Subclinical Eating Disorders Research Articles

Cognitive dysfunction in eating disorders

Recent theories have implicated disturbed cognitions in the etiology and perpetuation of eating disorders. However, the specific nature of these disturbances has received only limited empirical attention. Therefore the present study assessed subjects with a range of eating pathology on three types of cognitive dysfunction: logical errors, cognitive slippage, and conceptual complexity. Affective features were also assessed for purposes of contrast and discriminant validity. The Cognitive Error Questionnaire (Lefebvre, 1981), Thought Disorder Index (Blatt & Ritzier, 1974), Friedman's Developmental Level (Goldfried, Stricker, & Weiner, 1971), Sentence Completion Test (Loevinger & Wessler, 1970), Dysphoria Questionnaire (Johnson & Larson, 1982), and Beck Depression Inventory (Beck, 1978) were administered to 19 restrictive anorexics, 14 bulimic anorexics, 17 normal-weight bulimics, 15 subclinical eating disorders, and 17 normal control subjects. All groups were matched for age, sex, race, education, and marital status. The eating disordered groups were matched for duration of illness and treatment history, and the anorexic groups were matched on percent of ideal body weight. Both anorexic groups manifested more logical errors than the control group; the normal-weight bulimic and subclinical groups were indistinguishable from the controls on this index. There were no significant differences among groups on cognitive slippage or conceptual complexity. In contrast, dysphoria and depression were prominent features of all four eating disordered groups. The significance and conjoint influence of cognitive and affective factors in eating pathology is discussed.

Subclinical eating disorders and glycemic control in adolescents with type I diabetes.

Several recent case reports have shown that anorexia nervosa and bulimia negatively affect glycemic control in diabetic patients. However, there have been no systematic studies to assess the prevalence of clinical or subclinical eating disorders among diabetic patients or to determine the impact of such disturbances on glycemic control. This study reports a survey of 202 adolescents, aged 12-18 yr, seen in the Diabetes Clinic, Children's Hospital of Pittsburgh, who were asked to complete the Binge Eating Scale (BES) and the EAT-26 questionnaire. Responses of diabetic patients to the EAT-26 questionnaire were compared with those of a nondiabetic control group and were related to measures of glycemic control. Diabetic subjects scored higher on the total EAT-26 than nondiabetic control subjects, ordinarily indicative of more eating pathology. However, diabetic subjects scored higher only on the dieting subscale of this questionnaire, probably reflecting adherence to the diabetes dietary regimen. Subjects with diabetes scored lower, or did not differ significantly, from nondiabetic control subjects on measures of oral control and bulimia. Among diabetic subjects, self-reported bulimic behaviors were related to poorer glycemic control. Patients with the highest scores on the BES had an average HbA1 of 13.1% compared with 11.8% for age- and sex-matched patients at the 50th percentile, and 10.8% for patients in the lowest 10th percentile. Further studies are needed to determine whether modification of these eating behaviors would improve glycemic control.