Criteria For Bulimia Nervosa Research Articles

IDIOPATHIC ACHALASIA PRIMARILY DIAGNOSED AS BULIMIA NERVOSA: THE IMPORTANCE OF THE NUTROLOGYST

Idiopathic achalasia is a primary esophageal motor disorder characterized byesophageal aperistalsis and abnormal lower esophageal sphincter relaxation in responseto deglutition. Bulimia nervosa is an eating disorder, which amongst other symptomspresents with self-induced vomiting after repetitive episodes of binge eating in order toprevent weight gain. The present study reports the case of a female patient initiallydiagnosed with bulimia nervosa, after ruling out an etiology of organic cause throughlab tests and endoscopy. The patient was referred to a nutrologyst for treating the eatingdisorder, and after nutritional evaluation, she received nutritional supplementation dueto severe dysphagia, regurgitation and weight loss. As diagnostic criteria of bulimianervosa were not met, a further investigation was conducted, which eventuallyconfirmed idiopathic achalasia through two specific tests: digitalesophagogastroduodenal seriography, and esophageal manometry. Chagas disease, themajor cause of idiopathic achalasia in Brazil, was ruled out by specific lab test. In viewof the severity of the disease, the patient underwent urgent cardiomyotomy andfundoplication. Later, balloon dilators were also used in two occasions. After sixteenmonths of medical and nutrology follow-up, the patient now is in good nutritional statusand was able to go back to her daily activities and healthy lifestyle.

Eating Disorder Symptoms in Australian Actors and Performing Artists.

Anecdotal evidence suggests that actors and other performing artists are under great pressure to conform to idealized appearances and body types. The pursuit of such appearances may trigger eating disorder symptoms, such as unhealthy attitudes towards body weight and shape. Thus far, there has been no dedicated empirical study of the prevalence of such problems in Australian actors and performing artists specifically. Therefore, this study sought to examine eating disorder symptomatology in Australian actors and performing artists. An online survey was distributed to the Equity Foundation membership representing Australian actors and performing artists, of whom 573 individuals completed the survey. This survey gauged demographic information and eating disorder symptoms using the psychometrically validated Eating Disorder Diagnostic Scale (EDDS). A large proportion of actors reported unhealthy attitudes such as 'feeling fat' even though they are of normal weight or underweight; reported an extreme fear of gaining weight; and evaluated their self-worth based on their body weight and shape, particularly women. Results also showed that 2.5% of women in the study met the diagnostic criteria for anorexia nervosa and 13% met diagnostic criteria for bulimia nervosa based on their scores on the EDDS. Performers may be a particularly at-risk population for the development and/or maintenance for a range of eating disorders.

2013 and 'DSMitis': implications for the Journal of Eating Disorders and its authors.

