Eating Disorder Inventory Scores Research Articles

Психометрические свойства шкалы оценки образа тела (апробация на российской выборке)

<p>Body image disorders are closely associated with eating disorders, suicidal thoughts and intentions. In foreign science and practice, the Contour Drawing Rating Scale (CDRS) by M. Thompson and J. Gray is widely used for diagnosing body image disorders. The purpose of the present study was to adapt the CDRS on a population sample of Russian-speaking respondents. Five hundred and sixty respondents completed the Russian-language versions of the CDRS, Eating Disorder Inventory (EDI), and the Depression, Anxiety, and Stress Scale-21 (DASS-21). To assess the convergent and concurrent validity of the Russian CDRS, the r-Pearson correlation coefficient was used. Sex and age differences in body image were examined using the Student's t-test and one-way analysis of variance (ANOVA). Results showed that real and ideal body images according to the CDRS correlated statistically significantly with the EDI and DASS-21 scores, as well as reported weight and BMI. These findings proved the convergent and concurrent validity of the adapted instrument. Females and older respondents reported a greater discrepancy between real and ideal body images than did males and younger respondents. In conclusion, the Russian CDRS showed convergent and concurrent validity.</p>

An Analysis of Eating Disorders in Adolescent Idiopathic Scoliosis: A Prospective Cross-sectional Study in a Female Population.

Prospective cross-sectional study. We designed this study to investigate whether adolescent girls with idiopathic scoliosis show a predisposition for eating disorders (EDs) and alterations of the quality of life and body image self-perception, compared to same-age healthy females. Idiopathic scoliosis is the most common spinal deformity of adolescence. Recent findings about the impairment of the self-body image in adolescents with idiopathic scoliosis provide a common trait of scoliosis and EDs and could lead to the suspicion of an association between these two pathological conditions. Despite this, current literature shows the lack of evident results about the impact of adolescent idiopathic scoliosis (AIS) on the possibility to develop of EDs. One hundred forty-four females with diagnosis of AIS (aged 10-18 years) formed the scoliosis group. One hundred forty-six same-age healthy girls were enrolled in the control group. For all subjects, we considered sport practice. Only for Scoliosis Group, we also considered the severity of scoliosis, the use of brace and the practice of physiotherapy scoliosis-specific exercises. The participants were asked to answer to the Scoliosis Research Society-22 revised Patient Questionnaire (SRS-22r) and the Eating Disorders Inventory (EDI). In the scoliosis group, significantly lower scores on the SRS-22r total and in the self-image domain were detected. The two groups showed differences in the total EDI score and in the body dissatisfaction EDI's domain. Severity of scoliosis was correlated with worse SRS-22r total score and SRS-22r self-image domain score. There were no differences in the scores of the SRS-22r and EDI between braced and nonbraced subjects. Lower scores in SRS-22r total and self-image domain were found in girls who practiced physiotherapy exercises. Subjects who practiced a sport showed higher SRS-22r total scores. The AIS cohort in our study demonstrated lower levels of eating psychopathology than healthy controls. Surprisingly, eating behavior does not seem to be affected by orthotic management. However, quality of life and self-body image could be impaired in scoliotic girls, especially when they practice physiotherapy exercises, whereas those who practice sport seem to be preserved in this regard.Level of Evidence: 4.

Anorexia nervosa restricting type has increased in severity over three decades: Japanese clinical samples from 1988 to 2018.

ObjectiveAlthough eating disorders (EDs) surged in the late 1900s and are now recognized worldwide, the time trend of ED characteristics remains unknown. This study aimed to clarify changes in characteristics of anorexia nervosa restricting type (AN‐R) over 30 years.MethodsWe conducted a cross‐sectional study and examined 996 female treatment‐seeking patients with AN‐R in Japan from 1988 to 2018. Demographics, body mass index (BMI), and Eating Disorder Inventory scores were compared among three groups in accordance with the time of initial consultation: Group 1 (1988–1998), Group 2 (1998–2008), Group 3 (2008–2018).ResultsThe mean BMI at the initial consultation significantly decreased by 0.6 kg/m2 (from 14.0 kg/m2 in Group 1 to 13.4 kg/m2 in Group 3). Groups 2 and 3 scored significantly higher in drive for thinness, interpersonal distrust, and interoceptive awareness than those in Group 1. The range of onset age is wider and the number of late‐onset AN‐R with prolonged delay in treatment has increased over time.DiscussionThis study shows that AN‐R has increased in physical and psychopathological severity over the past 30 years in Japan. Interdisciplinary research is needed to clarify the relationship between AN‐R and time trend.

