Bulimic Patients Research Articles

Validating the EDI-2 in three Swedish female samples: Eating disorders patients, psychiatric outpatients and normal controls

The aim of the current study was to validate the Eating Disorders Inventory 2 (EDI-2) in a Swedish population by investigating how it discriminates between three female samples aged 18 to 50 years: patients with eating disorders (n=978), psychiatric outpatients (n=106) and normal controls (n=602), as well as between different eating disorder diagnoses. The internal consistency of the EDI-2 was above 0.70 for most subscales. The EDI-2 discriminated well between patients with eating disorders and normal controls on all subscales. On the symptom-related subscales, eating disorder patients scored highest followed by psychiatric controls and normals. All subscales except Perfectionism, Interoceptive awareness and Asceticism discriminated eating disorder patients and psychiatric controls. Bulimia patients scored higher than anorexics on the symptom subscales. It is concluded that the EDI-2 discriminates well between eating disorder patients and both psychiatric and normal controls.

Correlation between psychometric and biological parameters in anorexic and bulimic patients during and after an intensive day hospital treatment

This study describes: 1. The therapeutic effects on anorexia nervosa (AN) and bulimia nervosa (BN) patients of a psycho-nutritional intensive day-hospital program; 2. The possible correlation between the changes observed in the psychometric tests and the variations of a number of biological parameters. Forty-six female patients (24 AN and 22 BN) were assessed through a semi-structured clinical interview based on DSM-IV criteria for Eating Disorders (ED) and a number of psychometric tests (SCL-90R, BDI, EDI-2, EAT-40, BITE, BAT) at the beginning and at the end of treatment, and after a 6-month follow-up. At these three times, we also assessed the plasma level of leptin, cortisol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and 17beta-estradiol together with body mass index (BMI) and menstrual cycle. From beginning to discharge, the scores on all psychometric tests improved in the whole sample, except for the Perfectionism subscale of EDI-2 in both groups (AN and BN), the Anger-Hostility, Phobic Anxiety and Paranoid Ideation subscales of SCL-90 and the Interpersonal Distrust subscale of EDI-2 in the BN group. At follow-up, there was a worsening of the BITE scores and of a number of EDI-2 subscales, especially in the AN subgroup - with these changes correlating with the trend of BMI. In AN patients, plasma leptin levels changed from the beginning to the end of treatment and at follow-up according to BMI changes. The mean plasma leptin level in the BN subgroup was higher than in the AN one. We found a statistically significant correlation with the scores of BDI, SCL-90R Depression and Ineffectiveness subscales, EAT-40, BITE-Symptom subscale and the trend of menses dividing these patients into two subgroups (according to the plasma leptin concentration, higher or lower than the top leptin level in the anorexics). These data seem to confirm that leptin secretion doesn't correlate univocally to BMI.

Topiramate treatment in bulimia nervosa patients: A randomized, double-blind, placebo-controlled trial

The aim of the current study was to test the influence of topiramate on behavior, body weight, and health-related quality of life (HRQOL) in bulimic patients. Thirty patients with bulimia nervosa were treated with topiramate in a 10-week randomized, double-blind, placebo-controlled study. The subjects were randomly assigned to receive topiramate (topiramate group [TG]; n = 30) or a placebo (control group [CG]; n = 30). Primary outcome measures were changes in the frequency of binging/purging, in body weight, and on the SF-36 Health Survey (SF-36) scales. In comparison to the CG group (according to the intent-to-treat principle), significant changes in the frequency of binging/purging (a > 50% reduction: TG, n = 11 [36.7%]; CG, n = 1 [3.3%]; p < .001), body weight (difference in weight loss between the two groups: 3.8 kg, 95% confidence interval [CI] = -5.4 to -2.1; p < .001), and SF-36 (all ps < .001) could be seen. All patients tolerated topiramate well. Topiramate appears to safe and effective in influencing the frequency of binging/purging, body weight, and HRQOL in bulimic patients.

