Clinical Eating Disorders Research Articles

Ultra-Marathon Athletes at Risk for the Female Athlete Triad.

BackgroundWorldwide female participation in ultra-endurance events may place them at risk for the female athlete triad (FAT). The study objectives were to establish triad knowledge, occurrence of disordered eating and triad risk amongst participants of the 2014 89-km Comrades Marathon event.MethodsA survey utilising the Low Energy Availability in Females questionnaire (LEAF-Q) and Female Athlete Screening Tool (FAST) questionnaire was conducted on female participants in order to determine the risk. In addition, seven questions pertaining to the triad were asked in order to determine the athlete’s knowledge of the triad. Athletes were requested to complete the anonymous questionnaire after written informed consent was obtained while waiting in the event registration queues. Statistical analyses included Pearson product–moment correlations, chi-square tests and cross-tabulations to evaluate associations of interest.ResultsKnowledge of the triad was poor with 92.5 % of participants having not heard of the triad before and most of those who had, gained their knowledge from school or university. Only three athletes were able to name all 3 components of the triad. Amenorrhoea was the most commonly recalled component while five participants were able to name the component of low bone mineral density. Of the 306 athletes included in the study, 44.1 % were found to be at risk for the female athlete triad. One-third of participants demonstrated disordered eating behaviours with nearly half reporting restrictive eating behaviours. There is a significant association between athletes at risk for the triad according to the LEAF-Q and those with disordered eating (χ2(1) = 8.411, p = 0.014) but no association (or interaction) between triad knowledge and category (at risk/not at risk) of LEAF-Q score (χ2(1) = 0.004, p = 0.949). More athletes in the groups with clinical and sub-clinical eating disorders are at risk for the triad than expected under the null hypothesis for no association.ConclusionsOnly 7.5 % of the female Comrades Marathon runners knew about the triad despite 44.1 % being at a high risk for the triad. Therefore, education and regular screening programmes targeting these athletes are overdue. Postmenopausal athletes are at particularly high risk for large losses in bone mass if they experience chronic energy deficiency and hence require special focus.

Coach Pressure and Disordered Eating in Female Collegiate Athletes: Is the Coach-Athlete Relationship a Mediating Factor?

When athletes “uncritically accept” the coaching expectations associated with their sport, negative health consequences (e.g., disordered eating behaviors, clinical eating disorders) may result. The coach’s influence on disordered eating behaviors may be a product of factors related to overconformity to the sport ethic, issues with coach communication regarding recommendations for weight management, and the strength of the coach-athlete relationship. The present study investigated perceived weight-related coach pressure, the coach-athlete relationship, and disordered eating behaviors by surveying 248 female varsity athletes and dancers from four universities. Mediational analysis revealed that the coach-athlete relationship was a partial mediating variable between perceived coach pressures and disordered eating behaviors. Subsequently, strong relationships between coaches and their athletes may reduce the negative impact of perceived weight-related coach pressure on the development or exacerbation of disordered eating behaviors in female collegiate athletes.

Religiosity, spirituality in relation to disordered eating and body image concerns: A systematic review.

ObjectiveThis systematic review aims to critically examine the existing literature that has reported on the links between aspects of religiosity, spirituality and disordered eating, psychopathology and body image concerns.MethodA systematic search of online databases (PsycINFO, Medline, Embase and Web of Science) was conducted in December 2014. A search protocol was designed to identify relevant articles that quantitatively explored the relationship between various aspects of religiosity and/or spirituality and disordered eating, psychopathology and/or body image concerns in non-clinical samples of women and men.ResultsTwenty-two studies were identified to have matched the inclusion criteria. Overall, the main findings to emerge were that strong and internalised religious beliefs coupled with having a secure and satisfying relationship with God were associated with lower levels of disordered eating, psychopathology and body image concern. Conversely, a superficial faith coupled with a doubtful and anxious relationship with God were associated with greater levels of disordered eating, psychopathology and body image concern.DiscussionWhile the studies reviewed have a number of evident limitations in design and methodology, there is sufficient evidence to make this avenue of enquiry worth pursuing. It is hoped that the direction provided by this review will lead to further investigation into the protective benefits of religiosity and spirituality in the development of a clinical eating disorder. Thus a stronger evidence base can then be utilised in developing community awareness and programs which reduce the risk.

