Yale-Brown-Cornell Eating Disorder Scale Research Articles

Prominent autistic traits and subthreshold bipolar/mixed features of depression in severe anorexia nervosa.

Objective:Autistic traits are associated with a burdensome clinical presentation of anorexia nervosa (AN), as is AN with concurrent depression. The aim of the present study was to explore the intertwined association between complex psychopathology combining autistic traits, subthreshold bipolarity, and mixed depression among people with AN.Method:Sixty patients with AN and concurrent major depressive episode (mean age, 22.2±7 years) were cross-sectionally assessed using the Autism-Spectrum Quotient test (AQ-test), the Hamilton depression scales for depression and anxiety, the Young Mania Rating Scale (YMRS), the Hypomania-Checklist-32 (HCL-32), second revision (for subthreshold bipolarity), the Brown Assessment and Beliefs Scale (BABS), the Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS), and the Eating Disorder Examination Questionnaire (EDE-Q). Cases were split into two groups depending on body mass index (BMI): severe AN (AN+) if BMI < 16, not severe (AN-) if BMI ≥ 16.Results:The “subthreshold bipolarity with prominent autistic traits” pattern correctly classified 83.6% of AN patients (AN+ = 78.1%; AN- = 91.3%, Exp(B) = 1.391). AN+ cases showed higher rates of positive scores for YMRS items 2 (increased motor activity-energy) and 5 (irritability) compared to AN- cases.Conclusions:In our sample, depressed patients with severe AN had more pronounced autistic traits and subtly mixed bipolarity. Further studies with larger samples and prospective follow-up of treatment outcomes are warranted to replicate these findings.

Obsessive-compulsive symptomatology in female adolescent inpatients with restrictive compared with binge-purge eating disorders.

Strong relationships exist between obsessive-compulsive (OC) disorder and eating disorders (EDs). The aim of the study was to investigate whether OC symptoms would be expressed differently in different ED types. Ninety-four female adolescent inpatients with restricting anorexia nervosa (AN-R), 67 with binge/purge AN (AN-B/P), and 48 with bulimia nervosa (BN) were assessed on admission and discharge using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS), Eating Attitude Test-26 (EAT-26), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI). On admission, patients with AN-B/P exhibited higher scores on the Y-BOCS, YBC-EDS, EAT-26, and BDI in comparison with patients with AN-R or BN. A significant improvement on all psychometric variables from admission to discharge was found for all participants taken together. Nonetheless, patients with AN-B/P and/or BN showed a greater improvement on Y-BOCS, BDI, and STAI than patients with AN-R, whereas no between-group difference was found for YBC-EDS and EAT-26. Obsessionality is more severe in acutely ill AN-B/P patients than in patients with AN-R and BN, whereas a greater improvement in obsessionality from the acutely ill to the stabilized ED condition is found in patients with binge/purge in comparison with restrictive pathology.

A family-based association study of the HTR1B gene in eating disorders.

Objective:To explore the association of three polymorphisms of the serotonin receptor 1Dβ gene (HTR1B) in the etiology of eating disorders and their relationship with clinical characteristics.Methods:We analyzed the G861C, A-161T, and A1180G polymorphisms of the HTR1B gene through a family-based association test (FBAT) in 245 nuclear families. The sample was stratified into anorexia nervosa (AN) spectrum and bulimia nervosa (BN) spectrum. In addition, we performed a quantitative FBAT analysis of anxiety severity, depression severity, and Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS) in the AN and BN-spectrum groups.Results:FBAT analysis of the A-161T polymorphism found preferential transmission of allele A-161 in the overall sample. This association was stronger when the sample was stratified by spectrums, showing transmission disequilibrium between the A-161 allele and BN spectrum (z = 2.871, p = 0.004). Quantitative trait analysis showed an association between severity of anxiety symptoms and the C861 allele in AN-spectrum participants (z = 2.871, p = 0.004). We found no associations on analysis of depression severity or preoccupation and ritual scores in AN or BN-spectrum participants.Conclusions:Our preliminary findings suggest a role of the HTR1B gene in susceptibility to development of BN subtypes. Furthermore, this gene might have an impact on the severity of anxiety in AN-spectrum patients.

Are Second-generation Antipsychotic Drugs Effective in Treating Anorexia Nervosa?

