Subthreshold Eating Disorders Research Articles

Course and predictors of maternal eating disorders in the postpartum period

To investigate course and predictors of eating disorders in the postpartum period. A total of 77,807 women, participating in the Norwegian Mother and Child Cohort Study (MoBa), completed questionnaires during pregnancy including items covering DSM-IV criteria for prepregnancy anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS-P), and binge eating disorder (BED). Additional questionnaires were completed at 18 and 36 months postpartum. Proportions of women remitting at 18 months and 36 months postpartum were 50% and 59% for AN, 39% and 30% for BN, 46% and 57% for EDNOS-P, and 45% and 42% for BED, respectively. However, disordered eating persisted in a substantial proportion of women meeting criteria for either full or subthreshold eating disorders. BN during pregnancy increased the risk for continuation of BN. BMI and psychological distress were significantly associated with course of BED. This is the first large-scale population-based study on course of eating disorders in the postpartum period. The results indicated that disordered eating persists in a substantial proportion of women with prepregnancy eating disorders. Health care professionals working with women in this phase of life need to pay specific attention to eating disorder symptoms and behaviors.

Latent profile and latent transition analyses of eating disorder phenotypes in a clinical sample: A 6-year follow-up study

The DSM-IV classification of Eating Disorders (EDs) identifies clinical entities showing considerable overlap and diagnostic instability across time. Latent profile analysis (LPA) allows the identification of underlying groups of individuals according to their patterned responses across a set of features. LPA was applied to data regarding EDs symptoms of a clinical sample of 716 EDs patients, with a current DSM-IV diagnosis of threshold and subthreshold EDs. Latent transition analysis (LTA) was used to examine the longitudinal stability of the obtained profiles. The latent profiles were compared for psychopathological variables and long-term outcomes (recovery, relapse), based on a 6-year follow-up after a cognitive behavioural treatment. Five different phenotypes were identified: “severe binging”, “moderate binging”, “restricted eating”, “binge and moderate purging”, and “binge and severe purging”. The relevance of this characterization was confirmed by the differences in terms of psychopathological features and outcomes. Over the long term, a three-profile solution was adopted, clustering the subjects into “binge eating”, “binge eating and purging”, and “restricted eating”. Latent profiles showed a moderate stability over the 6-year period, with probability estimates of stability within status over time of 0.57 for “binge eating”, 0.40 for “binge eating and purging”, and 0.41 for “restricted eating”. The implications for DSM 5 were discussed, and the relative high rate of transition within phenotypes confirmed the significant instability of EDs phenomenology.

Effects of an Internet-based intervention for subthreshold eating disorders: A randomized controlled trial

Background Women reporting initial eating disorder (ED) symptoms are at highest risk for the development of an eating disorder. Preventive interventions should, therefore, be specifically tailored for this subgroup. Aims To adapt and evaluate the effects of the Internet-based prevention program “Student Bodies™” for women with symptoms of disordered eating and/or subthreshold eating disorder (ED) syndromes. Method 126 women, reporting subthreshold ED symptoms (high weight and shape concerns and below threshold bingeing, purging, chronic dieting or several of these symptoms) were randomly assigned to a Student Bodies™+ (SB+) intervention or a wait-list control group and assessed at pre-intervention, post-intervention, and 6-month follow-up. “Student Bodies™” was adapted to be suitable for subthreshold EDs. Main outcome measures were attitudes and symptoms of disordered eating. Pre-follow-up data were analyzed by ANCOVAS with mixed effects. Results At 6-month follow-up, compared to participants in the control group, participants in the intervention group showed significantly greater improvements on ED-related attitudes. Intervention participants also showed 67% (95% CI = 20–87%) greater reductions in combined rates of subjective and objective binges, and 86% (95% CI = 63–95%) greater reduction in purging episodes. Also, the rates of participants abstinent from all symptoms of disordered eating (restrictive eating, binge eating and any compensatory behavior) were significantly higher in the intervention group (45.1% vs. 26.9%). Post-hoc subgroup analyses revealed that for participants with binge eating the effect on EDE-Q scores was larger than in the pure restricting subgroup. Conclusion The adapted “SB+” program represents an effective intervention for women with subthreshold EDs of the binge eating subtype.

Comorbidity of partial and subthreshold ptsd among men and women with eating disorders in the national comorbidity survey-replication study.

