higher levels of testosterone but lower meal-related CCK secretion than controls. OC treatment reduced meal-related hunger and gastric distention in bulimics. CCK secretion in response to the meal was unchanged in bulimic women but decreased in the controls. Ghrelin secretion was comparable between groups and did not change in response to OC treatment. The treatment improved bulimic behavior in relation to a decline in testosterone levels in the entire group. Our results support the suggestion that androgens play a role in bulimic behavior. Treatment with an antiandrogenic OC may serve as a new strategy for treatment of bulimia nervosa and particularly in those patients with hyperandrogenic symptoms.

Binge Eating Behaviors, Neuroticism, and Compulsive Clothing Buying: Are They Related?

The purpose of this research is to determine if bulimic behaviors and high levels of neuroticism lead to compulsive clothing buying. Female students from a large midwestern university in the United States were administered a Compulsive Clothing Buying scale, the binging/control subscale of the BULIT-R, and the NEO-FFI personality questionnaire. Using Amos 6.0, a path analysis indicated that neuroticism significantly predicted binging behaviors, and binging tendencies significantly predicted compulsive clothing buying. Neuroticism was not found to be related to compulsive clothing buying directly. Findings may suggest that appearance and appearance-related products are of utmost importance to female consumers who engage in compulsive consumption behaviors (i.e., binging or compulsive buying).

Death and annihilation anxieties in anorexia nervosa, bulimia, and self-mutilation.

Self-starvation, bulimic behavior, and self-mutilation comprise a triad of associated self-harm syndromes that are potentially life threatening, with anorexia nervosa having the highest mortality rate of any psychiatric disorder. They are associated with trauma and are extremely resistant to treatment. These patients present a disturbing lack of anxiety about their own life-threatening behavior, yet are preoccupied with death and anxiety about annihilation. Because dissociation compartmentalizes and separates psychological and somatic aspects of traumatic experience (psychological and somatoform dissociation), it enables these patients to disavow the life-threatening nature of their behavior, which makes the dissociative processes the most destructive factor in this psychopathology. The self-harm symptoms are a presymbolic form of communication that must be decoded and confronted in treatment to make recovery possible. For many patients who starve, purge, or mutilate themselves, the body is speaking of death. They require a treatment that protects their safety, determines their personal construct of death, treats the dissociative pathology and sadomasochism, and builds signal anxiety and other ego functions, especially affect regulation.

Adolescents’ Eating, Exercise, and Weight Control Behaviors: Does Peer Crowd Affiliation Play a Role?

To examine the association between peer crowd affiliation (e.g., Jocks, Populars, Burnouts, Brains) and adolescents' eating, exercise, and weight control behaviors. The roles of gender and ethnicity were also examined. Ethnically diverse adolescents (N = 705; 66% girls) completed the Peer Crowd Questionnaire, eating and exercise items from the Youth Risk Behavior Surveillance System, and weight control behaviors from the Eating Attitudes Test-12. Controlling for gender and ethnicity, adolescents affiliating with the Burnouts reported more unhealthful eating and more bulimic behaviors than others; adolescents affiliating with the Brains reported more healthful eating, less unhealthful eating, and more dieting; those affiliating with Jocks and Populars reported engaging in more exercise; and Populars also reported more unhealthful eating. In addition, boys exercised more than girls; girls reported more dieting and bulimic behaviors. Black adolescents reported more unhealthful eating and less dieting than other adolescents. Along with gender and ethnicity, peer crowd affiliation is related to adolescents' eating, exercise, and weight control behaviors. Prevention programs should consider adolescent peer crowds in developing health promotion and obesity prevention programs.