Objectives To determine the efficacy, acceptability, and tolerability of second-generation antipsychotic drugs (SGAs) in anorexia nervosa. Methods We covered all randomized controlled trials (RCTs) comparing a pharmacotherapy with SGAs to placebo or no treatment in anorexia nervosa. Primary outcome was weight gain assessed by mean change in body mass index (BMI). Secondary outcomes were change of anorectic symptoms assessed by the Yale–Brown–Cornell Eating Disorders Scale (YBC-EDS) score and the Eating Disorders Inventory (EDI) score, and premature discontinuation of treatment. Using the random-effects model of Der-Simonian and Laired standardized mean differences based on Hedges's g and risk ratios were calculated. Results Seven RCTs investigating olanzapine (N=4), quetiapine (N=2), and risperidone (N=1) with 201 subjects were included. There was no significant between-group difference in mean BMI change when comparing the pooled group of SGA drugs with the pooled control group (N=6, n=152; Hedges's g=0.17, 95% CI: -0.14-0.48; p=0.28). None of the examined single SGAs was significantly superior to placebo/no treatment in achieving BMI gain. We found no significant between-group differences for all secondary outcomes with the exception of the EDI total score which decreased statistically significant more in the pooled control group. The antipsychotic medication was well tolerated. Conclusions Because of lacking evidence SGAs cannot be generally recommended in anorexia nervosa although some individuals or subgroups of patients might respond to an antipsychotic medication. Further research is needed to identify which anorectic patients could probably benefit from treatment with antipsychotic drugs. The medication with SGAs was well accepted and tolerated in anorectic patients.

Second-Generation Antipsychotic Drugs in Anorexia Nervosa: A Meta-Analysis of Randomized Controlled Trials

Background: Second-generation antipsychotic drugs (SGAs) are increasingly administered to achieve weight gain in anorexia nervosa. In this meta-analysis, we aimed to determine if any evidence for this treatment option can be derived from randomized controlled trials (RCTs). Methods: Based on the ‘World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Eating Disorders', a systematic update literature search was applied to identify all RCTs investigating the efficacy, acceptability, and tolerability of SGAs in anorexia nervosa in comparison to placebo/no treatment. The primary outcome was weight gain measured by mean change in body mass index (BMI). Secondary outcomes were mean changes in Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS) total score and Eating Disorders Inventory (EDI) total score and premature discontinuation of treatment. Employing a random-effects model standardized mean differences based on Hedges's g and Mantel-Haenszel risk ratios were calculated. Results: Seven RCTs (n = 201) investigating olanzapine (N = 4), quetiapine (N = 2), and risperidone (N = 1) were included. We found no statistically significant between-group differences for mean BMI change when pooling the SGAs (N = 7, n = 161; Hedges's g = 0.13, 95% CI: -0.17 to 0.43; p = 0.4) and when examining the individual drugs. Furthermore, the SGAs failed to differentiate statistically significantly from placebo/no treatment for all secondary outcomes. Conclusions: Based on the current evidence, pharmacological treatment of anorexia nervosa with SGAs cannot be generally recommended although some individuals or subgroups of patients might benefit from an antipsychotic medication. Further research is required to identify which patients will likely benefit from such a treatment option.

The prevalence of orthorexia nervosa among eating disorder patients after treatment.

The pursuit for healthy food consumption is considered a laudable habit. This attitude can turn into pathological when cognitions and worries about healthy nutrition lead to such an accurate food selection that correct diet becomes the most important part of one's own life leading to important dietary restrictions, stereotyped eating or impairment in important areas of functioning. This behaviour is coined orthorexia nervosa (ON) and can share common characteristics with anorexia nervosa (AN) and bulimia nervosa (BN). The purpose of the present study was to examine the frequency of ON among women with eating disorders (EDs) and to evaluate if it changed after treating the ED. Thirty-two patients with AN or BN were evaluated by means of the ORTO-15, the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) and the Eating Attitude Test (EAT-26) before (t0) and 3 years after the treatment of their ED (t1), and compared to 32 female healthy controls (HC) matched by gender, age, and BMI at t1. A significantly higher percentage of patients either at t0 (28 %) or t1 (58 %) resulted positive to ORTO-15 compared to controls (6 %). YBC-EDS and EAT-26 scores were higher among ED patients than in HC, but they decreased from t0 to t1. Orthorexia nervosa symptoms are highly prevalent among patients with AN and BN, and tend to increase after treatment. ON seems associated both with the clinical improvement of AN and BN and the migration towards less severe forms of EDs. It is necessary to clarify if ON residual symptomatology can be responsible for a greater number of relapses and recurrences of EDs.