The comorbidity of posttraumatic stress disorder (PTSD) and eating disorders (EDs) is high among women but has been understudied in men. Little is known about the association between partial or subthreshold PTSD and EDs among women or men. This study included PTSD and ED data from male (n = 2,382) and female (n = 3,310) National Comorbidity Survey-Replication study participants. The vast majority of women and men with anorexia nervosa, bulimia nervosa (BN), and binge eating disorder (BED) reported a history of interpersonal trauma. Rates of PTSD were significantly higher among women and men with BN and BED. Subthreshold PTSD was more prevalent than threshold PTSD among women with BN and women and men with BED. Interpersonal forms of trauma, PTSD, and subthreshold/partial PTSD, were prevalent among men and women with EDs. Findings highlight the importance of assessing for trauma and PTSD in ED patients.

Eating Disorders in Adolescence: When Should Prevention Occur?

Disordered eating behaviors can have severe effects on medical, psychological, and social functioning (1,2), making these behaviors an important focus of multidisciplinary attention. The median age of onset of eating disorders across the population ranges from 18 to 21 years, depending on the condition, with the earliest age of onset at 10 years for anorexia nervosa and 15 years for other disorders (3). Subthreshold eating disorders, which are conditions that involve disordered eating but do not meet full criteria for an eating disorder, are common and frequently associated with increased levels of impairment (2,4). Recent data indicate that in adolescents age 13 to 18 with eating disorders, median age of onset ranges from 12.3 to 12.6 years across disorders (2). Treatment of these conditions is known to be challenging (5). These data, together with the observation that the presence of maladaptive eating attitudes and behaviors in adolescence has been linked to the subsequent development of eating disorders (6), underscore the importance of effective interventions to prevent and treat maladaptive eating patterns and eating disorders in adolescents. Longitudinal studies, such as the study presented in this issue of the Journal of the American Dietetic Association by Neumark-Sztainer and colleagues (7), that describe patterns of symptoms over time move the field an important step closer to developing effective prevention strategies by providing information about the appropriate population, timing, and content of prevention efforts. Neumark-Sztainer and colleagues (7) report on a 10-year longitudinal study of the prevalence of weight control and eating behaviors from early adolescence through middle young adulthood. Study participants included males (n1,030) and females (n1,257) in early adolescence (30% of sample; mean age 12.80.7 years) or middle adolescence (70% of sample; mean age 15.90.8 years) at baseline and in early to middle young adulthood at followup. Participants completed surveys at baseline (19981999) and at 10-year follow-up (2008-2009). A 48.2% follow-up response rate was attained, and data used in the study analyses were weighted to account for differences in attrition across demographic variables. The study sample was well-distributed across sex, ethnicity, and socioeconomic status. Specific weight-control and eating behaviors that were assessed included dieting, unhealthy and extreme weight-control behaviors, and binge-eating with loss of control. Trends in the prevalence of behaviors across time and intra-individual tracking of behaviors were explored. Results of the study suggest that the prevalence of dieting and unhealthy weight-control behaviors (eg, fasting, skipping meals, etc) remained fairly consistent over time across age and sexes, with the exception of increases in dieting among older males and decreases in unhealthy weight-control behaviors among older females. Extreme weight-control behaviors (ie, using diet pills/laxatives/ diuretics or vomiting) and binge-eating with loss of control, the less prevalent but arguably most concerning behaviors that were assessed given that these behaviors are part of the diagnostic criteria for clinical eating disorders, increased significantly across nearly all age groups and sexes, particularly among older adolescents. Increases in diet-pill use in all groups are particularly concerning given that long-term results of such medications are not completely clear, and pharmacotherapy for weight loss in adolescents is recommended only in rare cases (8,9). Intra-individual tracking analyses indicated that adolescents endorsing dieting and unhealthy weightcontrol behaviors were significantly more likely to continue endorsing such behaviors into young adulthood, across ages and sexes. This pattern was also found for extreme weight-control behaviors and binge-eating with loss of control, although almost exclusively among the older groups of male and female adolescents. The prevalence and continuity of disordered eating behaviors found in this study highlight the need to identify and develop prevention and intervention programs for adolescents to help curtail distressing and potentially dangerous symptoms in a timely way.

CS04-01 - Subthreshold eating disorders: diagnostic issues, natural evolution and treatment implications

