Risk Factors For Bulimia Nervosa Research Articles

Retrospective Correlates for Bulimia Nervosa: A Matched Case-Control Study.

There have been few studies investigating the risk factors for bulimia nervosa (BN), and most have been in Anglo-Saxon countries. This study aimed to (i) replicate the uncontested retrospective correlates for BN and clarify the role of factors with inconsistent findings and (ii) evaluate the strength of these factors in a different culture. A case-control design was used to compare 60 women who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for BN to 60 healthy controls and 60 participants with other psychiatric disorders. Retrospective correlates were assessed by interviewing each person with the Oxford Risk Factor Interview. The primary retrospective correlates identified from the comparison of BN participants to healthy controls were general high maternal expectations, negative attitudes about parental weight and obesity in childhood and adolescence. Compared with participants with other psychiatric disorders, those with BN also reported higher rates of childhood obesity, deliberate self-harm, family conflicts, general high maternal expectations and feeling fat in childhood. The common findings across cultures suggest that, at least, individuals subjectively experience a number of similar factors that increase risk for developing BN. In addition, the difference regarding self-harm is notable.

Distinguishing Between Risk Factors for Bulimia Nervosa, Binge Eating Disorder, and Purging Disorder.

Binge eating disorder and purging disorder have gained recognition as distinct eating disorder diagnoses, but risk factors for these conditions have not yet been established. This study aimed to evaluate a prospective, mediational model of risk for the full range of binge eating and purging eating disorders, with attention to possible diagnostic differences. Specific aims were to determine, first, whether eating, weight and shape concerns at age 14 would mediate the relationship between parent-perceived childhood overweight at age 10 and a binge eating or purging eating disorder between age 15 and 20, and, second, whether this mediational model would differ across bulimia nervosa, binge eating disorder, and purging disorder. Participants (N=1,160; 51% female) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to age 20. Eating disorders were assessed via self-report questionnaires when participants were aged 14, 17 and 20. There were 146 participants (82% female) with a binge eating or purging eating disorder with onset between age 15 and 20 [bulimia nervosa=81 (86% female), binge eating disorder=43 (74% female), purging disorder=22 (77% female)]. Simple mediation analysis with bootstrapping was used to test the hypothesized model of risk, with early adolescent eating, weight and shape concerns positioned as a mediator between parent-perceived childhood overweight and later onset of a binge eating or purging eating disorder. Subsequently, a conditional process model (a moderated mediation model) was specified to determine if model pathways differed significantly by eating disorder diagnosis. In the simple mediation model, there was a significant indirect effect of parent-perceived childhood overweight on risk for a binge eating or purging eating disorder in late adolescence, mediated by eating, weight and shape concerns in early adolescence. In the conditional process model, this significant indirect effect was not moderated by eating disorder group. The results support a prospective model of risk that applies to bulimia nervosa, binge eating disorder and purging disorder. Common prevention approaches may be possible for bulimia nervosa, binge eating disorder and purging disorder.

Risk factors across the eating disorders

This study sought to examine risk and onset patterns in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Women with AN (n=71), BN (n=66), BED (n=160) and non-psychiatric controls (n=323) were compared retrospectively on risk factors, symptom onset, and diagnostic migration. Eating disorder groups reported greater risk exposure than non-psychiatric controls. AN and BED differed on premorbid personality/behavioral problems, childhood obesity, and family overeating. Risk factors for BN were shared with AN and BED. Dieting was the most common onset symptom in AN, whereas binge eating was most common in BN and BED. Migration between AN and BED was rare, but more frequent between AN and BN and between BN and BED. AN and BED have distinct risk factors and onset patterns, while BN shares similar risk factors and onset patterns with both AN and BED. Results should inform future classification schemes and prevention programs.

2D:4D Ratio in children at familial high‐risk for eating disorders: The role of prenatal testosterone exposure

ObjectivesMarkers of prenatal hormone exposure have been associated with the development of eating disorder (ED) behaviors. Our aim was to determine whether 2D:4D ratio, a marker for in utero testosterone exposure, is associated with risk for ED in a large population-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC).MethodsThis is the first study to investigate prenatal testosterone exposure in children at high-risk for ED, using 2D:4D as a marker. We compared children whose mothers reported a lifetime ED (anorexia, bulimia, or both; N = 446) to children whose mothers did not (n = 5,367).ResultsDaughters of women with lifetime bulimia nervosa (BN) had lower 2D:4D ratio (B: −0.01, 95% CI: −0.02 to −0.002, P = 0.02), indicating higher prenatal testosterone exposure, than daughters of mothers unaffected by ED. No differences were observed in the male children of women with an ED.ConclusionsFindings suggest that children at high-risk for BN may be exposed to higher levels of testosterone in utero. Fetal exposure to androgen excess is thought to be causal in the development of polycystic ovary syndrome (PCOS), a disorder which is highly comorbid with binge eating and BN. Future research should investigate the potential role of testosterone exposure in utero as a risk factor for BN and binge eating. Am. J. Hum. Biol. 26:176–182, 2014. © 2013 Wiley Periodicals, Inc.