Functional hypothalamic amenorrhea is associated with elevated ghrelin and disordered eating

To determine whether ghrelin, an orexigen released by the stomach, is elevated in women with hypothalamic amenorrhea who are of normal weight and whether this is associated with abnormal eating behaviors. Controlled clinical study. Healthy volunteers in an academic research environment. Twenty-seven women with functional hypothalamic amenorrhea (FHA) and 42 normally menstruating women. None. Ghrelin and eating behavior. Ghrelin was significantly elevated in FHA (648.4 +/- 92.0 pg/mL vs. controls 596.7 +/- 79.0 pg/mL), while leptin, although lower, was not significantly so (FHA 5.4 +/- 2.8 ng/mL vs. controls 6.4 +/- 3 ng/mL). Eating Attitudes Test (EAT) scores were also significantly elevated in FHA (15.3 +/- 10.6 vs. controls 10.3 +/- 8.4), particularly on the subscale that measured bulimic behaviors. However, FHA patients consumed significantly more kilocalories (1,930 kcal/day vs. 1,588 kcal/day). High ghrelin in women with FHA may be linked to abnormal dietary behaviors, as reflected in high EAT scores yet characterized by normal caloric intake. Ghrelin may act as a restraining metabolic signal preventing a return to cyclicity in women with both disordered eating and FHA, prolonging amenorrhea when leptin has returned to normal.

Childhood adversity, poly-substance use, and disordered eating in adolescent Latinas: Mediated and indirect paths in a community sample

Objective Although many studies have identified associations between childhood maltreatment and later substance use and disordered eating, few have examined causal or explanatory pathways, and whether victim characteristics predict the development of one versus the other of these outcomes remains uninvestigated. Furthermore, relatively little childhood maltreatment research has examined Latino samples. To address these gaps, this study examined among Latina adolescents the effects of sexual abuse, physical/emotional abuse, neglect, disconnection from family, and parental alcohol problems on poly-substance use and disordered eating, and whether five individual characteristics explain or differentiate these outcomes. Method Data from a community sample of 361 Latina adolescents were analyzed using structural equation modeling. Results Physical/emotional abuse predicted poly-substance use and weight concerns, and these associations were mediated by impaired current attachment. Disconnection from family predicted bulimic behaviors, and this association was mediated by dysphoria. One indirect path also emerged: Disconnection from family predicted low social conformity, and low social conformity predicted poly-substance use. Childhood sexual abuse did not uniquely predict any adverse outcome or individual characteristic examined. Conclusions Dysphoria and impaired current attachment appear to play important roles in the development of substance use and disordered eating in Latina adolescents when physical/emotional abuse or disconnection from family predicts these outcomes. Dysphoria and low social conformity may differentiate the development of bulimic behaviors and poly-substance use, respectively, when family disconnection predicts these outcomes.

Is Internalized Homonegativity Related to Body Image?

The authors examined relationships among internalized homonegativity, body image, eating disturbance, and self‐esteem of gay men. Internalized homonegativity is believed to be experienced by all gay men and is tied to self‐esteem, which is a factor in the etiology of eating disorders and body image disturbance. It was hypothesized that internalized homonegativity would predict body image, self‐esteem, and eating disturbance. A total of 213 gay men participated in an online survey that used established measures. Results showed that specific components of internalized homonegativity predict body image, self‐esteem, and bulimic behaviors. Findings imply that internalized homonegativity is a viable link for assessing body image and self‐esteem among gay men. This study adds new dimension to the literature by linking internalized homonegativity with body image and by demonstrating a specific component of internalized homonegativity as predicting the variables tested. Future research and limitations are discussed.

Erratum: Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents

Correction to: International Journal of Obesity (2007) 31, 340–346. doi:10.1038/sj.ijo.0803400 Since the publication of the above paper the authors have noticed an error in the corresponding authors email address. The correct email address for Dr P Isnard is shown below: pascale.isnard@bch.aphp.fr The authors would like to apologize for this mistake.

Perfectionism and eating attitudes in Portuguese university students

The main objective was to explore which are the dimensions of perfectionism that are linked to disordered eating behaviour (EB) in a large non-clinical sample of both genders. One thousand one hundred and sixty-three undergraduate students of the University of Coimbra completed the Portuguese versions of the multidimensional perfectionism scale (MPS) and the eating attitudes test (EAT-40). In both genders, the MPS total score was associated with the EAT total score and all EAT dimensions (except for socially prescribed perfectionism in females). Self-oriented perfectionism (SOP) and socially prescribed perfectionism (SPP) were associated with EAT total score, diet concerns (DC) and bulimic behaviour (BB) in females while in males the social prescribed perfectionism (SPP) was the useful predictor of EAT total score, BB and social pressure to eat (SPE). These results confirm that in general high levels of perfectionism are associated with abnormal EB. This was the case for both genders for SPP but for SOP for females only. The association for other oriented perfectionism (OOP) was greater for males than for females.