The effects of calorie labels on those at high-risk of eating pathologies: a pre-post intervention study in a University cafeteria

ObjectivesThe aim of the study was to examine the effect of a public policy (menu labelling) on those at high-risk for eating pathologies. Specifically, the study looked for any adverse effects related to eating disturbance level. Study designThe study employed a pre-post intervention design. Baseline collection took place in October 2012. One week prior to follow-up in November 2012, calorie labels were displayed next to virtually all menu items in a University cafeteria. Labels remained throughout the entire duration of follow-up. MethodsParticipants were female undergraduates (N = 299). At baseline and follow-up, a survey assessed eating disturbance level (Eating Attitudes Test-26), emotional state, frequency of engaging in unhealthy weight-related behaviours, and calorie consumption. ResultsGeneralized estimating equations were used to test changes in negative outcomes over time in response to calorie labels. Calorie consumption did not significantly decrease from baseline (mean = 660.5 kcal) to follow-up (mean = 600.5 kcal; P = 0.104). There were no changes in emotional states such as body image satisfaction (P = 0.447), anxiety (P = 0.595), positive affect (P = 0.966), negative affect (P = 0.576), and unhealthy weight-related behaviours such as binging (P = 0.268), exercising excessively (P = 0.847), or restricting calories (P = 0.504). Additionally, there were no interactions between eating disturbance level and time. ConclusionsOverall, no adverse outcomes were found for this at-risk population. Calorie labels did not differentially affect those with higher levels of eating disturbance. Future research should focus on examining the impact of calorie labels among those with clinical eating disorders.

Negative affect prior to and following overeating-only, loss of control eating-only, and binge eating episodes in obese adults.

The objective was to examine the trajectory of five types of negative affect (global negative affect, fear, guilt, hostility, sadness) prior to and following three types of eating episodes (overeating in the absence of loss of control [OE-only], loss of control eating in the absence of overeating [LOC-only], and binge eating) among obese adults using ecological momentary assessment (EMA). Fifty obese adults (84% female) completed a two-week EMA protocol during which they were asked to record all eating episodes and rate each episode on continua of overeating and loss of control. Momentary measures of global negative affect, fear, guilt, hostility, and sadness were assessed using an abbreviated version of the Positive and Negative Affect Schedule (PANAS). Trajectories for each of the five types of negative affect were modeled prior to and following episodes of OE-only, LOC-only, and binge eating. Consistent with previous findings, global negative affect and Guilt increased prior to and decreased following binge eating episodes (all ps < .05). Guilt also decreased following OE-only episodes (p < .05). These results are consistent with the affect regulation model of binge eating and suggest that binge eating may function to regulate global negative affect, and more specifically, guilt among obese adults. These data suggest that the relationship between negative affect and binge eating may not be unique to individuals with clinical eating disorders and indicate that targeting negative affect may be an effective strategy for the treatment of binge eating in the context of obesity.

The Reliability and Validity of the Clinical Perfectionism Questionnaire in Eating Disorder and Community Samples.

Clinical perfectionism is a risk and maintaining factor for anxiety disorders, depression and eating disorders. The aim was to examine the psychometric properties of the 12-item Clinical Perfectionism Questionnaire (CPQ). The research involved two samples. Study 1 comprised a nonclinical sample (n = 206) recruited via the internet. Study 2 comprised individuals in treatment for an eating disorder (n = 129) and a community sample (n = 80). Study 1 factor analysis results indicated a two-factor structure. The CPQ had strong correlations with measures of perfectionism and psychopathology, acceptable internal consistency, and discriminative and incremental validity. The results of Study 2 suggested the same two-factor structure, acceptable internal consistency, and construct validity, with the CPQ discriminating between the eating disorder and control groups. Readability was assessed as a US grade 4 reading level (student age range 9-10 years). The findings provide evidence for the reliability and validity of the CPQ in a clinical eating disorder and two separate community samples. Although further research is required the CPQ has promising evidence as a reliable and valid measure of clinical perfectionism.