Association of etiological factors across the extreme end and continuous variation in disordered eating in female Swedish twins.

Accumulating evidence suggests that many psychiatric disorders etiologically represent the extreme end of dimensionally distributed features rather than distinct entities. The extent to which this applies to eating disorders (EDs) is unknown. We investigated if there is similar etiology in (a) the continuous distribution of the Eating Disorder Inventory-2 (EDI-2), (b) the extremes of EDI-2 score, and (c) registered ED diagnoses, in 1481 female twin pairs at age 18 years (born 1992-1999). EDI-2 scores were self-reported at age 18. ED diagnoses were identified through the Swedish National Patient Register, parent-reported treatment and/or self-reported purging behavior of a frequency and duration consistent with DSM-IV criteria. We differentiated between anorexia nervosa (AN) and other EDs. The heritability of the EDI-2 score was 0.65 (95% CI 0.61-0.68). The group heritabilities in DeFries-Fulker extremes analyses were consistent over different percentile-based extreme groups [0.59 (95% CI 0.37-0.81) to 0.65 (95% CI 0.55-0.75)]. Similarly, the heritabilities in liability threshold models were consistent over different levels of severity. In joint categorical-continuous models, the twin-based genetic correlation was 0.52 (95% CI 0.39-0.65) between EDI-2 score and diagnoses of other EDs, and 0.26 (95% CI 0.08-0.42) between EDI-2 score and diagnoses of AN. The non-shared environmental correlations were 0.52 (95% CI 0.32-0.70) and 0.60 (95% CI 0.38-0.79), respectively. Our findings suggest that some EDs can partly be conceptualized as the extreme manifestation of continuously distributed ED features. AN, however, might be more distinctly genetically demarcated from ED features in the general population than other EDs.

MON-225 A Randomized Placebo-Controlled Trial of Low-Dose Testosterone Therapy in Women with Anorexia Nervosa

Background: Anorexia nervosa is a serious psychiatric illness with significant mortality and no approved medical therapies. Comorbid affective disorders are highly prevalent, and we have shown that relative androgen deficiency in anorexia nervosa is associated with depression and anxiety symptom severity. As women with anorexia nervosa are relatively testosterone deficient, we hypothesized that physiologic testosterone therapy would improve weight, depressive and anxiety symptoms, and eating disorder symptoms and behavior. Methods: 90 women 18-45 yo with anorexia nervosa and free testosterone levels below the median for healthy young women were randomized to testosterone 300 mcg daily or placebo patch (Procter & Gamble) for 6 months. % free testosterone was measured by equilibrium dialysis and total testosterone by HTLC (Mayo Labs). Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV. Depression and anxiety symptom severity were assessed [Hamilton Depression Rating Scale (HAM-D); Hamilton Anxiety Rating Scale (HAM-A)]. Eating disorder psychopathology/behaviors were assessed [Eating Disorder Examination (EDE) and Eating Disorder Inventory-2 (EDI-2)]. Primary outcome was BMI. Secondary outcomes were HAM-D, HAM-A, EDE, and EDI-2 scores. Results: Baseline characteristics, including mean testosterone levels, did not differ between the active and placebo groups. Mean age was 27±7(SD) years, BMI 18.3±1.6 kg/m2, and free testosterone 0.4±0.2 ng/dL (normal: 0.3-1.9 ng/dL). 64% of subjects met criteria for major depressive disorder and 68% for generalized anxiety disorder. Mean HAM-D score was 15±4 (moderate depression severity) and mean HAM-A score was 15±5 (mild anxiety severity). Groups did not differ in % of subjects who started/discontinued (44%) or changed psychiatric medication dose (30%) during the study. Mean increase in serum free testosterone was 0.9±0.9 ng/dL in the testosterone group. Mean BMI increased by 0.02±1.01 kg/m2 in the active, and 0.5±1.1 kg/m2 in the placebo, group (p=0.03) over 6 months. At 4 weeks, there was a trend toward a greater decrease in mean depression (-1.6±2.8 vs -0.7±3.0, p=0.09 by HAM-D), but not anxiety, severity score in the testosterone vs. placebo group. At 6 months, mean HAM-D and HAM-A scores decreased similarly in both groups [HAM-D -2.9±4.9 (testosterone) vs -3±5 (placebo), p=0.72; HAM-A -4.5±5.3 (testosterone) vs -4.3±4.4 (placebo), p=0.25]. There were no significant differences in EDE or EDI-2 scores between groups. Testosterone was well-tolerated with no difference between groups in androgenic side effects. Conclusion: Contrary to what was hypothesized, low-dose testosterone therapy for 6 months in women with anorexia nervosa resulted in less weight gain, and did not lead to sustained improvements in depression, anxiety, or disordered eating symptoms, relative to placebo.

