Subthreshold Eating Disorders Research Articles

Exploring multisensory integration of non-naturalistic sounds on body perception in young females with eating disorders symptomatology: a study protocol

BackgroundBodily illusions can be used to investigate the experience of being in a body by manipulating the underlying processes of multisensory integration. Research suggests that people with eating disorders (EDs) may have impairments in visual, interoceptive, proprioceptive, and tactile bodily perception. Furthermore, people with EDs also show abnormalities in integrating multisensory visuo-tactile and visual-auditory signals related to the body, which may contribute to the development of body image disturbances. Visuo-auditory integration abnormalities have been observed also in people with subthreshold ED symptomatology. However, it remains unclear whether these impairments are specific to bodily signals or if they extend to any auditory signals.MethodsWe will recruit 50 participants (aged 18–24; females assigned at birth) with ED symptomatology (subthreshold group) and 50 control participants. The Eating Disorder Examination Questionnaire will be administered to screen for ED symptomatology and divide the sample into two groups accordingly (control and subthreshold group using a clinical cut-off score of 2.8). The strength of both illusions will be measured implicitly with estimations of body part position and size, and explicitly with self-report questionnaires. As a secondary aim, regression analysis will be run to test the predictive role of susceptibility for both illusions on interoceptive body awareness (measured by the Multidimensional Assessment of Interoceptive Awareness Scale) and sensory-processing sensitivity (measured by the Highly Sensitive Person Scale).DiscussionOur study may contribute to our understanding of the mechanisms underlying body image disturbances. The results may pave the way for novel clinical interventions targeting early symptoms prior to the development of the disorder in young females.

Changes in Eating Attitudes and Risk for Developing Disordered Eating Behaviors in College Students with Subthreshold Eating Disorders: A Cohort Study

Introduction: The number of young adults with eating disorders or subthreshold eating disorders has increased recently. Although disordered eating behaviors persist once they appear, there have been relatively few studies on factors that might cause disordered eating behaviors. The purpose of this study was to investigate how the eating attitudes of young adults change over time and the risk factors that increase disordered eating behaviors. Methods: A total of 1,141 college students, 639 males and 502 females, participated. We investigated changes in eating attitudes (using EAT-26 and BITE), depressive symptoms (using BDI-II), and stress coping (using CISS, which has three subscales) between 2 time points: at college entrance and in the fourth year of college. We divided the students into three groups (clinical, subthreshold, and healthy) based on EAT-26 scores and compared their BDI-II and CISS scores. Next, we identified students who developed disordered eating behaviors, both clinical and subthreshold, during their time at college (exacerbated students) and compared depressive symptoms and stress coping styles between exacerbated students and healthy students (unchanged students). Results: The students in the subthreshold group (both males and females) scored significantly higher on the BDI-II and emotion-oriented coping (CISS-E) than the students in the healthy group at college entrance. Additionally, the exacerbated students (both males and females) scored significantly higher on the CISS-E in the fourth year than unchanged students. The female exacerbated students scored significantly higher on the BDI-II than female unchanged students at both time points. Conclusions: Our results show that depressive symptoms and nonadaptive stress coping are associated with an increased risk of disordered eating behaviors. This study suggests that early intervention may be necessary for both the clinical and subthreshold groups. The key to early intervention may be to manage not only eating behaviors but also depressive symptoms and stress coping.

Understanding the Effects of Disordered Eating on Fertility and Fertility Outcomes

Disordered eating and subthreshold eating disorders can affect fertility. A negative cumulative energy balance that occurs through inadequate nutrition and excessive exercise is often found in individuals engaging in disordered eating behaviors; these disruptions can affect the normal functioning of the hypothalamic–pituitary–gonadal axis and, thus, fertility. Appropriate screening; assessment; and medical, nutritional, and psychosocial interventions are needed to successfully treat these individuals. Educating nurses about the impact of disordered eating on fertility status will enable those who work with clients of reproductive age to better recognize signs and symptoms of disordered eating and to ultimately provide better care. This article addresses how to appropriately recognize and treat individuals presenting with infertility and disordered eating symptomatology.