Eating disorders in adult women: biopsychosocial, developmental, and clinical considerations

Research and clinical practice indicate that increasing numbers of adult women are suffering from both clinical and subclinical eating disorders and are now seeking treatment. The unique needs and experiences of this population bear examination through the lens of female adult development. The rapid increase in eating disorders, the ongoing gender disparity, and the complex realities of female biology suggest that this evaluation will be best informed by a biopsychosocial perspective. Developmental transitions including marriage, divorce, pregnancies, parenting, menopause, and the ageing process all create risk in an era that promotes weight loss, thinness, and a youthful appearance as the ultimate signs of success for women. Globalisation has contributed to the emergence of eating disorders in diverse countries and cultures. Consequently, all primary mental health and medical providers must understand the risk factors, signs, and symptoms of adult eating disorders, as well as the effect of environmental ...

Depression and anxiety in early adulthood following adolescent onset disordered eating: a longitudinal study

Disordered eating is common among adolescent females. Clinical eating disorders are associated with high rates of depression and anxiety in adulthood. However, the extent to which this is the case for subthreshold disordered eating remains unclear, and raises issues for early detection and intervention, prognosis and treatment planning. The current study aimed to enhance knowledge on the longitudinal course of adolescent onset disordered eating and young adult psychopathology (specifically depression and anxiety); and to establish whether the outcomes differed among males and females. Longitudinal data from a large community sample, the Australian Temperament Project (ATP) was utilized, with respect to disordered eating staus during adolescence and mood and anxiety symptoms in early adulthood (N = 686). Overall, adolescents meeting the criteria for subthreshold disordered eating have higher levels of anxiety in adulthood compared to the non-disordered eating group. Furthermore, males with disordered eating experienced higher levels of depression at eight-year follow up. Given the level of subsequent psychopathology associated with adolescent onset disordered eating, targeting preventative interventions at adolescents with subthreshold disordered eating may reduce the risk of developing a clinical eating disorder as well as reducing the risk of developing depression and anxiety in early adulthood. This abstract was presented in the Disordered Eating and Body Image stream of the 2014 ANZAED Conference.

Is Feeling Extraneous from One's Own Body a Core Vulnerability Feature in Eating Disorders?

Objective: To identify core vulnerability features capable of discriminating subjects who are more prone to develop eating disorders. Sampling and Methods: A nonclinical group composed of 253 university students was studied by means of the Identity and Eating Disorders questionnaire (IDEA), exploring abnormal attitudes toward one's own body and difficulties in the definition of one's own identity, the Body Uneasiness Test (BUT) and different self-reported questionnaires evaluating the specific and general psychopathology of eating disorders. The results were compared with those of a clinical eating disorder group. Results: In the student sample, a group composed of 35 subjects with abnormal eating patterns and a group (218 subjects) without such features were identified. The IDEA total and subscale scores were found to be significantly higher in subjects with abnormal eating patterns than in subjects without them (all p < 0.001). Positive correlations between the IDEA total and subscale scores and the BUT global score were observed in both groups (all p < 0.01). The comparison of the scores on the IDEA between the clinical group (patients with full-blown eating disorders) and the subjects with abnormal over-threshold eating patterns yields a significant difference in the ‘feeling extraneous from one's own body' subscale of the IDEA. Conclusions: The IDEA resulted in being a valid instrument to identify a vulnerability to eating disorders in subjects with abnormal eating patterns in the general population and to recognize the presence of a significant discomfort related to the body. Feeling extraneous from one's own body is the experience that discriminates most between clinical and nonclinical subjects.