Cognitive reappraisal fails when attempting to reduce the appetitive value of food: An ERP study

This event-related potential (ERP) study investigated neural correlates of cognitive reappraisal during the exposure to food cues. Thirty-three healthy, normal-weight women viewed images of high-caloric food and non-food items after an overnight fast. The participants were instructed to either passively look at the pictures, or to change (increase, decrease) the appetitive value of the food items.The P300 and the late positive potential (LPP) were higher across all conditions for food relative to non-food pictures. In the ‘increase condition’ the food images were rated as more appetizing and arousing than during passive viewing which was accompanied by increased amplitudes of the P300 and LPP. In contrast, the ‘watch condition’ and the ‘decrease condition’ did not differ with regard to appetite and arousal ratings as well as ERPs. Amplitudes of late positive potentials in the ‘decrease condition’ were positively correlated with scores on eating disorder scales indicating bulimic tendencies.The ERP data show that the appetitive value of food cues can easily be enhanced via reappraisal but is difficult to reduce, especially in women who display non-clinical forms of purging. The reduced ERP reactivity might constitute a risk factor for bulimia nervosa. Future longitudinal-prospective studies should follow up on this aspect.

Mediators in the dissonance eating disorder prevention program

Previous research has supported thin-ideal internalization as a partial mediator of the effects of the dissonance eating disorder prevention program. The current study replicated previous findings and examined an additional mediator, body dissatisfaction, hypothesized to account for partial intervention effects. As a secondary goal, we developed a more rigorous and accurate test of mediation that accounted for the temporal, causal interplay between mediator and outcome, and controlled for “reverse mediation”. Results from a sample of 71 high-risk females ( M age = 19.8, SD = 1.3) who participated in a four-week dissonance intervention supported thin-ideal internalization as a partial mediator of the effects of the dissonance intervention on bulimic symptoms, even after controlling for body dissatisfaction as a second mediator. Furthermore, results supported body dissatisfaction as a partial mediator for bulimic symptoms after controlling for thin-ideal internalization. Significant “reverse mediation” effects suggested the reciprocal influence of some risk factors for bulimia nervosa and bulimic symptoms. These results contribute to our understanding of the mediators in the dissonance intervention, which can help refine eating disorder prevention programs.

Five novel single nucleotide polymorphisms (SNPs) of the ghrelin receptor (<i>GHSR</i>) gene in cattle (Brief report)

Abstract. The growth hormone secretagogue receptor (ghrelin receptor, GHSR) gene plays an important role in the regulation of food intake and energy homeostasis. The GHSR gene lies on human chromosome 3q26 within a quantitative trait locus strongly linked to multiple phenotypes related to obesity and the metabolic syndrome (BAESSLER et al., 2005). In human, the 171T/C SNP mutation is a risk factor for bulimia nervosa (MIYASAKA et al., 2006). The 611 C/A transversion unveils the critical importance of the GHSR-associated constitutive activity, and discloses an unusual pathogenic mechanism of growth failure in humans (PANTEL et al., 2006). By now, no polymorphism of bovine GHSR gene is reported. In the present paper, partial 5’ untranslated region, coding region and partial 3’ untranslated region of GHSR were screened to detect the SNPs in Chinese cattle breeds.