Suicidal Behavior in Adolescent Girls with Eating Disorders

IntroductionEating disorders are associated with suicidal behavior in adolescents. But the relationship between subthreshold eating disorders and suicidality is not well understood.ObjectivesTo examine suicidal behavior in adolescent girls with eating disorders (ED) and subthreshold eating disorders (SED).MethodsThe study of 917 girls aged 12–17 used the Body Image and Eating Distress scale (Koskelainen et al., 2001) and questions about intentional self-harm (burns or cuts), suicidal thoughts and suicidal attempts. Adolescents were divided into three groups: girls with ED (n = 20); girls with SED (n = 88); and control group (CG, n = 809).ResultsSelf-harm was reported by 55% of girls with ED, 35.2% of girls with SED and 20.2% of CG girls (χ2 = 15.82, p <0.001). Suicidal ideation was reported by 65% of girls with ED, 51.1% of girls with SED and 27.2% of CG girls (χ2 = 21.86, p <0.001). Suicidal attempts were reported by 45% of girls with ED, 17.1% of girls with SED and 7.5% of the CG. There were no differences in the prevalence of self-harm and suicidal ideation between the ED and SED groups, rates of suicide attempts were 2.6 times higher in the ED group.ConclusionsGirls with both ED and SED have a high risk of suicidal behavior: 2.7-4.5 times higher rates of self-harm, 1.9-2.4 times higher rates of suicidal ideation, and 2.3-6 times higher rates of suicidal attempts. Management of such adolescents should include assessment of the risk of suicide.DisclosureThe study was supported by the Russian Science Foundation grant # 21-15-00033.

Prevalence of eating disorders in adolescent girls in Siberia

IntroductionEating disorders (ED) are an urgent public health problem, however, many adolescents with clinical symptoms fail to meet stringent diagnostic criteria.ObjectivesTo estimate the prevalence of eating disorders (ED) and subthreshold eating disorders (SED) in adolescent girls.MethodsA cross-sectional study of girls attending secondary schools (n = 917) was carried out. The sample comprised of 18.3% early adolescents (aged 12-13), 51% middle adolescents (aged 14-15), and 30.6% late adolescents (aged 16-17). We used the Body Image and Eating Distress scale (Koskelainen et al., 2001) coded on a 1-3 scale. The answers were scored on a scale of 1-3. Adolescents scoring 12 or above on four items measuring body dissatisfaction were considered as dissatisfied with their bodies and were further divided into two subgroups: girls scoring 10 or above on three items measuring eating distress were considered as having ED, whereas girls scoring less than 10 were considered as having SED.ResultsThe prevalence of ED was 2.1% (CI 1.4-3.3), the prevalence of SED was 9.6% (CI 7.8-11.7). In early adolescence, the prevalence of SED was 1.6% (CI 0.9-2.7). In middle adolescence, the prevalence of SED was 5.1% (CI 3.9-6.7), the prevalence of ED was 0.9% (CI 0.5-1.8). In late adolescence, the prevalence of SED was 2.8% (CI 1.9-4.1), the prevalence of ED was 1.2% (CI 0.7-2.1).ConclusionsIn adolescent girls, the SED are 4.6 times commoner than overt above-threshold ED. During adolescence, the prevalence of SED decreases, while the prevalence of ED increases with age.DisclosureThe reported study was funded by grant RNF according to the research project № 21-15-00033

Association of Eating Disorders with Recurrent Pain in Adolescent Girls

IntroductionEating disorders (ED) are associated with other mental illnesses, but the association of ED with pain is less well understood.ObjectivesTo study the association of ED with headache and abdominal pain in adolescent girls.MethodsIn 2015-2018, 917 girls aged 12-17 were examined using the Body Image and Eating Distress scale (Koskelainen et al., 2001) and questions about frequency of recurrent headache and abdominal pain over the past six months. Adolescents were divided into three groups: girls with eating disorders (ED, n = 20); subthreshold eating disorders (SED, n = 88); and a control group (CG, n = 809).ResultsHeadaches of varying frequency are were reported by 80% of girls with ED, 70.4% of girls with SED and 52.2% of CG girls. Frequent headaches (every week) were reported by 60% of girls with ED, 40.9% of girls with SED, and 29.9% of CG girls (χ2 = 20.21, p = 0.003). Recurrent abdominal pain was reported by 65% of girls with ED, 56.8% of girls with SED, and by 46.6% of CG girls. Weekly abdominal pain affected 30% of girls with ED, 20.4% of girls with SED and 12.9% of CG girls. Combined weekly pain were commoner in girls with eating distress (in 20% of girls with ED and in 12.5% with SED) than in CG (7.7%, χ2 = 3.92, p = 0.04).ConclusionsEating disorders in adolescents are often associated with pain, which can lead to late recognition of the disease, worsening its course and prognosis.DisclosureThe study was supported by the Russian Science Foundation grant # 21-15-00033