Dependency and suicidality in addictive disorders

Excessive interpersonal dependency has been described in depression and addictive disorders. Moreover, excessive dependency and suicidality are linked in psychiatric subjects, but their relationships have not been studied in specific addictions. Separate samples of female anorectic patients ( n = 150), female bulimic patients ( n = 95), male ( n = 150) or female ( n = 68) alcoholics, male ( n = 94) or female ( n = 54) drug abusers and non-psychiatric control subjects ( n = 683) were included in the study. On the basis of a structured interview, suicidal ideations, number of previous suicide attempts and diagnoses of dependent personality disorder (DSM-IV) were collected, and the subjects completed the Interpersonal Dependency Inventory and the Beck Depression Inventory. Logistic regression analysis revealed that excessive dependency and notably dependent personality disorder increased the likelihood of suicidal ideation or suicide attempts with a range of 2.65 to 9.42 in bulimic patients, female alcoholics and male drug abusers. Excessive dependency in specific addictive disorders as well as in male non-psychiatric subjects could constitute a risk factor for suicide. This hypothesis must be confirmed using prospective studies.

An attempt at distinguishing subgroups of women with anorexia nervosa and bulimia nervosa by means of the Defense Mechanism Technique modified (DMTm) and the Eating Disorder Inventory (EDI)

In an attempt to identify diagnostically meaningful subgroups in a group of sixty women 18-34 years of age, 19 of them having a DSM-IV diagnosis of anorexia nervosa and 41 of bulimia nervosa, a hierarchical cluster analysis was performed on their data obtained from the Defense Mechanism Technique modified (DMTm) and the Eating Disorder Inventory (EDI). Variables also taken into account in the cluster analysis were those of the main diagnosis, depression, personality disorder, binge eating, purging, Body Mass Index (BMI), and exercise. Five distinct clusters were found. Six of the eight EDI variables and fourteen of the twenty DMTm variables were represented in the description of the clusters. One anorexic and one bulimic cluster included DMTm signs previously found in patients with fibromyalgia. Two bulimic clusters included DMTm signs previously observed in patients with either distal or total ulcerative colitis. Hysteria was linked with the remaining anorexic cluster. On both EDI and DMTm the two main groups of anorexic and bulimic patients displayed few differences. It was mainly the various constellations of DMTm variables, interpreted in terms of the Andersson developmental and psychodynamic model of the mind, that were crucial for understanding the five clusters obtained.

Usefulness of amenorrhoea in the diagnoses of eating disorder patients

We investigated the usefulness of amenorrhoea as a criterion in eating disorder diagnoses. Menstrual history, eating disordered behavior and weight history of 251 female eating disorder inpatients were assessed on admission to hospital. Menstrual status of 88 (35%) could not be assessed (80 taking hormonal contraception, 5 ( < 16 years) had never menstruated, one hysterectomized, 2 postmenopausal). Of the remaining 163; 90 had secondary amenorrhoea (no periods for > 3 months), 19 irregular periods and 54 regular cycles. Some patients with recent changes in energy status, who warranted inpatient treatment for their eating disorder did not develop amenorrhoea until later during their admission. Menstrual disturbance is not limited to anorexia nervosa, 24% of patients with an eating disorder not otherwise specified (EDNOS) and 15% of bulimic patients had amenorrhoea/oligomenorrhoea on admission. The best predictors (82% cases, 83% noncases, R2 = 0.41) of secondary amenorrhoea at admission, were; current BMI ⩽ 18, and having rules for exercising. Menstrual status of women with an eating disorder diagnosis cannot always be assessed, is mostly measuring low body weight and exercise and is not useful in planning or initiating treatment. There is insufficient evidence to support the use of amenorrhoea as a criterion for any eating disorder.

Evaluation and deployment of evidence based patient self-management support program for bulimia nervosa

This article presents initial results from a European multi-centre study to determine the effectiveness and feasibility of an online self-help treatment support program for Bulimia Nervosa (BN). The online program is based on Cognitive Behavioral Therapy (CBT) and consists of seven steps that patients work through progressively. An overall sample of 141 women suffering from BN used the program over a 6-month period. Patients were supported by three face-to-face evaluation interviews with a therapist, and a weekly e-mail contact. Data on general psychopathology and specific eating disorder symptoms were also collected at the evaluation interviews. Initial results from the Swiss sample (N=41) showed significant improvement of overall psychological health (p<.001) as measured by the Symptom Checklist (SCL-90R), and for all dimensions of the Eating Disorder Inventory (EDI-2). An online Self-Help program for BN can be used effectively to reduce eating disorder symptoms in Bulimic patients and user feedback showed that this approach contributed to increase patient involvement and service availability. Additional data from the other centers will further inform the efficacy and impact of this approach.