Psychometric properties of the Compulsive Exercise Test in an adolescent eating disorder population

The objective of this study was to evaluate the factor structure, validity, and reliability of the Compulsive Exercise Test (CET) in an adolescent clinical eating disorder population. The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project, a prospective ongoing registry study comprising consecutive pediatric tertiary eating disorder referrals. Adolescents (N=104; 12–17years) with eating disorders completed the CET and other measures. Factor structure, convergent validity, and internal consistency were evaluated. Despite failing to identify a factor structure, the study provided clear evidence of the multidimensionality of the measure. The total score correlated significantly with measures of eating pathology, perfectionism, and frequency of exercise for shape and weight control (r=0.32–0.70, ps<0.05). More research into the multidimensional nature of compulsive exercise in clinical populations is needed. Further, research into compulsive exercise offers promise as an addition to existing cognitive behavioral models and treatments for eating disorders.

Somatoform dissociation among Swedish adolescents and young adults: The psychometric properties of the Swedish versions of the SDQ-20 and SDQ-5

Background: Somatoform dissociation is supposed to be a vital aspect of the general concept of dissociation. The Somatoform Dissociation Questionnaire-20 (SDQ-20) and the brief version SDQ-5 are self-report instruments constructed to identify somatic dissociation. Aim: In the present study, the psychometric qualities of the Swedish version of the SDQ-20 and its brief version, the SDQ-5, were examined among adolescents and young adults. Reliability and concurrent validity were investigated. Methods: A total of 512 adolescents and young adults participated in the study: 461 adolescents from a non-clinical sample and 50 adolescents and young adults from a clinical eating disorder outpatient unit. They completed the self-report instruments the SDQ-20, the SDQ-5 (part of SDQ-20), the Linköping Youth Life Experience Scale (LYLES, a trauma history scale) and the Dissociation Questionnaire-Sweden (Dis-Q-Sweden). Results: Both internal consistency and test–retest reliability of the Swedish version of SDQ-20 were good in both the non-clinical (α = 0.83) and the clinical groups (α = 0.84); the reliability for the SDQ-5 was, however, lower (non-clinical α = 0.50, clinical α = 0.64). Significant differences were found between the clinical and non-clinical groups on both somatoform and psychoform dissociation. Correlations between the Dis-Q-Sweden, SDQ-20 and SDQ-5 were generally high. The criterion and convergent validity was acceptable for both scales but somewhat better for SDQ-20 than for SDQ-5. Conclusion: The advantage with both the SDQ-20 and the SDQ-5 is that they are short questionnaires, but the results suggests that SDQ-20 is preferable based on the higher-quality psychometric properties of the SDQ-20.

The Comorbidity of ADHD and Eating Disorders in a Nationally Representative Sample

Evidence suggests a comorbidity of childhood attention-deficit/hyperactivity disorder (ADHD) and subsequent eating disorders. However, most studies have assessed this comorbidity among patient populations as opposed to nationally representative samples and have not explored differences by subtype of each disorder. The current study aims to investigate the association between both clinical (i.e., diagnosed) and subclinical (i.e., presence of behaviors but not all diagnostic criteria) ADHD and eating disorders via a secondary data analysis of the National Longitudinal Study of Adolescent Health (n = 12,262). Results reveal that those with clinical ADHD are more likely to experience (a) clinical eating disorder, (b) clinical-level binging and/or purging behaviors, and (c) clinical-level restrictive behaviors. Those with subclinical ADHD (both inattentive and hyperactive/impulsive) were more likely to experience subclinical binging and/or purging behaviors but not subclinical restrictive behaviors. Implications of study findings pertain to both secondary/targeted prevention of eating disorders and tertiary prevention via patient-specific treatment plans.

Sexual orientation and disordered eating behaviors among self-identified male and female college students