Feminist-Informed Protective Factors for Subthreshold Eating Disorders.

Despite knowledge that the larger sociocultural context contributes to the development of eating disorders, few studies have examined protective factors for women with subthreshold eating disorders. Using feminist-informed constructivist grounded theory methodology, 15 women (ages 18-25 years) with subthreshold eating disorders were interviewed. Results suggest that participants spoke of their subthreshold eating disorders in an externalized way and used protective factors to guide decision making toward their preferred values. A grounded theory model was developed to illustrate this process. Protective factors included (a) people who provide emotional and tangible support, (b) support people who challenge the eating disorder, (c) personal sense of agency, and (d) community activism and involvement. Participants experiencing subthreshold eating disorders demonstrated a capacity to distinguish their own thoughts and values from those of the "eating disorder voice," and protective factors facilitated this process. Implications for future research and practice are discussed.

Prevalence and correlates of eating disorders in greek-cypriot adolescents and young adults

The present study aimed to explore the prevalence rates of eating disorders among Greek-Cypriot adolescents and young adults and examine the role of the following variables in relation to eating disorder risk: gender, age, dieting, exercise and present-ideal weight discrepancy. One thousand and eighty-one middle, high school and university students responded to self-reported measures assessing eating disorders, weight-related concerns and behaviors. Prevalence estimates were 26% for high eating disorder risk and 14.98% for subthreshold eating disorders symptoms while 12% of participants met criteria of an eating disorder diagnosis. Multivariate logistic regression confirmed well-established predictors for eating disorder risk including present to ideal weight discrepancy which had a differential effect on risk in adolescents (i.e., 6-10 kg) and young adults (11+kg). This is the first study to provide prevalence rates of the entire eating pathology spectrum among Greek-Cypriot youth. Results are discussed in terms of their implications in the development of age-specific screening tools and prevention programs.

Ten Years of the Yale Food Addiction Scale: a Review of Version 2.0

The Yale Food Addiction Scale (YFAS) is a self-report questionnaire for the assessment of addiction-like consumption of high-calorie, processed foods. The original scale was developed in 2009 and—for its tenth anniversary—we now review studies using its revised version—the YFAS 2.0. The 11 symptoms of food addiction as measured with the YFAS 2.0 demonstrated high internal reliability and a unidimensional structure in several studies, supporting construct validity. Similar to the original YFAS, highest prevalence rates of YFAS 2.0 diagnoses were found in individuals with bulimia nervosa, followed by binge eating disorder, anorexia nervosa, subthreshold eating disorders, obesity, and unselected samples. Scores on the YFAS 2.0 were associated with other disordered eating behaviors and several co-morbid mental disorders. The YFAS 2.0 is an internal reliable measure that shows factorial validity, yet more studies are needed that demonstrate retest-reliability and predictive validity. Prevalence rates and correlates of YFAS 2.0 diagnoses are largely similar to those observed with the original YFAS.

Relevance of the Thought-Shape Fusion Trait Questionnaire for healthy women and women presenting symptoms of eating disorders and mixed mental disorders.

Thought-shape fusion (TSF) describes the experience of marked concerns about body weight/shape, feelings of fatness, the perception of weight gain, and the impression of moral wrongdoing after thinking about eating fattening/forbidden foods. This study sets out to evaluate the short version of the TSF trait questionnaire (TSF). The sample consists of 315 healthy control women, 244 women with clinical and subthreshold eating disorders, and 113 women with mixed mental disorders (mixed). The factor structure of the TSF questionnaire was examined using exploratory and subsequent confirmatory factor analyses. The questionnaire distinguishes between a Concept scale and a Clinical Impact scale. However, a lack of measurement invariances refers to significant differences between groups in terms of factor loadings, thresholds, and residuals, which questions cross-group validity. Results indicate that the concept is understood differently in the 3 groups and refers to the suitability of the questionnaire primarily for individuals presenting with symptoms of eating disorders.