Authors: Phillipa Hay (corresponding author) [1,2]; Stephen Touyz [3] Editorial Some of us can recall the fervour and excitement surrounding the introduction of the third revision of the American Psychiatric Association?s Diagnostic and Statistical Manual of Mental Disorders (DSM) [1] onto the international psychiatric stage in 1980. History will judge the fifth revision of the DSM (DSM-5) [2] and whilst the response thus far appears more muted there are a number of substantive changes already impacting on clinicians and academics. For example, lecturers revising their power-points find it a much simpler system to explain with no axes to distinguish it from general medical classifications or to be a proxy for a simplified formulation. In assessment, Engel [3] and colleagues? ?biopsychosocial? approach to psychiatric formulation may thus resume importance in capturing the understanding of the patient?s problems beyond the diagnosis. Whether the WHO disability scale [4] will have the utility and familiarity as the Global Assessment of Function (GAF [5]) is also unknown, particularly given the highly variable use of the GAF. Beyond the clinician what do the changes mean for academics? Already instruments like the Mini International Neuropsychiatric Interview [6] need urgent official upgrades. Fortunately the gold standard assessment instrument in Eating Disorders research, the Eating Disorder Examination (EDE) [7] and its self-report sister instrument the EDE-Q [8] require little adaptation and indeed have benefited from the alignment of criteria for presence of bulimia behaviours across disorders. Thus researchers will no longer have to inquire about binge eating over the past 6-months (as it is now diagnosed over 3-months) and the final question on menstrual function is no more a diagnostic item for anorexia nervosa. Will Journal of Eating Disorders accept papers using DSM-IV [5] criteria? The short answer is in most instances ?no?, unless authors make a compelling argument. For example in a longitudinal study it is usually not possible to reclassify participants diagnosed according to DSM-IV criteria at entry to the study. There will be an expectation that authors doing systematic reviews carefully check the criteria used for diagnoses in papers. Many applied broad criteria for bulimia nervosa or anorexia nervosa (e.g., the ?Oxford? criteria of once weekly binge eating [7]) that now accord with DSM-5 criteria and this should be reported in the review. What about the alternate international scheme, the World Health Organisation?s International Classification of Diseases and Related Health Problems (ICD)? The tenth revision of the ICD (ICD-10) and DSM-IV schemes currently use similar diagnostic terms and the same numerical systems. This assisted hospital administrators who need to convert DSM-IV into ICD-10 for government data collection and similar purposes, but it was of less interest to researchers and academics. Now however there is potential for confusion with the DSM-5 using some ICD-10 terms, e.g., ?atypical? anorexia nervosa and bulimia nervosa, with different criteria. In addition, the 11th revision of the ICD [9] may remove the requirement of an objectively large amount in the criterion for binge eating episodes. These changes are of notable concern to researchers attempting to estimate incidence and prevalence data across time and space. With loosening of some diagnostic criteria (e.g., removal of the amenorrhoea criteria for anorexia nervosa) and expansion of the field to new and added disorders of feeding and eating (e.g., Avoidant/Restrictive Food Intake Disorder (ARFID)), care will need to be taken to avoid artificial increases in estimates of burden. And looking forward? We anticipate a stream of papers with reference to the new eating disorders, in particular ARFID. This is both from the child and adolescent and the adult fields as ARFID encompasses both. The area is wide open for research on ARFID assessment, epidemiology, treatment and outcome. …

Eating and Weight/Shape Criticism as a Specific Life-Event Related to Bulimia Nervosa: A Case Control Study

ABSTRACT The present study aims to evaluate the occurrence of life events preceding the onset of eating problems in bulimia nervosa patients. A case-control design was used involving the comparison of 60 female subjects who meet DSM-IV criteria for bulimia nervosa with 60 healthy control subjects and 60 subjects with other psychiatric disorders. The RFI (Fairburn et al., 1998) subset of factors that represent exposure to life events in the 12 months immediately before the development of eating problems was used. Women with bulimia nervosa reported higher rates of major stress, criticism about eating, weight and shape and also a great number of antecedent life events during the year preceding the development of eating problems than the healthy control group. However, when compared with the general psychiatric control group only the exposure to critical comments about weight, shape, or eating emerged as a specific trigger for bulimia nervosa. Our findings support the fact that eating and shape/weight criticism in the year preceding the development of eating disturbance seems to be specifically related to bulimia nervosa.

Thought–shape fusion in anorexia and bulimia nervosa: a comparative experimental study

'Thought-shape fusion' (TSF) is a cognitive distortion specific in patients with eating disorders and occurs when the thought about eating a forbidden food increases a person's estimate of her weight/shape, elicits a perception of moral wrongdoing and makes her feel fat. This study aimed to experimentally induce, study and compare TSF between patients with bulimia nervosa (BN) and patients with anorexia nervosa (AN). 31 patients diagnosed with a current eating disorder, of which 20 met DSM-IV-TR criteria for BN and 11 for AN, participated in a mixed-model experimental design with the aim of eliciting TSF and investigating the effects of corrective behaviors (checking and mental neutralizing). Verbal analogue scales constituted the main outcome measures. TSF was experimentally induced and expressed in a similar way in both clinical groups, apart from 'feeling fat' which was higher in BN patients. TSF induction triggered heightened levels of anxiety, guilt and urges to engage in corrective behaviors in both groups. Body dissatisfaction only increased in the BN patients. Mental neutralizing and to a lesser extent checking reduced most effects of the experimental procedure, but this effect was larger for BN patients. The nature of TSF seems to have similarities between BN and AN patients; however, the precise connection between TSF and different types of eating disorders remains to be explored in future clinical trials.