Effects of Binge Eating Behavior on Fuel Oxidation and Body Composition

Objective: To investigate energy expenditure and glucose metabolism after a standard oral glucose load (75 g) in 8 normal weight bulimic women and 8 normal weight control women and to evaluate the relative endocrine implication.Design: Serum glucose and insulin were measured both in basal conditions and after the glucose load; a basal endocrine assessment and body composition was evaluated and glucose induced thermogenesis (GIT) was calculated during 300 min following the glucose load.Results: Serum glucose levels were significantly lower in bulimics both in fasting and in post-prandial state. Insulin levels were similar in bulimic and control women before and after the glucose load. FSH, leptin and free urinary cortisol (FUC) were all within the normal ranges, but significantly lower in bulimic patients compared with controls (p < 0.001). Fat mass (FM) and Fat-free mass (FFM) were reduced in bulimic patients, even if they normalized after correction per body weight. Resting energy expenditure (REE) was similar in the two groups even after FFM normalization, while GIT was lower in bulimic patients and it was strongly related to free urinary chortisol. Glucose oxidation was higher in fasting state and post glucose load, while lipid oxidation was strongly reduced.Conclusion: An energy preservation mechanism seems to be the key element for normal-weight bulimic patients’ metabolism, consisting in leptin levels and GIT reduction, and lipid oxidation inhibition.

Évolution des boulimiques en psychothérapie dans le test de Rorschach

This purpose of this study is to evaluate the development of female bulimic patients during their treatment and in particular during the psychotherapy. The method of evaluation takes into account the side effects associated with eating disorders with regard to self image and object relations. It consists in comparing the results of the Rorschach test at the beginning (t1) and at a later stage of the therapy (t2). We assume that four properties (determinants, reaction to symmetry, recurence, contents of the response) are likely to show changes that reflect the patient's development between two tests. Results demonstrate certain changes that are linked to the four properties studied.

Homocysteine plasma levels are elevated in females with anorexia nervosa

In the present pilot study significantly (T = 2.46, P = 0.018) higher levels of homocysteine were found in female anorectic patients (14.07, SD 7.3 micromol/l; n = 18) when compared with bulimic patients (10.25, SD 2.82; n = 27) or healthy controls (8.10, SD 1.79; n = 25). Since homocysteine can induce neuronal cell death leading to brain atrophy in different diseases and since it has been linked to depressive disorders these findings may have important implications for understanding common symptoms in patients suffering from anorexia.

Depressive personality dimensions and alexithymia in eating disorders

An association has been reported between high levels of alexithymia and depression in patients with eating disorders. This study has examined alexithymic features and depressive experiences in patients with DSM-IV eating disorder (restricting anorexia, n = 105; purging anorexia, n = 49; bulimia, n = 98) and matched controls ( n = 279). The subjects were assessed with the Toronto Alexithymia Scale (TAS-20); the Beck Depression Inventory; and the Depressive Experiences Questionnaire, which defines two types of depressive personality style (dependent and self-critical). The patients had high levels of alexithymic features and depressive symptoms. Comparisons of alexithymic features between patients and controls after adjustment for depression showed a significant difference between bulimic patients and controls for the TAS Difficulty Identifying Feelings factor, and between restricting anorexic patients and controls for the TAS Difficulty Describing Feelings factor. With regard to depressive personality styles, only scores on the self-critical dimension were significantly higher in bulimic patients than in restricting anorexic patients and controls. In the entire group of eating disorders, dependency was associated with the TAS Difficulty Identifying Feelings factor only in anorexic patients. Self-criticism, on the other hand, was associated with the TAS Difficulty Identifying Feelings factor in all subtypes of eating disorders, although the relationship was significantly stronger in restricting anorexic than in bulimic patients. The results of this study suggest that people with restricting anorexia and bulimia show specific clinical profiles associating alexithymic features and depressive dimensions.