IntroductionEating disorders (EDs) exist on a continuum ranging from innocuous but persisting dieting, through subthreshold states of uncertain significance, to full-blown cases of anorexia nervosa (AN) and bulimia nervosa (BN). Subthreshold EDs resemble AN or BN, but do not meet all their diagnostic criteria. The terms “partial syndromes” and “atypical EDs” are also used to identify these conditions.Objectives. To verify whether atypical syndromes are less severe forms of EDs or represent starting phases of EDs, we designed a two-step prospective study assessing the natural outcome of those syndromes over a 4-year time period.MethodsIn the first step, we screened 495 female students attending the first year of their high school by means of ad hoc rating questionnaires. Those students identified to being at risk for an ED underwent a psychiatric diagnostic interview. In the second step, 4 years later, we reassessed 140 of those schoolgirls who had participated in the first step.ResultsIn the first step, we identified 1 subject with full-blown BN, 1 with partial-syndrome BN, 2 with subclinical BN and 8 with subclinical AN. At the reassessment 4 years later, none of the girls had received any form of help. The full-blown BN case, the partial-syndrome BN case and 1 of the subclinical AN cases persisted unchanged; 1 of the subclinical BN cases shifted to subclinical AN; the remaining subclinical cases remitted spontaneously.ConclusionsPresent findings provide the evidence that subclinical AN and subclinical BN represent unstable states that can spontaneously remit over time.

An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents.

The authors examined the natural history of threshold, subthreshold, and partial eating disorders in a community sample of 496 adolescent girls who completed annual diagnostic interviews over an 8-year period. Lifetime prevalence by age 20 years was 0.6% and 0.6% for threshold and subthreshold anorexia nervosa (AN), 1.6% and 6.1% for threshold and subthreshold bulimia nervosa (BN), 1.0% and 4.6% for threshold and subthreshold binge-eating disorder (BED), and 4.4% for purging disorder (PD). Overall, 12% of adolescents experienced some form of eating disorder. Subthreshold BN and BED and threshold PD were associated with elevated treatment, impairment, and distress. Peak age of onset was 17-18 years for BN and BED and 18-20 years for PD. Average episode duration in months was 3.9 for BN and BED and 5.1 for PD. One-year recovery rates ranged from 91% to 96%. Relapse rates were 41% for BN, 33% for BED, and 5% for PD. For BN and BED, subthreshold cases often progressed to threshold cases and diagnostic crossover was most likely for these disorders. Results suggest that subthreshold eating disorders are more prevalent than threshold eating disorders and are associated with marked impairment.

Disturbed eating behaviors in Taiwanese adolescents with type 1 diabetes mellitus: a comparative study

This study aimed to (i) compare disturbed eating behaviors in adolescents with type 1 diabetes mellitus (T1D) with a matched group of adolescents in Taiwan and (ii) examine the relationships of disturbed eating behaviors to body mass index (BMI) and metabolic control among adolescents with T1D. A cross-sectional study was conducted in southern Taiwan. Seventy-one adolescents with T1D (aged 10-22 yr; 41 females and 29 males) were matched to a group of non-diabetic adolescents. Adolescents completed two self-reported measures of eating behavior, the Bulimic Investigatory Test, Edinburgh and the Eating Attitude Test-26. Metabolic control was assessed by glycosylated hemoglobin A1c levels. Both adolescent females and males with T1D had more symptoms of bulimia and bulimic behaviors than their non-diabetic peers. There were no group differences in the proportion of subthreshold eating disorders. BMI and metabolic control were significant factors predicting disturbed eating behaviors. Both adolescent females and males with T1D exhibited a higher level of disturbed eating behaviors than their non-diabetic adolescent counterparts. Preventive programs that address disturbed eating behaviors should be provided for adolescents with T1D, particularly for adolescents with a high BMI and poor metabolic control.

Eating Disorders: From Twin Studies to Candidate Genes and Beyond

Substantial effort has been put into the exploration of the biological background of eating disorders, through family, twin and molecular genetic studies. Family studies have shown that anorexia (AN) and bulimia nervosa (BN) are strongly familial, and that familial etiologic factors appear to be shared by both disorders. Twin studies often focus on broader phenotypes or subthreshold eating disorders. These studies consistently yielded moderate to substantial heritabilities. In addition, there has been a proliferation of molecular genetic studies that focused on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) AN and BN. Seven linkage regions have been identified in genome-wide screens. Many genetic association studies have been performed, but no consistent association between a candidate gene and AN or BN has been reported. Larger genetic association studies and collaborations are needed to examine the involvement of several candidate genes and biological pathways in eating disorders. In addition, twin studies should be designed to assist the molecular work by further exploring genetic determinants of endophenotypes, evaluating the magnitude of contribution to liability of measured genotypes as well as environmental risk factors related to eating disorders. In this manner twin and molecular studies can move the field forward in a mutually informative way.