Childhood body mass index and development of eating disorder traits across adolescence.

Understanding the role of premorbid body mass index (BMI) in the emergence of eating disorders may be key to identifying effective prevention strategies. We explore relations between BMI and eating disorders traits in young twins. The effect of BMI at age 9/12 and 15 on eating disorder traits measured using the Eating Disorders Inventory-2 (EDI) at ages 15 and 18 was examined using bivariate modelling in a longitudinal population sample of Swedish twins. The correlation between BMI and EDI within individuals was stable across all ages and remained significant after adjusting for later BMI. Bivariate analysis indicated significant positive genetic correlations between BMI ages 9/12 and 15 and subsequent EDI scores. The relationship remained significant for BMI age 9/12 and EDI age 15 in the adjusted model, indicating a longitudinal association. Our results have implications for conceptualizing the interrelation of BMI and eating disorders across childhood and adolescence.

Weight Suppression But Not Symptom Improvement Predicts Weight Gain During Inpatient Treatment for Bulimia Nervosa.

Fear of gaining weight is a common obstacle to seeking treatment for bulimia nervosa (BN). We investigated changes in body mass index (BMI) during inpatient treatment for BN in relation to treatment outcome and weight suppression (WS). Female inpatients of a specialized eating disorders clinic were grouped as deteriorated/unchanged, reliably improved, and clinically significantly improved based on Eating Disorder Inventory-2 scores. Repeated measures ANOVA was employed to examine changes in BMI between admission and discharge depending on treatment outcome and WS. One-hundred seventy-nine patients were included. Overall, the average BMI significantly increased by 0.54kg/m2 (SD = 1.24). Repeated measures ANOVA revealed no association of change in BMI with treatment outcome [F(df) = 1.13 (2166), p = 0.327] but with WS [F(df) = 2.76 (3166), p < 0.044]. Bulimia nervosa can be successfully treated without causing excessive weight gain. Patients with higher WS might expect somewhat more weight gain. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Attachment and motivational systems: Relevance of sensitivity to punishment for eating disorder psychopathology

An altered balance of reward and inhibition systems may explain Eating Disorder (ED) behaviors and could be related to difficulties in socio-emotional processing. According to attachment theory, early interaction with caregivers affects the ability to regulate emotion in adult interpersonal situation. The aim of our study was to investigate if insecure attachment may be related to ED symptomatology through changes in reward and inhibition systems.Seventy-eight people affected by EDs and 45 healthy controls (HC) filled in the Attachment Style Questionnaire (ASQ), the Behavioral Inhibition System-Behavioral Activation System Scale (BIS-BAS) and the Eating Disorders Inventory-2 (EDI-2) questionnaire.ED people reported significantly higher scores than HC in EDI-2 scores, all dimensions of insecure attachment style and sensitivity to punishment (BIS score). In ED patients, ASQ anxiety scores correlated with almost all EDI-2 subscores and sensitivity to punishment. The association between anxious attachment style and ED symptomatology (drive to thinness and body dissatisfaction) was totally mediated by an indirect effect of sensitivity to punishment.These findings suggest, for the first time, increased sensitivity to punishment as a pathway that may explain the relationship between anxious attachment and ED symptomatology highlighting the relevance to target social experiences as an important psychotherapeutic focus.