Association of ghrelin receptor gene polymorphism with bulimia nervosa in a Japanese population

Eating disorders (EDs) have a highly heterogeneous etiology and multiple genetic factors might contribute to their pathogenesis. Ghrelin, a novel growth hormone-releasing peptide, enhances appetite and increases food intake, and human ghrelin plasma levels are inversely correlated with body mass index. In the present study, we examined the 171T/C polymorphism of the ghrelin receptor (growth hormone secretagogue receptor, GHSR) gene in patients diagnosed with EDs, because the subjects having ghrelin gene polymorphism (Leu72Met) was not detected in a Japanese population, previously. In addition, beta3 adrenergic receptor gene polymorphism (Try64Arg) and cholecystokinin (CCK)-A receptor (R) gene polymorphism (-81A/G, -128G/T), which are both associated with obesity, were investigated. The subjects consisted of 228 Japanese patients with EDs [96 anorexia nervosa (AN), 116 bulimia nervosa (BN) and 16 not otherwise specified (NOS)]. The age- and gender-matched control group consisted of 284 unrelated Japanese subjects. The frequency of the CC type of the GHSR gene was significantly higher in BN subjects than in control subjects (chi(2) = 4.47, p = 0.035, odds ratio = 2.05, Bonferroni correction: p = 0.070), while the frequency in AN subjects was not different from that in controls. The distribution of neither beta3 adrenergic receptor gene nor CCK-AR polymorphism differed between EDs and control subjects. Therefore, the CC type of GHSR gene polymorphism (171T/C) is a risk factor for BN, but not for AN.

Childhood gastrointestinal complaints in women with bulimia nervosa

The current study describes childhood gastrointestinal (GI) complaints in adult women presenting for a treatment trial for bulimia nervosa (BN) and examines the correlates of BN symptomatology. The sample comprised 135 women with BN who underwent an assessment including questions regarding childhood GI complaints. Individuals were grouped into one of three categories: no GI complaints, GI complaints with/without constipation (GI complaints), and constipation only. Eating disorder psychopathology was compared across these groups. One third of participants reported GI complaints or constipation only in childhood. Women with GI complaints were younger, and had an earlier onset of BN and self-induced vomiting compared with women with no GI complaints. Trends existed for a younger age of first binge, and a higher frequency of binge eating in this group. These findings suggest that individuals with childhood GI complaints and other risk factors for BN may be at greater risk of developing a more severe eating disorder at an earlier age.

Beliefs of women concerning causes and risk factors for bulimia nervosa

To examine the beliefs of women concerning causes and risk factors for eating-disordered behaviour.Face-to-face interviews were conducted with a community sample of 208 women aged 18-45 years. Respondents were presented with a vignette describing a fictional person meeting diagnostic criteria for bulimia nervosa (BN) and were asked to indicate whether each of several factors was 'very likely', 'likely' or 'not likely' to be a cause of the problem described, which factor was most likely to be a cause, and whether particular subgroups of people would be 'more likely', 'less likely' or 'equally likely' to have or develop the problem described.'Having low self-esteem' was considered very likely to be a cause of BN by 75.0% of respondents, and the most likely cause by 40.5% of respondents. Other factors perceived as significant were 'problems from childhood', 'portrayal of women in the media', 'being overweight as a child or adolescent' and 'day-to-day problems', while genetic factors and pre-existing psychological problems were perceived to be of minor significance. Most respondents believed that women aged under 25 years were at greatest risk of having or developing BN.Women's beliefs concerning causes and risk factors for BN are generally consistent with empirical evidence. However, information concerning the increased risk associated with pre-existing anxiety and affective disorders might usefully be included in prevention programs. Systematic investigation of the benefits of addressing individuals' beliefs concerning risk factors for eating disorders - as opposed to risk factors per se - would be of interest.

Beliefs of women concerning causes and risk factors for bulimia nervosa.

To examine the beliefs of women concerning causes and risk factors for eating-disordered behaviour. Face-to-face interviews were conducted with a community sample of 208 women aged 18-45 years. Respondents were presented with a vignette describing a fictional person meeting diagnostic criteria for bulimia nervosa (BN) and were asked to indicate whether each of several factors was 'very likely', 'likely' or 'not likely' to be a cause of the problem described, which factor was most likely to be a cause, and whether particular subgroups of people would be 'more likely', 'less likely' or 'equally likely' to have or develop the problem described. 'Having low self-esteem' was considered very likely to be a cause of BN by 75.0% of respondents, and the most likely cause by 40.5% of respondents. Other factors perceived as significant were 'problems from childhood', 'portrayal of women in the media', 'being overweight as a child or adolescent' and 'day-to-day problems', while genetic factors and pre-existing psychological problems were perceived to be of minor significance. Most respondents believed that women aged under 25 years were at greatest risk of having or developing BN. Women's beliefs concerning causes and risk factors for BN are generally consistent with empirical evidence. However, information concerning the increased risk associated with pre-existing anxiety and affective disorders might usefully be included in prevention programs. Systematic investigation of the benefits of addressing individuals' beliefs concerning risk factors for eating disorders - as opposed to risk factors per se - would be of interest.