Eating Disorders: From Twin Studies to Candidate Genes and Beyond

AbstractSubstantial effort has been put into the exploration of the biological background of eating disorders, through family, twin and molecular genetic studies. Family studies have shown that anorexia (AN) and bulimia nervosa (BN) are strongly familial, and that familial etiologic factors appear to be shared by both disorders. Twin studies often focus on broader phenotypes or subthreshold eating disorders. These studies consistently yielded moderate to substantial heritabilities. In addition, there has been a proliferation of molecular genetic studies that focused on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) AN and BN. Seven linkage regions have been identified in genome-wide screens. Many genetic association studies have been performed, but no consistent association between a candidate gene and AN or BN has been reported. Larger genetic association studies and collaborations are needed to examine the involvement of several candidate genes and biological pathways in eating disorders. In addition, twin studies should be designed to assist the molecular work by further exploring genetic determinants of endophenotypes, evaluating the magnitude of contribution to liability of measured genotypes as well as environmental risk factors related to eating disorders. In this manner twin and molecular studies can move the field forward in a mutually informative way.

Effects of pregnancy on eating attitudes and disorders: A prospective study

The aim of this prospective study was to investigate the effects of pregnancy on eating disorders (ED), dietary habits and body image perception. One hundred and fifty pregnant women were interviewed between the period January 2001 and May 2003. Ninety-seven women completed the study and were divided in three subgroups: pregnant women with a positive history of dieting ( n=37), pregnant women with a positive history of dieting with a complete diagnosis of a current ED ( n=11) and pregnant women with a negative history either of dieting or ED (control group; n=49). Age, education and parity were equally distributed in all three groups. To verify if pregnancy exerts a specific protective effect, a battery of psychometric tests was administered to women at 12° (T0), 22° (T1), and 34° pregnancy weeks (T2), and 2 days (T3) and 4 months (T4) after delivery, respectively. The study showed a quadratic trend for ED, subthreshold ED and body satisfaction, with a general improvement in the middle of pregnancy and a return to previous levels after delivery. Some interesting significant differences came out among the groups.

Trastornos de la conducta alimentaria en adolescentes jóvenes con diabetes mellitus tipo 1

We aimed at determining the prevalence of eating disorders (ED) in young adolescents with type 1 diabetes. 60 boys and 38 girls with type 1 diabetes and 321 boys and 254 girls, age-matched non-diabetic controls. The Eating Attitudes Test (EAT-40) and semistructured diagnostic interview on Eating Disorders Examination (EDE) were used. Weight, height, body mass index (BMI), glycated hemoglobin and insulin manipulation for weight loss were evaluated. No anorexia or bulimia were found in diabetic patients and non-diabetic controls. Eating Disorders Not Otherwise Specified (EDNOS) were more prevalent in diabetic patients than in controls, both in boys (1.7% vs 0.9%; odds ratio [OR] = 1.7; CI 95%, 0.2-17.6) and girls (5.3% vs 1.6%; OR = 3.2; CI 95%, 0.6-17.2). Sub-threshold ED were more common in male diabetic patients than in non-diabetic peers (10% vs 4.4%; OR = 2.4; CI 95%, 0.9-6.6), and in female diabetic patients than in non-diabetic peers (10.5% vs 9.9%; OR = 1.1; CI 95%, 0.4-3.2). No statistical differences were found regarding these results. Glycated hemoglobin values were higher in diabetic patients with ED (9.7% [1.52]; 5.6 [2.8], n = 13) than in those without ED (8.4% [1.5]; 5.1 [2.7], n = 85); p = 0.049. Nine diabetic patients (9.1%) manipulated insulin for weight loss. EDNOS were more prevalent in male and female diabetic patients than in non-diabetic peers. Sub-threshold ED were more prevalent in male diabetic patients than in non-diabetic peers, with no differences between female diabetic patients and their non-diabetic peers.

Eating disorders in young women with type 1 diabetes mellitus

Research findings from the past decade regarding the association of type 1 diabetes mellitus and eating disorders are critically reviewed in this paper. Although there has been much debate regarding the specificity of this association, a recent large multisite case-controlled study demonstrated that the prevalence rates of both full syndrome and subthreshold eating disorders among adolescent and young adult women with diabetes are twice as high as in their nondiabetic peers. Further, a 4-year follow-up study showed that disordered eating behavior in young women with diabetes often persists and is associated with a threefold increase in the risk of diabetic retinopathy. These eating disturbances tend to be associated with impaired family functioning and with poor diabetes management. Health care professionals should maintain a high index of suspicion for the presence of an eating disturbance among young women with diabetes, particularly among those with persistently poor metabolic control and/or weight and shape concerns. Screening for such disturbances should begin during the prepubertal period among girls with diabetes. A brief psychoeducational intervention leads to a reduction in disturbed eating attitudes and behavior but is not sufficient to improve metabolic control. More intensive treatment approaches, which should include a family-based component, may be needed to improve metabolic control. The evaluation of these and other treatment approaches is indicated in view of the serious short- and long-term health risks associated with eating disorders in young women with diabetes.