The disorder of lived corporeality: A possible link between attachment style and eating disorder psychopathology

IntroductionAccording to the trans-diagnostic perspective, disturbances in eating patterns of eating disorders (EDs) are considered as epiphenomena secondary to the patient's overvaluation of his/her body shape and weight.ObjectivesThe phenomenological theory states that the main feature of ED psychopathology is a disturbance in the way affected persons experience their own body (embodiment). Insecure attachment may promote the development of unstable self-identity leading to use body weight as a source of self-definition.AimsThe aim of our study was to assess the role of embodiment impairments in the relationships between attachment stiles and ED psychopathology.MethodsOne hundred twelve ED patients and 108 healthy subjects filled in the Identity and Eating Disorders (IDEA) questionnaire, which assesses embodiment and personal identity abnormalities, the eating disorder inventory-2 (EDI-2) and the experiences in close relationships (ECR) scale, which defines attachment styles.ResultsED patients showed IDEA, EDI-2 and ECR scores significantly higher than controls. Significant correlations between IDEA scores, insecure attachment and almost all EDI-2 sub-item scores emerged in ED patients but not in controls. IDEA total score mediated the relationship between avoidant attachment and EDI-2 interoceptive awareness.ConclusionsThese findings demonstrate that in ED patients insecure attachment is correlated to disorder of identity and lived corporeality that, in turn, mediates the association between attachment and a specific ED psychopathological trait. Therefore, we suppose that early relationships, through the development of disturbances in identity and embodiment, lead to altered perception of bodily signals and deranged discrimination of one's emotions, which could contribute to EDs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Patient- and clinician- reported outcome in eating disorders

Patient-reported outcome is increasingly applied in health sciences. Patients with eating disorders (EDs) characteristically have a different opinion of their needs to that of the health professionals, which can lead to ambivalence towards treatment and immense compliance difficulties. This cross-sectional study compared data assessed by the clinician to patient-reported measures in patients with a history of EDs.We included data from a cohort of patients with EDs (n=544) referred to a specialized ED unit in Denmark. Patient-reported measures included the Eating Disorder Inventory-2 (EDI-2) and the Short Form 36 (SF-36), and clinical data included remission status and body mass index (BMI). We found a positive association between BMI and EDI-2 scores for anorexia nervosa (AN) and eating disorder not otherwise specified (EDNOS), reflecting increasing ED symptomatology with increasing BMI. This association was not observed in bulimia nervosa (BN). We did not find a correlation between SF-36 scores and BMI in any of the diagnostic groups.

‘I can’t accept that feeling’: Relationships between interoceptive awareness, mindfulness and eating disorder symptoms in females with, and at-risk of an eating disorder

Mindfulness based therapies (MBTs) for eating disorders show potential benefit for outcomes yet evidence is scarce regarding the mechanisms by which they influence remission from symptoms. One way that mindfulness approaches create positive outcomes is through enhancement of emotion regulation skills. Maladaptive emotion regulation is a key psychological feature of all eating disorders. The aim of the current study was to identify facets of emotion regulation involved in the relationship between mindfulness and maladaptive eating behaviours. In three cross-sectional studies, clinical (n=39) and non-clinical (n=137 and 119) female participants completed: 1) the Eating Disorder Inventory (EDI) eating specific scales (drive-for-thinness and bulimia) and the EDI psychological symptom scales (emotion dysregulation and interoceptive deficits); and 2) mindfulness, impulsivity, and emotion regulation questionnaires. In all samples mindfulness was significantly and inversely associated with EDI eating and psychological symptom scales, and impulsivity. In non-clinical samples interoceptive deficits mediated the relationship between mindfulness and EDI eating specific scales. Non-acceptance of emotional experience, a facet of interoceptive awareness, mediated the relationship between mindfulness and eating specific EDI scores. Further investigations could verify relationships identified so that mindfulness based approaches can be optimised to enhance emotion regulation skills in sufferers, and those at-risk, of eating disorders.

Body image and eating behavior in young adults born preterm.