Changes in Internal States Across the Binge-Vomit Cycle in Bulimia Nervosa

While there is considerable evidence that bulimic behaviors serve the function of modifying internal states (e.g., satiety, mood), there is less clarity over the roles of the different behaviors across the binge-purge cycle. The present study examines the impact of bingeing and vomiting upon these internal states at different time points, and evaluates the potential reinforcement of those behaviors by the changes in internal states. Twenty-three women with diagnoses of bulimia nervosa completed a diary of all binge-vomit episodes over the course of 7 days, rating their internal states (satiety, negative mood, positive mood) at four time points during each episode. There were substantial changes across the cycle in levels of hunger, fullness, guilt/shame, anxiety/worry, and happiness/relief, but not in other states. The changes indicate that the binge-vomit cycle is maintained by the effects of both behaviors, but that the vomiting behavior evokes the strongest pattern of reinforcement. Further research is needed to determine the levels of internal states during the binge itself.

Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents

Preliminary evidence suggests a comorbidity between attention-deficit/hyperactivity disorder (ADHD) and obesity. This study was carried out to identify the clinical characteristics of obese adolescents with a higher probability of ADHD and advance the understanding of the potential factors underlying the comorbidity between obesity and ADHD. We evaluated the association between ADHD symptoms and bulimic behaviors, depressive and anxiety symptoms, degree of obesity, pubertal stage, age and gender in a clinical sample of obese adolescents. Cross-sectional study. Ninety-nine severely obese adolescents aged 12-17 years. Subjects filled out the Bulimic Investigatory Test, Edinburgh, the Beck Depression Inventory and the State-Trait Anxiety Inventory for Children. Their parents completed the Conners Parent Rating Scale, which assesses ADHD symptoms. The degree of overweight was expressed as body mass index-z score. Puberty development was clinically assessed on the basis of Tanner stages. Bulimic behaviors were significantly associated with ADHD symptoms after controlling for depressive and anxiety symptoms. The degree of overweight, pubertal stage, age and gender were not significantly associated with ADHD symptoms. Obese adolescents with bulimic behaviors may have a higher probability to present with ADHD symptoms independently from associated depressive or anxiety symptoms. The degree of overweight, pubertal stage, age and gender might not be useful for detecting obese adolescents with ADHD symptoms. Therefore, we suggest systematic screening for ADHD in obese adolescents with bulimic behaviors. Further studies are needed to understand which specific dimension of ADHD primarily accounts for the association with bulimic behaviors. Future research should also investigate the causal link between bulimic behaviors and ADHD and explore potential common neurobiological alterations. This may lead to a better understanding of the effectiveness of stimulants for the treatment of bulimic behaviors in obese subjects.

The relationship of momentary anger and impulsivity to bulimic behavior

Past research has suggested that negative affect may be a causal factor for eating disordered behaviors. More specifically, research has shown that anger appears to be one aspect of negative affect that is particularly relevant in bulimic patients. Previous studies have also shown that the relationship between negative affect and eating disordered behaviors may partially depend upon personality variables such as impulsivity. The present study examined whether the relationship between anger and eating disordered behaviors is moderated by impulsivity. Subjects completed an ecological momentary assessment (EMA) protocol for an average of 2 weeks. Findings revealed that overall antecedent anger level and the variability of antecedent anger predicted binge-eating episodes and that these relationships were moderated by participants’ level of impulsivity. These findings suggest that personality variables impact the way that anger and eating behaviors relate. They also suggest that the variability of antecedent anger may be a fruitful avenue for future research for those interested in causal variables associated with bulimia nervosa.