Sex influences on shared risk factors for bulimia nervosa and other psychiatric disorders.

The examination of opposite-sex and same-sex dizygotic twins allows us to explore the sex-specific comorbidity of psychiatric disorders. To date, this question has not been explored in eating disorders. To determine whether sex influences shared risk factors between bulimia nervosa (BN) and other forms of psychopathology. The study examines associations between BN and other forms of psychopathology in twin pairs using interview and survey reports. Twins from the Virginia population-based twin registry. Male-female dizygotic twins (N = 1192 pairs), mean (SD) age 36.6 (8.9) years, and female-female dizygotic twins (N = 467 pairs), mean (SD) age 36.0 (7.6) years. Lifetime psychiatric disorders as diagnosed by a structured psychiatric interview, including major depression, anxiety disorders, and substance abuse and dependence. Also, continuous measures of body mass index and personality, including neuroticism and novelty seeking. Significant within-person associations existed for women between BN and higher body mass index, neuroticism, novelty seeking, and all lifetime psychopathology. Results from this study suggest the presence of either familial or nonfamilial shared risk factors between BN and generalized anxiety disorder, neuroticism, psychoactive substance use, novelty seeking, major depression, and panic disorder. The shared risk factors between BN and generalized anxiety disorder and BN and novelty seeking were only present in men. Evidence supports the existence of a sex-specific manifestation of familial liability with respect to BN and generalized anxiety disorder and BN and novelty seeking.

Factors Associated with Weight Concerns andUnhealthy Eating Patterns Among YoungKorean Females

To identify factors associated with weight concerns and unhealthy eating patterns among young Korean females, previously validated Korean versions of the Eating Disorder Inventory-2 (EDI-2), and the Bulimia Test-Revised (BULIT-R), were administered to 533 Korean female students. Multiple regression analyses revealed five and six potential multidimensional risk factors for anorexia and bulimia nervosa, respectively. Further, logistic regression analyses identified six and five potential multidimensional risk factors for bulimia nervosa and dieters, respectively. Effective prevention strategies, for decreasing future prevalence rates of clinical eating disorders in Korea, should target these identified risk factors for unhealthy eating patterns among Korean female students.

Clarifying the role of impulsivity in bulimia nervosa.

With the goal of demonstrating that urgency impulsivity is associated with bulimic symptoms, not (lack of) planning impulsivity, the authors conducted two studies assessing these personality traits and bulimic symptoms in undergraduate women. In study 1 291 women completed urgency and deliberation scales of the NEO PIR and the BULIT-R. In study 2 101 women completed alternative measures tapping these personality constructs and the BULIT-R. In both studies, what is commonly assessed with impulsivity measures, a lack of planning, was not significantly associated with bulimic symptoms. However, urgency, the tendency to act rashly when experiencing negative affect, was positively correlated with bulimic symptoms. The authors suggest that future researchers assess urgency, not lack of planning, when assessing impulsivity as a risk factor for bulimia nervosa.

Genetic predisposition to obesity in bulimia nervosa: a mutation screen of the melanocortin-4 receptor gene.

Obesity has been identified as a risk factor for the development of bulimia nervosa (BN). Accordingly, we hypothesize that genotypes predisposing to obesity can be detected in patients with this eating disorder. In order to investigate this hypothesis we screened the melanocortin-4 receptor gene (MC4R) for mutations using single strand conformation analysis in 81 female inpatients treated for BN. A single patient with both extreme obesity and BN had a haplo-insufficiency mutation in the MC4R. Comparison of current and maximal body mass index (BMI) of all patients with cross-sectionally obtained BMI in the general population revealed an age appropriate distribution for current BMI and a substantially increased frequency for overweight at time of maximal BMI. Our findings suggest that overweight is a risk factor for BN in clinically ascertained patients. For the first time a genotype predisposing to obesity has been detected in an extremely obese patient with BN.

A COMPARISON OF TWO GROUPS OF WOMEN WITH BULIMIA NERVOSA ON SYMPTOMONSET

Bulimia nervosa (BN) is a significant mental health problem for women. Both children and adolescents develop risk factors for BN that are identifiable. An important role for psychiatric-mental health nurses is the prevention of psychiatric disorders through risk factor identification and intervention for early symptoms. The purpose of this study was to extend recent research on the sequencing of risk factors and symptoms in the development of bulimia nervosa. Symptom history was collected on 71 women who agreed to participate in research on eating disorders (EDs). Women were divided into two groups based on whether their first symptom manifested was bingeing (BF) or dieting (DF). The groups were compared on age of symptom onset, weight history, and history of diagnosis. There were significant differences between the groups, and the present findings contradict some of the important conclusions from three previous studies. The results are discussed and implications for strategies for early detection and prevention are presented.