Previous studies have suggested that people born preterm have increased rates of eating disorders (ED). However, a recent study suggested lower levels of ED-related symptoms in the extreme group of adults born preterm with very low birth weight (<1,500 g). We examined symptoms related to EDs in adults born early (<34 weeks of gestational age) or late (34 to <37 weeks of gestational age) preterm. We studied young adults (mean age 24.1 years) from two birth cohorts: ESTER (Northern Finland 1985-1989) and AYLS (Uusimaa, Finland, 1985-1986). Of the participants, 185 were born early preterm, 348 late preterm, and 637 were term-born controls (N = 1,170). They completed three subscales of the Eating Disorder Inventory (EDI)-2, including Drive for Thinness (DT), Body Dissatisfaction (BD), and Bulimia (B). Group differences were examined by linear regression. Young women born early preterm scored 4.1 points (95% CI -8.0, -0.2, P =.04) lower in summed EDI subscale scores than women born at term, when adjusted for age and cohort. This difference was observed also in DT and BD but not for B subscales. The differences persisted after adjustments for current, pre- and neonatal characteristics. We did not observe differences in EDI scores among men or women born late preterm when compared to controls. Women born early preterm have significantly fewer symptoms related to EDs in early adulthood when compared to their peers born at term, which may protect from developing an ED. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:572-580).

Elevated plasma concentrations of bacterial ClpB protein in patients with eating disorders.

Caseinolytic protease B (ClpB) produced by Enterobacteria, such as Escherichia coli, has been identified as a conformational mimetic of α-melanocyte-stimulating hormone (α-MSH), an anorexigenic and anxiogenic neuropeptide. In mice, ClpB induces α-MSH cross-reactive antibodies and activates anorexigenic brain neurons. In patients with eating disorders (ED), anti-ClpB and anti-α-MSH antibodies correlate with psychopathological traits. However, it is not known if ClpB is present in human plasma including ED patients. Plasma concentrations of ClpB were measured using a recently developed ClpB immunoassay in female patients with anorexia nervosa, bulimia nervosa, and binge-eating disorder and compared with healthy participants, all characterized by the Eating Disorder Inventory-2 (EDI-2) scale. We found that ClpB was readably detectable in plasma of healthy participants and ED patients and that its concentrations were elevated in ED patients, without significant differences in patient's subgroups. Plasma ClpB concentrations correlated with the EDI-2 scores, with α-MSH as well as with plasma levels of anti-ClpB and anti-α-MSH antibodies. These data revealed that bacterial ClpB is naturally present in human plasma and that its concentrations can be elevated in ED patients and associated with ED-related psychopathological traits. These results support a link between bacterial ClpB and the ED pathophysiology. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:805-808).

Disordered eating behavior among group fitness instructors: a health-threatening secret?

BackgroundThe present study aimed to examine disordered eating behavior (DE) and self-reported eating disorders (ED) among Norwegian group fitness instructors.MethodsGroup fitness instructors from Norway (n = 685 females and 152 males, response rate: 57 %) completed an online survey. The survey included the instruments Eating Disorders Inventory (EDI) and the Exercise Dependence Scale (EDS).ResultsA total of 22 % of the male and 59 % of the female respondents were classified with DE. The respondents classified with DE had higher BMI, more weight loss attempts, and higher total EDI score compared to the respondents with no DE. A correlation between EDI total score and EDS total score was found among both male and female group fitness instructors. No males and four percent of the females reported having a current ED. The instructors with self-reported current ED had higher weekly volume of instructing classes compared to the other instructors. None of the respondents with self-reported ED had informed their center manager about it.ConclusionThe high prevalence of DE behavior calls for concern. The reported secrecy regarding self-reported ED might decrease the possibility for early recognition and intervention. The findings reveal implications for the instructors’ physical and mental health, for their reputation and impact as important healthy role models and health/fitness authorities, and for the importance of prevention, identification and management of such behavior in fitness center settings.