Eating disorders in females with type 1 diabetes: an update of a meta‐analysis

AbstractObjective:Firstly to provide a quantitative summary of existing studies on the occurrence of eating disorders (ED) in females with type 1 diabetes (IDDM), with the focus on retinopathy and insulin misuse for the different eating disorders. Secondly to disseminate knowledge about useful statistical tools.Research Design and Methods:Data were extracted from the relevant case–control and follow‐up studies. Odds ratios (OR) and risk differences (RD) were the main effect sizes analysed. Analyses were based on ‘exact’ methods as many studies are sparse. Data and findings are presented in sufficient detail for re‐analysis.Results:An hypothesis of an increase in Anorexia Nervosa (AN) in IDDM is not supported by existing evidence. Bulimia Nervosa is increased (OR = 2.9 (95%CI: 1.03 to 8.4); pOR = 0.04) in IDDM. Both ED‐NOS and subthreshold ED is increased (OR ∼2; pOR < 0.001) in females with IDDM. Co‐existing ED in IDDM increases the overall common OR for retinopathy to 4.8 (95%CI: 3.0 to 7.8); pOR < 0.00001, and the overall mean RD is 33% (95%CI: 25% to 42%); pRD < 0.001. Insulin misuse (IM) is increased when ED co‐exists with IDDM: OR 12.6 (95%CI: 7.8 to 21.1); pOR < 0.00001, and mean RD is 40% (95%CI: 29% to 50%); pRD < 0.001.Conclusions:ED‐NOS and subthreshold ED seem to be the quantitatively most important EDs in type 1 diabetic females. Mismanagement of diabetes in the form of IM is frequent in eating disordered IDDM probands. Early occurrence of retinopathy and other complications is an increased risk in concurrent cases, as is premature death. The implications of Binge Eating Disorder (BED) and overweight needs to be elucidated for both type 1 and type 2 diabetes. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.

Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study

Objective: determine the prevalence of eating disorders in adolescent females with type 1 diabetes mellitus compared with that in their non-diabetic peers.Design: Cross sectional case-control led study.Setting: Diabetes clinics and...

Addictive-anxiety disorders comorbidity: Role of childhood separation anxiety disorder

The 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.109 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.Results 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.Previous 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.

Clinical and subthreshold eating disorders: case detection in adolescent schoolgirls.

The point prevalence of eating disorders was investigated in schoolgirls from lower socio-economic classes and a method of case detection was tested. A two-stage procedure (self-report measures and interviews) was followed. All girls meeting at least one of the following three criteria were recruited as possible cases: EAT > or = 30, BMI < 17.5, BMI < 19 or > 24 and EAT > or = 20. The Mann-Whitney's two-tailed test and the chi-square test were used to assess the significance of differences between the possible cases and the others and between the false positives and the cases. A diagnosis of eating disorder was made for 24 subjects (8.1%): 5 (1.7%) with bulimia nervosa and 19 (6.4%) with eating disorders not otherwise specified (EDNOS). Of the 24 girls with eating disorders only 16 had high EAT40 scores (> or = 30). The other 8 cases were identified by the help of other criteria that proved to be useful. Furthermore we found data on five self-report instruments (EAT40, EDI, SCANS, SCL90, SEI). On almost all the scales, the possible cases obtained scores significantly different from the others. On the contrary, we did not find any instrument able to discriminate between false positives and cases.

Relationship between disturbed eating behavior and other psychosomatic symptoms in adolescents.

There has been relatively little research on subthreshold eating disorders and factors which might promote their transition to eating disorders. A sample consisting of 1,944 Swiss adolescents of both sexes, 14-19 years of age, was investigated for eating behavior (EAT-26), psychological (SCL-90-R) and physical symptoms (GSCL-C). In addition, the relationship between eating behavior and other psychosomatic symptoms was analyzed. The results revealed significantly higher scores for females than males on all except one scale of the questionnaires. Three categories of disturbed eating behavior based on the EAT scores were described: EAT 0-9 = not disturbed (77.5% girls, 93.1% boys), EAT 10-19 = moderately disturbed (14.1% girls, 5.5% boys), and EAT > or = 20 = severely disturbed (8.3% girls, 1.5% boys). With regard to the three aspects, eating habits, psychosomatic symptoms and suicidality a significant correlation between disturbed eating behavior and concurrent psychological and physical symptoms was found in female but not in male subjects. The results emphasized that disordered eating behavior has to be seen as part of a broader psychopathological syndrome, especially in young women.