Attachment Styles and Attraction to Death: Diversities Among Eating Disorder Patients

The current research was aimed at examining how attachment styles are connected to attraction to death among eating disorder (ED) patients. A sample of 34 anorexic and 34 bulimic patients was matched by age, sex, and socioeconomic status to 37 normal controls. They were administered the Adult Attachment Scale, the Beck Depression Inventory, and the Multi-Attitude Suicidal Tendency Scale. Results show that ED patients scored significantly higher on the insecure attachment scale and were less attracted to and more repulsed by life than controls. No significant differences were found on death variables. A significant difference between the three attachment styles was found beyond depression. The results suggest a model that may explain the diversities of attachment styles and the relationship with death among ED patients. Insecure attachment style may explain the repulsion by life, while the illness itself may serve as a false “secure base” and may protect from the fear of death. Clinicians may thus attempt to replace the “illness secure base” by enriching the attraction to life.

Blood Levels of the Endocannabinoid Anandamide are Increased in Anorexia Nervosa and in Binge-Eating Disorder, but not in Bulimia Nervosa

The endocannabinoid system, consisting of two cannabinoid receptors (CB1 and CB2) and the endogenous ligands anandamide (arachidonoylethanolamide (AEA)) and 2-arachidonoylglycerol (2-AG), has been shown to control food intake in both animals and humans, modulating either rewarding or quantitative aspects of the eating behavior. Moreover, hypothalamic endocannabinoids seem to be part of neural circuitry involved in the modulating effects of leptin on energy homeostasis. Therefore, alterations of the endocannabinoid system could be involved in the pathophysiology of eating disorders, where a deranged leptin signalling has been also reported. In order to verify this hypothesis, we measured plasma levels of AEA, 2-AG, and leptin in 15 women with anorexia nervosa (AN), 12 women with bulimia nervosa (BN), 11 women with binge-eating disorder (BED), and 15 healthy women. Plasma levels of AEA resulted significantly enhanced in both anorexic and BED women, but not in bulimic patients. No significant change occurred in the plasma levels of 2-AG in all the patients' groups. Moreover, circulating AEA levels were significantly and inversely correlated with plasma leptin concentrations in both healthy controls and anorexic women. These findings show for the first time a derangement in the production of the endogenous cannabinoid AEA in drug-free symptomatic women with AN or with BED. Although the pathophysiological significance of this alteration awaits further studies to be clarified, it suggests a possible involvement of AEA in the mediation of the rewarding aspects of the aberrant eating behaviors occurring in AN and BED.

Enhanced serum cholesterol and triglyceride levels in bulimia nervosa: Relationships to psychiatric comorbidity, psychopathology and hormonal variables

Increased levels of cholesterol have been reported in patients with bulimia nervosa (BN), but all but one of the published studies were performed on non-fasting subjects, which limits the interpretation of this finding. Moreover, the relationships between serum lipids and comorbid psychiatric disorders or bulimic psychopathology have scarcely been investigated. We measured serum levels of total cholesterol, triglycerides, glucose, 17β-estradiol and thyroid hormones in 75 bulimic women and 64 age-matched healthy females after an overnight fast. Compared with healthy women, bulimic patients exhibited significantly enhanced serum levels of cholesterol and triglycerides, but similar values of glucose, 17β-estradiol, FT3 and FT4. No significant differences emerged in these variables between patients with or without comorbid depression, borderline personality disorder or lifetime anorexia nervosa. Circulating cholesterol was positively correlated to the patients' drive for thinness, ineffectiveness, enteroceptive awareness and impulse regulation sub-item scores of the Eating Disorder Inventory-2. These findings confirm that BN is associated with increased levels of serum lipids. This alteration may be involved in the pathophysiology of certain psychopathological characteristics of BN and cannot be explained by the co-occurrence of other psychiatric disorders.

Biochemical parameters in identifying patients with anorexia and bulimia nervosa

Biochemical parameters are shown to evaluate nutritional status in eating disordered patients in anorexia and bulimia nervosa. The spectrum of blood essential amino acids and nonessential amino acids are shown that are comparable between malnutrition and anorexia patients whereas bulimia patients showed better nutritional status. Comparison between total branched chain amino acid and neutral large amino acids are also shown together with blood content of cholecystokinin tetrapeptide sulfate (CCK-8s), cholesterol and cortisone. From this study it is suggested that, instead of DSM-IV as a classical method to assess both bulimics and anorectics, these parameters can be used to determine their nutritional status prior to therapy adopted and during any therapeutic approach.