Lack of pattern of birth in patients with bulimia nervosa

An excess of bulimia nervosa (BN) births during the fall has been recently reported, but this finding has not been yet adequately replicated. The purpose of our study was to evaluate the presence of a seasonal birth pattern in a representative clinical sample of women with BN. We registered the month of birth of 216 female patients who fulfilled all the criteria for BN according to DSM-IV on admission to a specialized eating disorders service in Spain. Our analyses showed no significant variation in the season of birth of our BN sample when compared to a general population. Our data do not support the hypothesis of a season of birth bias in BN.

Stability of long‐term outcome in bulimia nervosa: a 3‐year follow‐up

We report on the 3-year course and outcome of patients with bulimia nervosa (BN), initially treated in an inpatient or day clinic setting. Patients were assessed by structured interviews (Structured Clinical Interview for DSM Disorders I and II and Structured Interview for Anorexia and Bulimia Nervosa) and questionnaires (Eating Disorder Inventory-2, Symptom Checklist-90-R, and Social Adjustment Scale) at time points of admission, discharge, and 3-month, 12-month and 36-month follow-ups. Data of 83.7% of the 43 patients were available. After 3 years, about one third of patients showed complete remission, one third showed partial remission, and one third still fulfilled all the criteria of BN. Most changes occurred during hospitalization. Remission status showed substantial fluctuation over time, with little correlation between time points of assessment (discharge and 3-month, 12-month, and 36-month follow-ups). A cluster analysis revealed four patterns of longitudinal symptom change. Day clinic and inpatient treatment are overall effective. Longitudinal and repeated assessments are necessary to validly measure outcome in BN.

Five-year outcome of cognitive behavioral therapy and exposure with response prevention for bulimia nervosa

Few data exist examining the longer-term outcome of bulimia nervosa (BN) following treatment with cognitive behavioral therapy (CBT) and exposure with response prevention (ERP). One hundred and thirty-five women with purging BN received eight sessions of individual CBT and were then randomly assigned to either relaxation training (RELAX) or one of two ERP treatments, pre-binge (B-ERP) or pre-purge cues (P-ERP). Participants were assessed yearly following treatment and follow-up data were recorded. Eighty-one per cent of the total sample attended long-term follow-up. At 5 years, abstinence rates from binging were significantly higher for the two exposure treatments (43% and 54%) than for relaxation (27%), with no difference between the two forms of exposure. Over 5 years, the frequency of purging was lower for the exposure treatments than for relaxation training. Rates of recovery varied according to definition of recovery. Recovery continued to increase to 5 years. At 5 years, 83% no longer met DSM-III-R criteria for BN, 65% received no eating disorder diagnosis, but only 36% had been abstinent from bulimic behaviors for the past year. This study provides possible evidence of a conditioned inoculation from exposure treatment compared with relaxation training in long-term abstinence from binge eating at 5 years, and the frequency of purging over 5 years, but not for other features of BN. Differences among the groups were not found prior to 5 years. CBT is effective for BN, yet a substantial group remains unwell in the long term. Definition of recovery impacts markedly on recovery rates.

Deliberate Insulin Underdosing and Omission Should Be Included in DSM-V Criteria for Bulimia Nervosa

An endocrinologist referred a22-year-old woman with IDDM toour psychiatry clinic because of herbulimia, anxiety, and depression. Shestarted bingeing four to five times aweek during her sophomore year ofcollege. She felt out of control anddecided to disconnect her insulinpump overnight after bingeing. Shereasoned that omitting insulin wouldcause the same weight loss she expe-rienced in high school before shewas diagnosed with IDDM. Unhook-ing her pump partially reduced heranxiety about gaining weight, buther hemoglobin A1c climbed from7% to 16%, and guilty and embar-rassed by her behavior, she avoidedher family and her endocrinologist.We diagnosed her with bulimianervosa, with disconnection of herinsulin pump counted as the “inap-propriate compensatory behavior”needed for this diagnosis. We pre-scribed both low dose clonazepam tohelp with her anxiety and poor sleepand weekly psychotherapy forbulimia and depression. Sheresponded to graduated exposuretechniques to decrease her postbingeanxiety and the frequency of discon-necting her insulin pump. Shelearned to challenge cognitive distor-tions (e.g., that bingeing was areward and that her life was betterwhen she was thinner). During ther-apy, she practiced telling her familyand friends about her disorder, andher guilt, isolation, and anxietydeclined quickly after she shared her“secret” with them. She stopped dis-connecting her insulin pumpalthough she still has occasionalthoughts of restarting her diabulimicbehavior. Her mood was stable andeuthymic at her 3- and 6-month fol-low-up appointments. She has kepther regular appointments with usand with her endocrinologist, andher hemoglobin A1c has steadilyimproved.