Prevalence of Bulimic Behaviors in Female Athletes

Prevalence of Bulimic Behaviors in Female Athletes

Prevalence of Bulimic Behaviors in Female Athletes

Prevalence of Bulimic Behaviors in Female Athletes

Risk of Postnatal Depression, Miscarriage, and Preterm Birth in Bulimia Nervosa: Retrospective Controlled Study

Bulimia nervosa is common and treatable. An association between bulimia and obstetric complications has been suggested, but sample size and absence of control have limited previous studies. Our aim was to determine if active bulimia nervosa affects obstetric outcome. This was a retrospective case-control comparison of obstetric complications in primigravidae previously treated for bulimia in a specialist eating disorder service. A cohort of 122 women with active bulimia during pregnancy was contrasted against 82 with quiescent bulimia, using structured interviews comprising the Eating Disorders Examination, Structured Clinical Interview for DSM-III-R, and systematic questions addressing obstetric complications. Odds ratios (ORs) for postnatal depression, miscarriage, and preterm delivery were 2.8 (95% confidence interval [CI], 1.2-6.2), 2.6 (95% CI, 1.2-5.6) and 3.3 (95% CI, 1.3-8.8) respectively. Risk of unplanned pregnancy was markedly elevated (OR, 30.0; 95% CI, 12.8-68.7). Risk estimates were not explained by differences in adiposity, demographics, alcohol/substance/laxative misuse, smoking, or year of birth, but relative contributions of bulimic behaviors were not discerned. Active bulimia during pregnancy is associated with postnatal depression, miscarriage, and preterm delivery. Bulimia may be a treatable cause of adverse obstetric outcome.

Cohabitation reduces bulimic symptoms in young women

This current study examines the relationship between cohabitation and changes in bulimic symptoms in young adults. A sample of 2601 initially noncohabitating adolescents was followed over a 5-year period and growth curve analyses were conducted. Females who over the course of the study moved in with a partner had greater decreases in bulimic symptoms compared with female noncohabitators. This difference was highly significant, even if small in size. No such effect was found in males. When examining the frequency of bulimic behaviors in females, the most socially unacceptable bulimic behaviors were those most reduced by cohabitation, whereas less obtrusive bulimic behaviors were not reduced. The results give some indication that social control exercised in close relationships may account for decreased bulimic symptoms in female cohabitators. Further studies are needed to confirm the importance of social control and to examine how it affects symptom reduction.

Childhood emotional abuse and disordered eating among undergraduate females: Mediating influence of alexithymia and distress

Objective Drawing from stress-vulnerability and trauma theory (e.g., Rorty & Yager, 1996), this paper presents a model of associations among child emotional abuse (CEA), alexithymia, general distress (GD), and disordered eating (DE). This study extended previous research on psychological outcomes of child physical and sexual abuse to explore those of CEA using measures of specific emotionally abusive acts. Method Five hundred and eighty-eight female university students completed self-report surveys consisting of measures of CEA, alexithymia, depression, anxiety, and DE. Structural equation modeling was used to test this conceptual model. Results Comparison between measurement models suggested that bulimic behavior is a separate construct from restrictive eating behaviors and body dissatisfaction. In the structural model with the best fit, the association between CEA and DE was mediated by alexithymia and GD (i.e., a component of depression and anxiety). Specifically, CEA was associated with alexithymia, which was further related to GD. Then, restrictive eating behaviors and attitudes mediated the relation between GD and bulimic behaviors. By analyzing a second, nested model, this latter pathway was shown to be important. Conclusion While the best-fitting model is only one of many possibilities, these results point to a weak — but significant — complex relation between CEA and DE. They are associated through a series of mediating relations in a multivariate model including alexithymia and GD. The current study supports research suggesting that child emotional abuse can have a negative impact on its survivors. Treatment of those survivors manifesting disordered eating should be holistic, as opposed to targeted towards specific symptoms.