Psychotic phenomena in Binge Eating Disorder: an exploratory MMPI-2 study

Aim of the studyTo study putative psychotic phenomena in patients with Binge Eating Disorder (BED).Subject or material and methodsSixty patients with a DSM-5 diagnosis of BED were studied. Scores at the Sc, Pa and other subscales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were used to assess possible psychotic features. Eating phenomena were assessed by the Eating Disorder Inventory-2 (EDI-2). The relationship between them was studied.ResultsMean BMI was 38.24±8.43. The Sc and Pa scales of the MMPI-2 were above the cut-off in, respectively, 43.33% and 46.67% of patients. Regression analyses show that both Sc and Pa had a significant effect on EDI-2 scores, although only the Sc scale remained significant after adjusting for their possible interrelation. More than 40% of patients reported high scores (65 or more) at the following MMPI-2 “psychotic” subscales: Paranoia (Pa), Schizophrenia (Sc), Social Alienation (Sc1), Emotional Alienation (Sc2), and Lack of Ego Mastery, both cognitive and conative (Sc3 &amp; Sc4). Perfectionism, Impulse Regulation, Ascetism, Social Insecurity, Interoceptive Awareness, Ineffectiveness, and Maturity Fears are the EDI-2 scales significantly influenced by the Sc and Pa MMPI-2 scores.DiscussionSeveral putative psychotic phenomena were reported in our sample of binge eaters, and they were related to higher scores on several dimensions of the EDI-2.ConclusionsAt least in some patients, there might be an overlap between some psychotic basic phenomena (disordered sense of basic Self, of bodily experiences, and hyperreflectivity), and those basic disturbances in identity development and Self-schemas which are at the base of eating disorders.

Eating disorders risk among obese adolescents

Preliminary research suggests that eating disorders (ED) are common among overweight teenagers. Missing the diagnosis is a poor prognostic factor. To quantify the risk of ED and the effects of age, sex and severity of obesity in obese adolescents. We studied 99 obese adolescents with a body mass index (BMI) > percentile 95 of CDC-NCHS, 51% females, aged between 11 and 19 years, attending an obesity clinic. The Eating Disorders Inventory-2 (EDI-2) was used to evaluate the risk of ED. A score equal or higher than 110, corresponding to the 85th percentile, was considered as risky. Sixteen percent of studied adolescents had EDI scores > 110. No statistically significant differences were observed by age, sex or severity of obesity. EDI-2 scores in participants with a BMI z score over and under 4 were 93.6 ± 33.9 and 78.2 ± 38.8 respectively (p = 0.02). A high percentage of participants had body dissatisfaction (BD) and drive for thinness. Bulimic symptoms, inefficacy, fear of maturity, and impulsivity scores were significantly higher among participants with a high risk of developing ED. Obese adolescents have a high risk for ED, regardless of their age and sex. The risk increases along with higher BMI. The routine use of screening tests is fundamental for an early detection of ED.

Bacterial ClpB heat-shock protein, an antigen-mimetic of the anorexigenic peptide α-MSH, at the origin of eating disorders.

The molecular mechanisms at the origin of eating disorders (EDs), including anorexia nervosa (AN), bulimia and binge-eating disorder (BED), are currently unknown. Previous data indicated that immunoglobulins (Igs) or autoantibodies (auto-Abs) reactive with α-melanocyte-stimulating hormone (α-MSH) are involved in regulation of feeding and emotion; however, the origin of such auto-Abs is unknown. Here, using proteomics, we identified ClpB heat-shock disaggregation chaperone protein of commensal gut bacteria Escherichia coli as a conformational antigen mimetic of α-MSH. We show that ClpB-immunized mice produce anti-ClpB IgG crossreactive with α-MSH, influencing food intake, body weight, anxiety and melanocortin receptor 4 signaling. Furthermore, chronic intragastric delivery of E. coli in mice decreased food intake and stimulated formation of ClpB- and α-MSH-reactive antibodies, while ClpB-deficient E. coli did not affect food intake or antibody levels. Finally, we show that plasma levels of anti-ClpB IgG crossreactive with α-MSH are increased in patients with AN, bulimia and BED, and that the ED Inventory-2 scores in ED patients correlate with anti-ClpB IgG and IgM, which is similar to our previous findings for α-MSH auto-Abs. In conclusion, this work shows that the bacterial ClpB protein, which is present in several commensal and pathogenic microorganisms, can be responsible for the production of auto-Abs crossreactive with α-MSH, associated with altered feeding and emotion in humans with ED. Our data suggest that ClpB-expressing gut microorganisms might be involved in the etiology of EDs.