Are Diagnostic Criteria for Eating Disorders Markers of Medical Severity?

The objective of this study was to compare the medical severity of adolescents who had eating disorders not otherwise specified (EDNOS) with those who had anorexia nervosa (AN) and bulimia nervosa (BN). Medical records of 1310 females aged 8 through 19 years and treated for AN, BN, or EDNOS were retrospectively reviewed. Patients with EDNOS were subcategorized into partial AN (pAN) and partial BN (pBN) when they met all Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria but 1 for AN or BN, respectively. Primary outcome variables were heart rate, systolic blood pressure, temperature, and QTc interval on electrocardiogram. Additional physiologically significant medical complications were also reviewed. A total of 25.2% of females had AN, 12.4% had BN, and 62.4% had EDNOS. The medical severity of patients with EDNOS was intermediate to that of patients with AN and BN in all primary outcomes. Patients with pAN had significantly higher heart rates, systolic blood pressures, and temperatures than those with AN; patients with pBN did not differ significantly from those with BN in any primary outcome variable; however, patients with pAN and pBN differed significantly from each other in all outcome variables. Patients with pBN and BN had longer QTc intervals and higher rates of additional medical complications reported at presentation than other groups. EDNOS is a medically heterogeneous category with serious physiologic sequelae in children and adolescents. Broadening AN and BN criteria in pediatric patients to include pAN and pBN may prove to be clinically useful.

Symptoms of disordered eating, body shape, and mood concerns in male and female Chinese medical students

Objective This cross-sectional study explored the prevalence of disordered eating attitudes, body shape concerns, and social anxiety and depressive symptoms in male and female medical students in China. Method Four hundred eighty-seven students from Central South University (Hunan Province, Changsha City, China) completed the following self-report measures: Eating Attitudes Test-26, Eating Disorders Assessment Questionnaire, Body Shape Questionnaire, Swansea Muscularity Attitudes Questionnaire, Social Interaction Anxiety Scale, and the Self-Rating Depression Scale. Results A comparatively lower rate of at-risk eating attitudes (2.5%) and eating disorders (0.90%) were found compared to those reported in other studies. Significantly more female (3.2%) than male (1.2%) students had abnormal eating attitudes with 4 female students meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for bulimia nervosa. Significant relationships were observed between eating attitudes, body shape concern, social anxiety, depression, and body mass index. For females, the most significant correlate of distorted eating attitudes was body shape concern, whereas for male students, social anxiety and concern with muscle size and shape were most strongly correlated with distorted eating attitudes.

Cognitive therapy for bulimia nervosa: an A‐B replication series

AbstractObjective: To investigate whether a new treatment for bulimia nervosa (BN) works, and to examine its effects on key cognitions and behaviours hypothesized to be important in the underlying model.Method: An A‐B single‐case series with follow‐up was conducted. Treatment was based on a specific model of BN. It consisted of individualized formulation, enhancing motivation for change, cognitive restructuring of specific cognitions, behavioural experiments and targeting particular underlying assumptions and negative self‐beliefs. Relapse prevention was also addressed.Results: All treatment completers did extremely well and no longer met Diagnostic and Statistical Manual of Mental Disorders, 4th edition revised (DSM‐IV) criteria for bulimia nervosa. Two were entirely symptom‐free at the end of treatment and at follow‐up. The third experienced only very occasional binge eating and vomiting. Individual scores on self‐report symptom measures and on all measures of cognition indicated a return to normative levels.Discussion: Treatment focusing on specific cognitive change is a promising intervention for BN. Further work might usefully evaluate this treatment in a larger study. Copyright © 2007 John Wiley & Sons, Ltd.