An investigation of two dimensions of impulsivity as predictors of loss-of-control eating severity and frequency

Loss-of-control (LOC) eating episodes represent one form of dysregulated eating common to full- and sub-threshold eating disorders. Extensive evidence suggests that impulsivity, particularly in the context of negative affect and/or depression, may play an important etiological role in the development and maintenance of LOC eating. However, most prior studies have considered LOC eating as a dichotomous rather than dimensional construct, and few studies have considered the interaction of multiple dimensions of impulsivity while also accounting for the role of depressive symptoms. The present study examined the independent and interacting effects of two facets of impulsivity—response inhibition and negative urgency—on LOC eating episode severity and frequency among college women (N = 102). Depressive symptom severity was included as a covariate. Results indicated that greater negative urgency was associated with greater LOC severity; this effect was moderated by response inhibition, such that the effect of urgency was particularly pronounced for individuals with higher response inhibition capacity. Negative urgency was the only significant predictor of LOC frequency. Depression had no significant effect on either LOC severity or frequency (ps ≥ 0.16). Results support the importance of considering multiple facets of impulsivity in predicting LOC eating behavior, and further indicate that factors influencing subjective severity and frequency of LOC may be distinct.

Epidemiology of eating disorders in Europe

Eating disorders - anorexia nervosa, bulimia nervosa, and binge eating disorder - affect numerous Europeans. This narrative review summarizes European studies on their prevalence, incidence, comorbidity, course, consequences, and risk factors published in 2015 and the first half of 2016. Anorexia nervosa is reported by <1-4%, bulimia nervosa <1-2%, binge eating disorder <1-4%, and subthreshold eating disorders by 2-3% of women in Europe. Of men, 0.3-0.7% report eating disorders. Incidences of anorexia appear stable, whereas bulimia may be declining. Although the numbers of individuals receiving treatment have increased, only about one-third is detected by healthcare. Over 70% of individuals with eating disorders report comorbid disorders: anxiety disorders (>50%), mood disorders (>40%), self-harm (>20%), and substance use (>10%) are common. The long-term course of anorexia nervosa is favorable for most, but a substantial minority of eating disorder patients experience longstanding symptoms and somatic problems. The risk of suicide is elevated. Parental psychiatric disorders, prenatal maternal stress, various family factors, childhood overweight, and body dissatisfaction in adolescence increase the risk of eating disorders. Eating disorders are relatively common disorders that are often overlooked, although they are associated with high comorbidity and serious health consequences.

Thinking dimensional: prevalence of DSM-5 early adolescent full syndrome, partial and subthreshold eating disorders in a cross-sectional survey in German schools

ObjectivesInvestigating for the first time in Germany Diagnostic and Statistical Manual Fifth Edition (DSM-5) prevalences of adolescent full syndrome, Other Specified Feeding or Eating Disorder (OSFED), partial and subthreshold anorexia...

An exploratory examination of At-Risk/Problematic Internet Use and disordered eating in adults

PurposeAt-Risk/Problematic Internet Use (ARPIU) has been associated with impairment in multiple domains including psychopathology. The present study examined the relationship between ARPIU and disordered eating in a large community sample. MethodsParticipants (n=1000) completed an online survey about health behaviors. Two thresholds of ARPIU and disordered eating each were examined. ResultsThe ARPIU and Sub-ED (subthreshold eating disorders) groups reported greater depressive symptoms and poorer self-control than the Control group; the Sub-ED group reported greater impulsivity than the Control group. The ARPIU and Sub-ED groups significantly differed in key features related to each condition. Finally, the co-occurrence of ARPIU and Sub-ED was associated with greater depression. In the second set of analyses based on more stringent thresholds, the Problematic Internet Use (PIU) and ED groups differed on all measures compared to the Control group. The PIU and ED groups also differed on key features related to each condition, but did not differ on measures of impulsivity or self-control. The co-occurrence of PIU and ED was associated with greater depressive symptoms than either PIU or ED independently. ConclusionsARPIU and Sub-ED share links to depression and poor self-control and these may represent possible therapeutic targets across Internet-use and disordered-eating behaviors. Co-occurring PIU and ED at either lenient or stringent thresholds is associated with greater depression. Future studies should examine the temporal nature of these associations and the extent to which targeting depression, Internet use, or disordered eating may lead to improvements across domains.