This study compared the risk of a) clinically diagnosed eating disorders, and b) disordered eating behaviors, separately among three groups of United States college students, controlling for known covariates. These groups included college students self-identifying as: 1) gay/lesbian; 2) bisexual; and, 3) unsure, with self-identified heterosexuals as the reference. Data from the American College Health Association's National College Health Assessment II (2008–2009) were utilized (N=110,412). Adjusted logistic regression analyses, stratified by self-reported gender, examined the effect of self-identified sexual identity on clinical eating disorder diagnosis and disordered eating behaviors. Covariates included self-reported binge drinking (past 2weeks), stress (last 12months), smoking (past 30days), depression (past 12months), fraternity/sorority membership, college athletics participations, and race. Additional logistic regression sub-analyses examined sexual minorities only, with gay/lesbian as the referent. Gay, unsure, or bisexual men were at significantly increased odds to report both clinical eating disorders and disordered eating behaviors when compared to heterosexual men in both the unadjusted and adjusted models (p<.002). All sexual minority men and women were significantly more likely to report dieting to lose weight compared to heterosexual men and women (p<.002). Targeted disordered eating and eating disorder prevention efforts are needed for those who are sexual minorities, particularly for sexual minority men.

Measuring eating disorder attitudes and behaviors: a reliability generalization study.

BackgroundAlthough score reliability is a sample-dependent characteristic, researchers often only report reliability estimates from previous studies as justification for employing particular questionnaires in their research. The present study followed reliability generalization procedures to determine the mean score reliability of the Eating Disorder Inventory and its most commonly employed subscales (Drive for Thinness, Bulimia, and Body Dissatisfaction) and the Eating Attitudes Test as a way to better identify those characteristics that might impact score reliability.MethodsPublished studies that used these measures were coded based on their reporting of reliability information and additional study characteristics that might influence score reliability.ResultsScore reliability estimates were included in 26.15% of studies using the EDI and 36.28% of studies using the EAT. Mean Cronbach’s alphas for the EDI (total score = .91; subscales = .75 to .89), EAT-40 (total score = .81) and EAT-26 (total score = .86; subscales = .56 to .80) suggested variability in estimated internal consistency. Whereas some EDI subscales exhibited higher score reliability in clinical eating disorder samples than in nonclinical samples, other subscales did not exhibit these differences. Score reliability information for the EAT was primarily reported for nonclinical samples, making it difficult to characterize the effect of type of sample on these measures. However, there was a tendency for mean score reliability to be higher in the adult (vs. adolescent) samples and in female (vs. male) samples.ConclusionsOverall, this study highlights the importance of assessing and reporting internal consistency during every test administration because reliability is affected by characteristics of the participants being examined.

Unhealthy Weight Control Behaviors and Related Risk Factors in Massachusetts Middle and High School Students

Unhealthy weight control behaviors may be precursors to clinical eating disorders; therefore, it is important to identify these actions, and what may trigger them, as early as possible. We used 2009 and 2011 Massachusetts Youth Health Survey data for middle and high school students. We studied age, sex, and race disparities related to unhealthy weight control behaviors in conjunction with other risk factors such as body mass index (BMI), body weight perception, involvement in bullying, and depressive symptoms. The surveys were completed in public schools. Bivariate and multinomial regression analyses were conducted to assess associations between weight control behaviors and BMI categories, body weight perception, bullying involvement, and depressive symptoms. Poor body weight perception, bullying involvement, and depressive symptoms were associated with significantly elevated odds of reporting unhealthy weight control behaviors in both middle and high school students. Most patterns were consistent for middle and high school students, with obesity and bullying involvement being prevailing risks for high school students. Though females were more likely to report unhealthy weight control behaviors we also showed the rarely presented prevalence of male involvement in disordered eating behaviors including those who perceived themselves to be underweight. Health education classes and school-based interventions may be two strategies to help prevent the development of unhealthy weight control behaviors. Continuation of youth surveys that gather data on weight control behaviors and known risk factors is essential for observing changes in behaviors over time.

Autobiographical memory specificity and social problem solving in females with subclinical eating psychopathology

In comparison to healthy participants, patients with clinical eating disorders have been shown to retrieve fewer specific, and a greater number of general, memories on the autobiographical memory test (AMT). ‘Overgeneral’ memory is associated with poor social problem-solving (SPS). The current study examined if subclinical eating psychopathology is also associated with ‘overgeneral’ AM and poor SPS. High and low scorers on the Eating Disorders Inventory (EDI-II) were compared on their ability to retrieve specific memories in response to emotional word cues. Participants also completed the means-end SPS task (MEPS). High EDI scorers retrieved significantly fewer specific, and a greater number of categorical, memories than did the low EDI scorers. They also produced fewer, and less effective, means on the MEPS. Performance on the MEPS was positively related to AM specificity and negatively related to the number of categorical memories. These findings remained significant even after controlling for depression.