Beliefs of adolescent girls concerning the severity and prevalence of bulimia nervosa

The beliefs of adolescent girls concerning an eating disorder problem were investigated. A vignette describing a fictional 16-year-old girl meeting diagnostic criteria for bulimia nervosa (BN) was presented to 522 high school students, followed by a series of questions concerning the severity and prevalence of the problem described. Most respondents believed that BN is a serious problem whose sufferers are deserving of sympathy. However, BN was perceived to be common among adolescent girls, far more common than estimates from epidemiological research would suggest, and many participants had at some stage thought that it “might not be too bad” to have such a problem. In addition, participants with a high level of eating disorder symptoms considered the prevalence of BN to be higher, and its symptoms more acceptable, than asymptomatic participants. These findings suggest that the perception of bulimic behaviours as normative and/or desirable may need to be addressed in prevention programs.

Prevalence and Long-Term Course of Lifetime Eating Disorders in an Adult Australian Twin Cohort

Few studies exist that have examined the spectrum and natural long-term course of eating disturbance in the community. We examine the lifetime prevalence and long-term course of anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) in an adult female twin population. Female twins (n = 1002) from the Australian Twin Registry, aged 28-39 years, were assessed using the Eating Disorder Examination, revised to yield lifetime diagnostic information. For women with lifetime eating disorders, the assessment occurred, on average, 14.52 years (SD = 5.65) after onset of their disorder. In accordance with other community studies, we found a 1.9% lifetime prevalence of AN, with an additional 2.4% who met the criteria for 'partial AN' (absence of amenorrhea). Criteria for BN were met by 2.9% of the women, an additional 2.9% of women met criteria for binge eating disorder, while 5.3% met criteria for purging disorder unaccompanied by binge eating (EDNOS-p). Eleven (7%) of the women with lifetime eating disorders had a current eating disorder. Each diagnostic group continued to be differentiated by current eating pathology from women without lifetime eating disorders. Although approximately 75% of the women had a good outcome, less than 50% of each diagnostic group was asymptomatic. Eating disorders tend to improve over time often reaching subdiagnostic levels of severity, but only a minority of sufferers becomes asymptomatic. The DSM-IV diagnosis EDNOS needs to be considered in studies of the prevalence and course of eating disorders.

Coprevalence of bulimia with alcohol abuse and smoking among Japanese male and female high school students.

Bulimia nervosa (bulimia) is often concomitant with alcohol and other substance abuse. To investigate the coprevalence of bulimia with alcohol abuse and smoking, we surveyed 2597 male and female Japanese high school students and obtained a group of bulimic students who fulfilled four of five DSM-III-R bulimia nervosa criteria and a control group who reported no binge-eating experience. Comparison of the groups showed significantly more alcohol abuse for both male and female bulimic students than for the non-bulimic control group. The male and female adolescents with symptoms of bulimia were similar in showing a high prevalence of alcohol abuse. The incidence of smoking was significantly higher among the bulimic females than among the female controls, but there was no significant difference between the male groups' smoking experiences.

An Analysis of the Role of Overeaters Anonymous in Women's Recovery from Bulimia Nervosa

This study presents a qualitative analysis of the role of the self-help group Overeaters Anonymous (OA) in the treatment experiences of women with bulimia nervosa. It specifies how various elements of OA facilitate or maintain recovery. Using focus groups and individual interviews, data were collected from 26 women who met the criteria for bulimia nervosa. Data analysis revealed that those participants used five OA skills or strategies. These included: (1) OA meeting attendance and participation, (2) interaction with a sponsor, (3) processing (i.e., writing and journaling), (4) spirituality (i.e., prayer and meditation), and (5) adherence to a food plan.

Thoughts on the 25th anniversary of bulimia nervosa

AbstractMy original article on bulimia nervosa appeared in the August 1979 issue of Psychological Medicine. It is timely to examine whether the description of this new disorder and the formulated diagnostic criteria have stood the test of time. A similar question is whether it was right to describe the new syndrome as an ominous variant of anorexia nervosa. The answers to these questions should really be given by other investigators. My own view is that the main clinical description and the diagnostic criteria of bulimia nervosa have proved reasonably robust, as has its close relationship to anorexia nervosa. On the other hand, my view about the ominous nature of bulimia nervosa was unduly pessimistic. The original description of bulimia nervosa had a significant impact on the clinical and scientific literature, which showed an accelerated growth during the 1980s, largely due to articles on bulimia and bulimia nervosa. The historical question ‘Is bulimia nervosa a new disorder?’ has hitherto been neglected. The evidence for answering this question in the affirmative is very strong and is derived from searches of the older psychiatric literature as well as more recent cohort studies which throw light on when the new syndrome burst from the blue upon modern society. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.