Evidence for a vagal pathophysiology for bulimia nervosa and the accompanying depressive symptoms

Background The bilateral vagus nerves (Cranial X) provide both afferent and efferent connections between the viscera and the caudal medulla. The afferent branches increasingly are being recognized as providing significant input to the central nervous system for modulation of complex behaviors. In this paper, we review evidence from our laboratory that increases in vagal afferent activity are involved in perpetuating binge-eating and vomiting in bulimia nervosa. Preliminary findings are also presented which suggest that a subgroup of depressions may have a similar pathophysiology. Methods Two main approaches were used to study the role of vagal afferents. Ondansetron (ONDAN), a 5-HT3 antagonist, was used as a pharmacological tool for inhibiting or reducing vagal afferent neurotransmission. Second, somatic pain detection thresholds were assessed for monitoring a physiological process known to be modulated by vagal afferents, including the gastric branches involved in meal termination and satiety. High levels of vagal activity result in an increase in pain detection thresholds. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Positron Emission Tomography (PET) was used to identify higher cortical brain areas activated by vagal stimulation produced by proximal gastric distention in normal eating subjects. Results Double-blind treatment of severe bulimia nervosa subjects with ONDAN resulted in a rapid and significant decrease in binge-eating and vomiting compared to placebo controls. The decrease in abnormal eating episodes was accompanied by a return of normal satiety. Pain detection thresholds measured weekly over the course of the treatment protocol were found to dynamically fluctuate in association with bulimic episodes. Thresholds were the most elevated during periods of short-term abstinence from the behaviors, suggesting that not engaging in a binge/vomit episode is accompanied by an increase in vagal activity. ONDAN also resulted in abolition of the fluctuations in pain thresholds. Depressive symptoms in these subjects also were reduced by ONDAN. Like pain thresholds, depressive symptoms varied dynamically with the bulimic behaviors, with BDI scores increasing (more depressed) as more time elapsed since the last bulimic episode. PET studies indicated that mechanical distention of the stomach with a balloon (a non-nutritive stimulus) was associated with the activation of several brain loci, including those associated with vagal activation (parabrachial nucleus), emotive aspects of eating (lateral inferior frontal and orbitofrontal), and depressive symptoms (anterior cingulate). Conclusions The results of the ONDAN study in bulimia nervosa subjects suggest that cyclic increases in vagal activity drive the urge to binge-eat and vomit. The alterations in vagal firing patterns are possibly a physiological adaptation to the high levels of vagal stimulation initially provided by voluntarily binge-eating and vomiting for weight control. The depressive symptoms that occur in association with the urge to binge-eat are also likely due to the cyclic increase in vagal activity. This suggestion is supported by the reduction of depressive symptoms during ONDAN treatment in bulimia subjects and PET imaging studies in normal eating subjects showing that brain loci classically involved in depression are activated by vagal stimulation administered by mechanical gastric distention. In normal eating individuals, depressions accompanying visceral diseases may also be vagally mediated. Ondansetron and other drugs known to modulate vagal activity may be helpful in treating depressions of this origin.

Predicting Eating Disorder Group Membership: An Examination and Extension of the Sociocultural Model

The purpose of this research was to examine and extend portions of the sociocultural model of bulimia nervosa (Stice, E. (1994). Review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action. Clinical Psychology Review, 14, 633–661; Stice, E., & Agras, W. S. (1998). Predicting onset and cessation of bulimic behaviors during adolescence: A longitudinal grouping analysis. Behavior Therapy, 29, 257–276). Participants were women who reported engaging in binge eating at baseline and the 1-year follow-up ( n = 26), women who began binge eating between these 2 points ( n = 25), and women who did not report binge eating during the course of the study ( n = 199). Results of the first discriminant function analysis provided support for the sociocultural model. However, the results of subsequent analyses suggest that additional variables, including stress, escape-avoidance coping, and interoceptive awareness, emerged as important. Implications of these findings for our understanding of the development and maintenance of binge eating are discussed.

Bulimia Revisited

This review addresses itself to the confusion over the terminology and diagnostic criteria currently in use for the bulimic disorders. It is suggested that the more specific bulimic syndromes should be delineated (e.g., bulimia nervosa), and for the remainder the severity of the disorder should be assessed in individual patients. Among possible indicators of severity, emphasis is given to the assessment of a patients determination to avoid a return to her “healthy weight” (to be defined in each patient). An account is given of two studies testing the actions of methyl amphetamine and fenfluramine in reducing bulimic behavior.