Can the dot probe task detect food-related attentional biases in restrained eaters?

Three studies explored whether food-related attentional biases (orientation/disengagement) can be found in non-clinically restrained eaters using dot probe tasks. It was hypothesised that highly restrained eaters (compared to unrestrained eaters) would be quicker to identify probes appearing in the same location as food compared to neutral pictures. Food/neutral picture pairs were presented for 200 ms (orientation) and 2000 ms (disengagement). In study one, 60 females divided into high (n = 29)/low (n = 31) restraint groups showed no evidence of attentional bias (orientation or disengagement). Both groups had negative mean bias scores indicating slight attentional avoidance of food. In study two, 60 females divided into high (n = 29)/low (n = 31) restraint groups completed a modified dot probe task based on image ratings. Again, no evidence of attentional bias was found amongst either participant group. In study three, 77 females divided into negative (n = 38) and neutral (n = 39) mood groups received a mood induction prior to completing a further modified dot probe task based on additional image ratings. There was no evidence of attentional bias, and no effect of restrained eating and/or mood on attention processing. These findings challenge the long-established theory that restrained eaters display biased attention processing of food, thought to maintain and exacerbate eating-related concerns. Therefore, the need for attention retraining amongst non-clinical females with eating-related concerns is also called into question. However, a few methodological limitations of the research could have contributed to null findings, and it is possible that attentional bias for food is only present in clinical eating disorder patients.

Factors Affecting Self-Image in Patients with a Diagnosis of Eating Disorders on the Basis of a Cluster Analysis

The aim of this study was to assess the relationship between self-image in eating disorders and age, duration and severity of the disorder, comorbidity, depressiveness and self-evaluation of eating problems. The results of the Offer self-image questionnaire for adolescents (QSIA) were compared in four groups: anorexia nervosa restrictive subtype (ANR, n: 47), anorexia nervosa binge/purge subtype (ANBP, n: 16), bulimia nervosa (BUL, n: 34) and eating disorders NOS (EDNOS, n: 19). The control group was age matched female pupils (NOR, n = 76). The Kruskal-Wallis test revealed significant differences between the age of patients from the ANR (16.34, SD 1.58) and BUL (17.56, SD 0.96) groups (p = .008). The self-image of schoolgirls from the NOR group was on most scales significantly better than the self-image of girls from clinical groups. On four scales differences between the (better) self-image in the ANR group and that in the BUL group were observed. Next, a cluster analysis using a generalised k-means algorithm with v-fold cross validation of QSIA questionnaire results was conducted in the group of clinical eating disorders (ANR, ANBP, and BUL). Three clusters were obtained. The first was characterized by very good self-image (above the average for the general population), the second by poor self-image and the third by negative self-image. Severity of depressiveness measured using the Beck Depression Inventory turned out to be the only factor which differentiated the clusters of self-image in eating disorders.

Troubles du comportement alimentaire et symptomatologie dépressive : étude épidémiologique chez les jeunes hommes