Eating Disorders in Girls and Women With Type 1 Diabetes: A Longitudinal Study of Prevalence, Onset, Remission, and Recurrence.

Girls and women with type 1 diabetes are at increased risk for developing eating disorders (EDs), and these disorders are associated with serious diabetes-related medical complications. This study describes the longitudinal course of disturbed eating behavior (DEB) and EDs in a cohort with type 1 diabetes. A total of 126 girls with type 1 diabetes receiving care for diabetes at The Hospital for Sick Children in Toronto participated in a series of seven interview-based assessments of ED behavior and psychopathology over a 14-year period, beginning in late childhood. Survival analysis was used. Mean age was 11.8 ± 1.5 years at time 1 and 23.7 ± 2.1 years at time 7. At time 7, 32.4% (23/71) met the criteria for a current ED, and an additional 8.5% (6/71) had a subthreshold ED. Mean age at ED onset (full syndrome or below the threshold) was 22.6 years (95% CI 21.6-23.5), and the cumulative probability of onset was 60% by age 25 years. The average time between onset of ED and subsequent ED remission was 4.3 years (95% CI 3.1-5.5), and the cumulative probability of remission was 79% by 6 years after onset. The average time between remission of ED and subsequent recurrence was 6.5 years (95% CI 4.4-8.6), and the cumulative probability of recurrence was 53% by 6 years after remission. In this longitudinal study, EDs were common and persistent, and new onset of ED was documented well into adulthood. Further research regarding prevention and treatment for this vulnerable group is urgently needed.

Weight Status and DSM-5 Diagnoses of Eating Disorders in Adolescents From the Community

To estimate jointly the point prevalence of weight and eating disorders in a community sample of adolescents; to investigate psychosocial correlates of thinness, overweight, and obesity, and of full- and subthreshold eating disorders (EDs); and to examine the relationships between weight status and prevalence of EDs. A total of 3,043 Canadian adolescents (1,254 males and 1,789 females; mean age = 14.19 years, SD = 1.61 years) completed self-report questionnaires, including the Eating Disorder Diagnostic Scale, and measures of psychosocial functioning. Objective weight and height were collected, and weight status was defined according to the International Obesity Task Force body mass index growth curve centiles. In all, 29.5% (95% CI = 26.7, 32.5) of males and 22.8% (95% CI = 20.5, 25.2) of females were overweight or obese. A total of 2.2% (95% CI = 1.5, 3.2) of males and 4.5% (95% CI = 4.4, 4.5) of females met DSM-5 criteria for an ED; in addition, 1.1% (95% CI = 0.7, 1.9) of males and 5.1% (95% CI = 4.0, 6.5) of females were identified with a subthreshold ED. Both full- and subthreshold EDs were significantly associated with markedly impaired psychosocial functioning. There was a significant relationship between prevalence of EDs and weight status, with an increased risk for a bulimic disorder in obese relative to normal-weight males (odds ratio [OR] = 7.86) and females (OR = 3.27). This study provides estimates for the prevalence of DSM-5 EDs in adolescents, further support for their impact on mental health, and new evidence for an association between bulimic disorders and obesity. Results call for an integrated approach in research and prevention regarding the whole spectrum of eating- and weight-related disorders.

Moderators and mediators of outcome in Internet-based indicated prevention for eating disorders

The objective of this study was to investigate moderators and mediators of the effect of an indicated prevention program for eating disorders (ED) on reduction of dysfunctional attitudes and specific ED symptoms. 126 women (M age = 22.3; range 18–33) reporting subthreshold ED symptoms were randomized to the Student Bodies™+ (SB+) intervention or an assessment-only control condition. Assessments took place at pre-intervention, mid-intervention (mediators), post-intervention, and 6-month follow-up. Mixed effects modeling including all available data from all time points were used for the data analysis. Intervention effects on the reduction of binge rate were weaker for participants with higher baseline BMI and for participants with a lower baseline purge rate. Intervention effects on reduction of eating disorder pathology were weaker for participants with higher baseline purge rate and with initial restrictive eating. No moderators of the intervention effect on restrictive eating were identified. An increase in knowledge mediated the beneficial effect of SB+ on binge rate. The results suggest that different moderators should be considered for the reduction of symptoms and change in attitudes of disturbed eating and that SB+ at least partially operates through psychoeducation.