Beliefs of women concerning the severity and prevalence of bulimia nervosa

Few studies have examined attitudes towards eating-disordered behaviour among women in the general population. A vignette describing a fictional person meeting diagnostic criteria for bulimia nervosa (BN) was presented to a community sample of women aged 18-45. Respondents (n = 208) were asked a series of questions concerning the severity and prevalence of the problem described. Most respondents viewed BN as a distressing condition whose sufferers are deserving of sympathy. However, more than one-third of respondents had at some stage believed that it 'might not be too bad' to be like the person described in the vignette. Most respondents believed that the prevalence of the problem described among women in the community was likely to be between 10 % and 30 % (48.6%) or between 30% and 50 % (23.1 %). Individuals with a clinically significant eating disorder (n = 13, 6.3%) were more likely to perceive the symptoms of BN as being acceptable, and its prevalence higher, than individuals with no eating disorder diagnosis. Information concerning the medical and psychological sequelae of BN and other eating disorders might usefully be incorporated in prevention programmes. Prospective community-based research is required to elucidate the nature of the relationship between perceived acceptability of eating disorder symptoms and actual eating disorder psychopathology. Extension of the present research to examine the views of women in other cultures would also be of interest.

Die Prävalenz von Essstörungen unter den Patientinnen einer Frauenarztpraxis

Purpose: The purpose of this study was to evaluate the prevalence of eating disorders in patients of a primary care gynaecologist. Material and Methods: A number of 500 patients was asked to complete a self-rating scale for bulimia known as the Bulimic InvestigatoryTest Edinburgh (BITE). The questionnaire consisted of 33 questions to investigate habits of dieting and symptoms and behaviour associated with binge eating. Subjects were scored and classified according to their score. Subjects with a BITE score above 20 were considered to be at high risk of bulimia, a score of 10-19 indicated a subclinical eating disorder and a score less than 10 was indicative of a normal eating pattern. The diagnoses of anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED) were simulated according to DSM-IV criteria. Results: We received a total of 486 questionnaires. In 5 women we diagnosed AN (1.02%), 9 patients fulfilled the DSM-IV criteria of BN (1.85%) and 17 cases of BED (3.49%) were identified. The difference between actual body weight and optional body weight (p-value < 0.01) and the degree of feeling overweight (p-value <0.01) correlated significantly with the BITE symptom scale. Despite regularly attending their gynaecologist, only 5 of 13 patients (38%) with BITE scores above 20 had ever consulted a physician for advice on eating problems. Conclusion: The high prevalence of AN, BN and BED in our sample of gynaecologic patients suggests that primary care gynaecologists should focus on the detection and prevention of eating disorders.

Characteristics of monozygotic twins discordant for bulimia nervosa

Objective We studied monozygotic (MZ) twins who were discordant for bulimia nervosa in order to identify environmental factors that could have contributed to the expression of bulimia nervosa in only one member of these genetically identical twin pairs. Method Female twin pairs from the Virginia Twin Registry were identified. One twin met DSM-III-R criteria for bulimia nervosa (excluding the frequency and duration criterion) and the co-twin either reported some symptoms of bulimia nervosa but never met full diagnostic criteria (n = 20 pairs) or reported no symptoms of bulimia nervosa (n = 10). We compared the twins on demographic, developmental, personality, and psychiatric dimensions using self- and maternal report. Results Affected twins were more likely to report lifetime generalized anxiety disorder and were described by their mothers as more anxious and fearful as children. They also had significantly lower mastery, optimism, and self-esteem, and significantly greater obsessive and compulsive symptoms than their unaffected co-twins. Affected twins recalled greater discord in their families but viewed their parents as more warm toward them than toward their unaffected co-twin. Discussion Given that MZ twins are genetically identical and share a common family background, differences between them must be attributable to unique environmental factors. Although it is difficult to disentangle predisposing risk factors from sequelae of psychiatric illness in a retrospective co-twin control design, the affected twins were perceived to have been more anxious as children by their mothers—possibly reflecting a predisposing trait. More extensive interviews are required to determine the nature of environmental events that contribute to the expression of the observed personality, behavioral, anxious, and eating-related traits in the affected twins.© 2000 by John Wiley & Sons, Inc. Int J Eat Disord 29: 1–10, 2001.