Impact of Physiologic Estrogen Replacement on Anxiety Symptoms, Body Shape Perception, and Eating Attitudes in Adolescent Girls With Anorexia Nervosa

Anorexia nervosa is characterized by low weight, aberrant eating attitudes, body image distortion, and hypogonadism. Anxiety is a common comorbid condition. Estrogen replacement reduces anxiety in animal models, and reported variations in food intake across the menstrual cycle may be related to gonadal steroid levels. The impact of estrogen replacement on anxiety, eating attitudes, and body image has not been reported in anorexia nervosa. We hypothesized that physiologic estrogen replacement would ameliorate anxiety and improve eating attitudes without affecting body image in anorexia nervosa. Girls 13-18 years old with anorexia nervosa (DSM-IV) were randomized to transdermal estradiol (100 μg twice weekly) with cyclic progesterone or placebo patches and pills for 18-months, between 2002 and 2010. The State-Trait Anxiety Inventory for Children (STAIC), the Eating Disorders Inventory-2 (EDI-2), and the Body Shape Questionnaire (BSQ-34) were administered. 72 girls completed these measures at baseline (n=38 [girls receiving estrogen] and n=34 [girls receiving placebo]) and 37 at 18 months (n=20 [girls receiving estrogen] and n=17 [girls receiving placebo]). The primary outcome measure was the change in these scores over 18 months. Estrogen replacement caused a decrease in STAIC-trait scores (-3.05 [1.22] vs. 2.07 [1.73], P=.02), without impacting STAIC-state scores (-1.11 [2.17] vs. 0.20 [1.42], P=.64). There was no effect of estrogen replacement on EDI-2 or BSQ-34 scores. Body mass index (BMI) changes did not differ between groups, and effects of estrogen replacement on STAIC-trait scores persisted after controlling for BMI changes (P=.03). Increases in serum estradiol were significantly associated with decreases in STAIC-trait scores (Spearman ρ = -0.45, P=.03). Estrogen replacement improved trait anxiety (the tendency to experience anxiety) but did not impact eating attitudes or body shape perception. ClinicalTrials.gov identifier: NCT00088153.

Integrated day-hospital treatment in subjects with overeating disorders

The efficacy of a multidisciplinary, intensive and integrated day-hospital treatment was evaluated in a group of overeaters (bulimia nervosa, binge eating disorder, obesity without binging). The study sample included 72 subjects consecutively admitted to DH who were evaluated at the first contact with the service, on admission, after 5 weeks of treatment, and at discharge. The primary outcome was the total score at the Eating Disorder Inventory (EDI), and the secondary outcome was change in body mass index (BMI). The effects of the duration of treatment on results were also assessed. The improvement of EDI and BMI was compared between the two groups of bingers and non-bingers. Four patients dropped during the treatment period. In the whole sample, both EDI and BMI improved significantly after 5 weeks (p=0.00) and continued to improve until the end of treatment (p=0.00). The duration of treatment did not have a significant impact on BMI improvement (p=0.07), but significantly affected EDI improvement (p=0.006), although only during the treatment period. No significant differences were observed between obese/overweight bingers and non-bingers in BMI improvement (p=0.41), whereas EDI improvement was higher in bingers (p=0.02). The relatively good compliance and the efficacy data suggest that in overeating subjects resistant to previous outpatient treatments a more intensive DH treatment may be useful. Our findings show that such a multidisciplinary therapeutic-rehabilitative treatment significantly improves both total EDI score (especially in bingers) and BMI.

Predicting eating problems among Malaysian Chinese: Differential roles of positive and negative perfectionism

Positive and negative perfectionism (measured by the Positive and Negative Perfectionism Scale; PANPS) are found to have differential roles in predicting eating problems. This study translated and back-translated the PANPS into Chinese and then examined whether its factor structure was comparable to the original PANPS. The relationships between positive and negative perfectionism (using Chinese PANPS) and eating problems were also evaluated. Malaysian Chinese (N=205) adults completed the Chinese PANPS, Eating Disorder Inventory (EDI) and Marlowe-Crowne Social Desirability Scale. Principal Component Analysis showed the two-factor solution of the Chinese PANPS accounted for 33.42% of the total variance, which was comparable to previous studies. Hierarchical multiple regressions revealed that negative perfectionism significantly predicted all eating disorder symptoms for females, but not drive for thinness and body dissatisfaction for males. Conversely, positive perfectionism significantly predicted lower total EDI scores, lower ineffectiveness and lower interpersonal distrust, but only predicted lower body dissatisfaction among females. In conclusion, negative perfectionism was consistently associated with eating problems whereas positive perfectionism might be a potentially adaptive factor, confirming the distinctive roles each played in the development of eating problems, even in a non-Western population.