Eating disorders in children and adolescents: state of the art review.

Despite their high prevalence, associated morbidity and mortality, and available treatment options, eating disorders (EDs) continue to be underdiagnosed by pediatric professionals. Many adolescents go untreated, do not recover, or reach only partial recovery. Higher rates of EDs are seen now in younger children, boys, and minority groups; EDs are increasingly recognized in patients with previous histories of obesity. Medical complications are common in both full and subthreshold EDs and affect every organ system. No single cause of EDs has emerged, although neurobiological and genetic predispositions are emerging as important. Recent treatment paradigms acknowledge that they are not caused by families or chosen by patients. EDs present differently in pediatric populations, and providers should have a high index of suspicion using new Diagnostic and Statistical Manual, 5th edition diagnostic criteria because early intervention can affect prognosis. Outpatient family-based treatment focused on weight restoration, reducing blame, and empowering caregivers has emerged as particularly effective; cognitive behavioral therapy, individual therapy, and higher levels of care may also be appropriate. Pharmacotherapy is useful in specific contexts. Full weight restoration is critical, often involves high-calorie diets, and must allow for continued growth and development; weight maintenance is typically inappropriate in pediatric populations. Physical, nutritional, behavioral, and psychological health are all metrics of a full recovery, and pediatric EDs have a good prognosis with appropriate care. ED prevention efforts should work toward aligning with families and understanding the impact of antiobesity efforts. Primary care providers can be key players in treatment success.

Prevalence of eating disorders in middle‐aged women

Little is known about the prevalence and correlates of eating disorders (ED) in middle-aged women. We mailed anonymous questionnaires to 1,500 Austrian women aged 40-60 years, assessing ED (defined by DSM-IV), subthreshold ED, body image, and quality of life. We broadly defined "subthreshold ED" by the presence of either (1) binge eating with loss of control or (2) purging behavior, without requiring any of the other usual DSM-IV criteria for frequency or severity of these symptoms. Of the 715 (48%) responders, 33 [4.6%; 95% confidence interval (CI): 3.3-6.4%] reported symptoms meeting full DSM-IV criteria for an ED [bulimia nervosa = 10; binge eating disorder = 11; eating disorder not otherwise specified (EDNOS) = 12]. None displayed anorexia nervosa. Another 34 women (4.8%; CI: 3.4-6.6%) displayed subthreshold ED. These women showed levels of associated psychopathology virtually equal to the women with full-syndrome diagnoses. ED appear common in middle-aged women, with a preponderance of binge eating disorder and EDNOS diagnoses as compared to the "classical" diagnoses of anorexia and bulimia nervosa. Interestingly, middle-aged women with even very broadly defined subthreshold ED showed distress and impairment comparable to women with full-scale ED.

Depression and coping in subthreshold eating disorders

ObjectiveThe eating disorder literature has sought to understand the role of comorbid psychiatric diagnoses and coping in relation to eating disorders. The present research extends these findings by studying the relationships among depression, coping, and the entire continuum of disordered eating behaviors, with an emphasis on subthreshold eating disorders. Method109 undergraduate females completed questionnaires to assess disordered eating symptoms, depressive symptoms, and the use of active and avoidant coping mechanisms. Hypotheses were tested using bivariate linear regression and multivariate linear regression. ResultsResults indicated that depression was a significant predictor of disordered eating symptoms after controlling for relationships between depression and coping. Although avoidant coping was positively associated with disordered eating, it was not a significant predictor after controlling for depression and coping. DiscussionPrevious research has found associations between depression and diagnosable eating disorders, and this research extends those findings to the entire continuum of disordered eating. Future research should continue to investigate the predictors and correlates of the disordered eating continuum using more diverse samples. Testing for mediation and moderation among these variables may also be a fruitful area of investigation.