Étude du processus de catégorisation chez des patientes aux troubles des conduites alimentaires : une nouvelle approche cognitive de la psychopathologie

Resume Les patientes anorexiques et boulimiques ont un rapport aux aliments et a l’alimentation en general fortement perturbe, alors qu’elles possedent pour la plupart de bonnes connaissances dietetiques et nutritionnelles. Quelques travaux ont objective des dysfonctionnements cognitifs sans vraiment les preciser, c’est pourquoi nous avons souhaite explorer le processus cognitif de categorisation qui constitue une fonction principale de la structuration de notre univers mental. Deux experimentations successives nous ont permis de montrer que les processus de categorisation utilises par les patientes anorexiques et boulimiques sont fort differents de ceux de sujets temoins. Le deuxieme temps experimental nous permet de preciser que ces patientes privilegient fortement les caracteristiques fonctionnelles attribuees aux aliments, alors que les sujets temoins accordent une importance privilegiee aux caracteristiques structurales.

Bulimic Patients Respond to Family Therapy, CBT

Bulimic Patients Respond to Family Therapy, CBT

FPI profiles in a European sample of 1068 female patients suffering from anorexia or bulimia nervosa

Thirty-two centres from nine European countries participated in a research programme about eating disorders. This study presents results of patients aged 17–26 years suffering from anorexia (N = 418) and bulimia nervosa (N = 650) according to DSM-IV criteria (American Psychiatric Association, 1994). Patients' personality profiles were assessed with the revised version of the Freiburger Personality Inventory (FPI-R). Compared to the comparison subjects, the eating-disordered patients showed lower life satisfaction, health concern and extraversion and higher social orientation, inhibition, irritability, strain, somatic complaints, frankness and emotionality. Anorexic patients had similar scores to the comparison group on achievement orientation and aggressiveness scales. Non-purging bulimic patients were not different from comparison subjects in aggressiveness and purging bulimic patients showed no difference for extraversion. Differences in the diagnostic subgroups are discussed in light of the literature in this area. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.

Predictive factors of social disability in anorexic and bulimic patients

The purpose of this study was to determine whether subjects suffering from anorexia nervosa (AN) or bulimia nervosa (BN) would demonstrate more severe social disability than a control group; and whether social disability could be best explained as a function of the eating disorder itself or as a function of comorbid anxiety or depressive disorders. Subjects were 166 AN subjects, 105 BN subjects and 271 control subjects matched for age, sex and socio-economic status. Prevalence of anxiety or depressive disorders was assessed (through the Mini International Neuropsychiatric Interview), and social functioning was measured (through the Groningen scale). The majority of AN and BN subjects demonstrated social disability in the "social role" (leisure time, time spent with friends) and the "occupational role" (work or educational activities). A regression analysis was employed to uncover predictive factors of social disability. Eating disorders (AN and BN), anxiety disorders and depression accounted for a large portion of social disability. Anxiety and depressive disorders appear to play an important role in the type of social disability demonstrated in eating disorder patients. Therapeutic implications are discussed.

Validity of the Eating Attitudes Test: A study of Mexican eating disorders patients

To evaluate the psychometric properties of the Mexican version of the Eating Attitudes Test (EAT-40) in clinical and control populations in Mexico City. 276 female patients with eating disorders [52 with anorexia nervosa (AN), 102 with bulimia nervosa (BN) and 122 with eating disorders not otherwise specified (EDNOS)] and a comparison group of 280 normal control female subjects completed the EAT. The EAT had an adequate level of internal consistency in the clinical sample (Cronbach's alpha=0.90). Total score was significantly correlated with criterion group membership (r=0.77, p< or =0.0001), suggesting a high level of concurrent validity. There was a small overlap in the frequency distribution of the 2 groups (eating disorders and control) and only 6% of the normal controls scored as high as lowest anorexic and bulimic patients. The factorial analysis yielded five factors accounting for 46.6% of total variance: 1) Dietary restraint, 2) Bulimia, 3) Drive of thinness, 4) Food preoccupation and 5) Perceived social pressure. This study provides evidence that the Mexican version of the EAT is an economical, reliable and potentially useful instrument for research in this field.