Risk factors for anorexia nervosa: three integrated case-control comparisons.

Many risk factors have been implicated in the development of anorexia nervosa. Little is known about their relative contributions, nor in most cases is it clear whether they are specific to anorexia nervosa or risk factors for all eating disorders or for psychiatric disorder in general. We used a case-control design involving the comparison of 67 female subjects with a history of anorexia nervosa with 204 healthy control subjects, 102 subjects with other psychiatric disorders, and 102 subjects with bulimia nervosa. A broad range of risk factors was assessed by interview. The subjects with anorexia nervosa and the healthy controls differed in their exposure to most of the putative risk factors. There was no greater exposure to factors that increased the likelihood of dieting, once the influence of other classes of risk factors had been taken into account. Premorbid perfectionism and negative self-evaluation were especially common and more so than among the general psychiatric controls. Parental obesity and an early menarche, together with parental psychiatric disorder, distinguished those with bulimia nervosa from those with anorexia nervosa. There appears to be a broad range of risk factors for anorexia nervosa and bulimia nervosa, some of which are shared with other psychiatric disorders. Factors that increase the likelihood of dieting seem to have more important influence as risk factors for bulimia nervosa than anorexia nervosa. Perfectionism and negative self-evaluation appear to be particularly common and characteristic antecedents of both eating disorders.

Dual Pathway Model of Bulimia Nervosa: Longitudinal Support for Dietary Restraint and Affect-Regulation Mechanisms

Although numerous risk factors for bulimia nervosa have been identified, no multivariate models of bulimia have been empirically investigated with longitudinal data. The current study provided a confirmatory test of the dual pathway model of bulimia nervosa using prospective data from a community sample of adolescents (N = 218). Latent variable modeling indicated that negative affect and dietary restraint predicted future bulimic symptomatology. Further, these two factors mediated the effects of initial perceived pressure for a thin body, body mass, ideal body internalization, and body dissatisfaction on subsequent bulimic pathology. These findings provide additional support for the dual pathway model of bulimia, suggest variables that might be targeted in prevention and treatment efforts, and point to several directions for future research.

Risk factors for binge eating disorder: a community-based, case-control study.

Many risk factors have been implicated for eating disorders, although little is known about those for binge eating disorder. A community-based, case-control design was used to compare 52 women with binge eating disorder, 104 without an eating disorder, 102 with other psychiatric disorders, and 102 with bulimia nervosa. The main risk factors identified from the comparison of subjects with binge eating disorder with healthy control subjects were certain adverse childhood experiences, parental depression, vulnerability to obesity, and repeated exposure to negative comments about shape, weight, and eating. Compared with the subjects with other psychiatric disorders, those with binge eating disorder reported more childhood obesity and more exposure to negative comments about shape, weight, and eating. Certain childhood traits and pronounced vulnerability to obesity distinguished the subjects with bulimia nervosa from those with binge eating disorder. Binge eating disorder appears to be associated with exposure to risk factors for psychiatric disorder and for obesity. When compared with the wide range of risk factors for bulimia nervosa, the risk factors for binge eating disorder are weaker and more circumscribed. Pre-morbid perfectionism, negative self-evaluation, and vulnerability to obesity appear especially to characterize those in whom bulimia nervosa subsequently develops.

Relationship of Childhood Sexual Abuse and Eating Disorders

To review the literature that has examined the relationship between childhood sexual abuse and the eating disorders. Each of the five authors reviewed all identified empirical studies to be certain that inclusion/exclusion criteria were met. Two teams of raters then independently reviewed each study to determine whether it supported any of a series of six hypotheses that had been tested in this literature. This review indicates that childhood sexual abuse is a nonspecific risk factor for bulimia nervosa, particularly when there is psychiatric comorbidity. There is some indication that childhood sexual abuse is more strongly associated with bulimic disorders than restricting anorexia, but it does not appear to be associated with severity of the disturbance. Childhood sexual abuse is a risk factor for bulimia nervosa with significant comorbidity. Further study of the nature of this relationship is warranted.