The objective of the study was to evaluate the incidence of eating disorders, including not otherwise specified eating disorders (EDNOS) and subthreshold disorders, inappropriate compensatory behaviors (such as self-induced vomiting, strict dieting, fasting) along with depressive symptoms among young French adult males. The sample was composed of 458 young men in age ranging from 18 to 30 years (mean age=21.9±2.4). The average body mass index was 22.8±3. Participants completed two questionnaires: the Questionnaire for Eating Disorders Diagnoses (Q-EDD) assessing full-criteria eating disorder symptoms based on DSM-IV criteria (i.e. clinical eating disorders) and subthreshold disorders, and the Center for Epidemiological Studies-Depression scale (CES-D) assessing depressive symptoms. Out of the 458 surveyed respondents, eating disorders were reported by approximately 17% of the overall sample, with 1.5% meeting diagnostic criteria for serious clinical disorders, 3% meeting diagnostic criteria for EDNOS and 12% meeting diagnostic criteria for subthreshold disorders. Exercise bulimia represented 1% of the overall sample and binge-eating disorder 2%. The most frequent subthreshold disorder was subthreshold nonbinging bulimia (7%). Participants with eating disorders were equally divided between those desiring weight gain, those desiring weight loss and those wanting to keep their current weight. Participants without eating disorders were more likely to want to gain weight compared to participants with eating disorders (45.5% versus 30% respectively; P<0.05). After controlling for body mass index, 30% of participants tended to perceive themselves as thinner than they actually were and 6% tended to perceive themselves as fatter. Regarding normal-weight participants, 28% perceived themselves as thinner and 8% as fatter than in reality. Overeating episodes were reported by 19% of participants. Binge-eating episodes (recurrent or not) were reported by 8% of young men, including 32% of participants with eating disorders and 3% of participants without eating disorder. Six percent reported repeated binging (at least twice a week for at least once a month). Inappropriate compensatory behaviors were mostly used by participants with eating disorders, except for excessive exercise (34% versus 35% for participants without eating disorders). The most typical compensatory behavior was fasting (11%). According to the cut-off score of 22, 18% of young men had a moderate to severe depressive symptomatology, including 5% of participants who also reported an eating disorder (i.e. 30 participants). A one-way ANOVA was conducted to examine differences in depressive symptoms as a function of eating disorder groups, namely the clinical eating disorders sample (n=22), the subthreshold disorders sample (n=54) and the asymptomatic sample (participants without eating disorder; n=382). Results were statistically significant, (F(2,455)=7.27, P<0.001) and post-hoc tests (Scheffé tests) were used to examine the group differences. The mean CES-D scores for the clinical eating disorders sample (19.45±8.2; P<0.05) and the subthreshold disorders sample (18.15±10.9; P<0.05) were significantly higher than for the asymptomatic sample (14.19±8.9). There was no significant difference between the two eating disorder groups (P>0.05). The results demonstrate that a significant proportion of men with eating disorders manifest comorbid depressive symptomatology. These results suggest that EDNOS and subthreshold disorders should be taken into consideration, as they represent 15% of the total sample. Participants reported high rate of excessive exercise and fasting, which could reflect the importance of muscle tone or strategies to increase muscle mass. Further research is necessary in order to better understand male eating behaviors and disorders.

The HOPE (Helping to Outline Paediatric Eating Disorders) Project: development and debut of a paediatric clinical eating disorder registry.

BackgroundThe HOPE (Helping to Outline Paediatric Eating Disorders) Project is an ongoing registry study made up of a sequential cross-sectional sample prospectively recruited over 17 years, and is designed to answer empirical questions about paediatric eating disorders. This paper introduces the HOPE Project, describes the registry sample to-date, and discusses future directions and challenges and accomplishments. The project and clinical service were established in a tertiary academic hospital in Western Australia in 1996 with a service development grant. Research processes were inbuilt into the initial protocols and data collection was maintained in the following years. Recognisable progress with the research agenda accelerated only when dedicated research resources were obtained. The registry sample consists of consecutive children and adolescents assessed at the eating disorder program from 1996 onward. Standardised multidisciplinary data collected from family intake interview, parent and child clinical interviews, medical review, parent, child and teacher psychometric assessments, and inpatient admission records populate the HOPE Project database.ResultsThe registry database to-date contains 941 assessments, of whom 685 met DSM-IV diagnostic criteria for an eating disorder at admission. The majority of the sample were females (91%) from metropolitan Perth (83%). The cases with eating disorders consist of eating disorders not otherwise specified (68%), anorexia nervosa (25%) and bulimia nervosa (7%). Among those with eating disorders, a history of weight loss since illness onset was almost universal (96%) with fear of weight gain (71%) common, and the median duration of illness was 8 months.ConclusionsOver the next five years and more, we expect that the HOPE Project will make a strong scientific contribution to paediatric eating disorders research and will have important real-world applications to clinical practice and policy as the research unfolds.