Confirmatory factor analysis and psychometric properties of the Yale–Brown–Cornell Eating Disorders Scale Self-Report version (SR-YBC-EDS) in Spanish clinical and non-clinical samples

ObjectiveThe aim of the study was to adapt and validate the Yale–Brown–Cornell Eating Disorder Scale (YBC-EDS) transformed into a self-report format in Spanish clinical and non-clinical samples. MethodEighty-three eating disordered patients and 358 non-clinical participants completed the Self Report-YBC-EDS version (SR-YBC-EDS), the Eating Attitudes Test (EAT), and the Penn State Worry Questionnaire (PSWQ). ResultsConfirmatory factor analyses of a two-factor second-order model showed adequate values of goodness-of-fit indices for non-clinical (normed χ2=13.4578; df =18; NFI=0.980; GFI=1.00; RMSEA=0.00) and clinical samples (normed χ2=26.5913; df =18; NFI=0.944; GFI=0.981; RMSEA=0.076). The factor loadings were high (preoccupations range: 0.69–0.91; rituals range: 0.61–0.94). Cronbach's alpha (range α=0.85–0.90) and test–retest 2weeks later (range: 0.84–0.91) were excellent in both samples. SR-YBC-EDS showed moderate-high indices of convergent validity with PSWQ and EAT. For the total score, a cutoff of 13 showed a sensitivity of 90.4%, a specificity of 91.6%, and a diagnostic accuracy of 91.4%. Positive and negative predictive values were excellent (71.4% and 97.6%, respectively). DiscussionFindings indicate that the SR-YBC-EDS is a reliable and valid instrument to identify symptoms and assess the severity of ED, and it can be used as a faster and less costly alternative to the YBC-EDS interview.

Motivation for change as a predictor of eating disorder treatment outcomes using a brief self-report YBC-EDS in a residential eating disorder population

The aim of this study was to investigate the factor structure and psychometric properties of a new brief self-report form of the Yale–Brown–Cornell Eating Disorder Scale (YBC-EDS-BSR) in a transdiagnostic eating disorder population, and to determine the predictive ability of motivation for change and ego syntonic subscales on treatment outcome. Self-report measures of the YBC-EDS-BSR, eating pathology, depression, anxiety and obsessive compulsive symptoms were collected from 164 individuals entering residential treatment. Of these, 107 individuals completed identical measures at discharge. The admission items on the YBC-EDS-BSR were examined for factor structure, and subscales were examined for internal, convergent and discriminant validity. Multiple regression analysis was used to investigate predictive value of the motivation and ego syntonic subscales on two measures of treatment outcome. Results indicate that the YBC-EDS-BSR demonstrated a robust factor structure and good psychometric properties in this population. The predicted ego-syntonic subscale did not emerge as an independent factor. The motivation for change subscale significantly predicted treatment outcome on the EDE-Q and the EDI-3 Global Maladjustment Scale. The ego-syntonic items and other psychopathology measures had no predictive value on treatment outcome. Results suggest that motivation for change is a significant predictor of treatment outcome over and above baseline psychopathology.

Orthorexia nervosa: a frequent eating disordered behavior in athletes.

Striving for enhancing athletic performance, many sportsmen undergo rigid dietary habits, which could lead to eating disorders (EDs) or Orthorexia Nervosa (ON), a psychopathological condition characterized by the obsession for high quality food. The aim of the study was to examine the occurrence of ON in athletes and to verify the relationship between ON and EDs. Five-hundred-seventy-seven athletes and 217 matched controls were administered the following tests: ORTO-15, Eating Attitude Test 26 (EAT-26), Body Uneasiness Test (BUT) and Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS). High positivity to ORTO-15 (28%) and EAT-26 (14%) emerged in athletes, whereas a high rate of BUT positivity was evident among controls (21%). Multivariate logistic regression analysis revealed that independent predictors of ON are previous dieting, age, positivity to YBC-EDS, positivity to EAT-26, competition level, and number of YBC-EDS preoccupations and rituals. Sharing many features with both EDs and Obsessive-Compulsive Spectrum, ON represents a crossroad between these pathologic conditions and might compromise the health state of an athlete. Therefore, coaches should consider important to detect symptoms of EDs and ON in their athletes.

Glucagon-like peptide-1 secretion in bulimia nervosa

Blood concentrations of the satiety-inducing glucagon-like peptide-1 (GLP-1) were compared in 20 bulimic patients and 20 healthy controls to examine whether secretory impairment of the peptide could be involved in bulimia nervosa (BN). Basal GLP-1 concentrations were measured by means of an enzyme-linked immunosorbent assay (ELISA) in blood samples taken four times over a 12-h period (08.00h, 12.00h, 16.00h, 20.00h) and seven times over a 3-h period following administration of a test meal. Eating-related and non-eating related patients' psychopathological aspects were measured by the use of a battery of ad hoc rating scales (Eating Disorder Inventory-2 = EDI-2, Bulimic Investigation test-Edinburgh = B.I.T.E., Montgomery–Åsberg Depression Rating Scale = MADRS, Spielberger State-Trait Anxiety Inventory = STAI, Yale–Brown–Cornell Eating Disorder Scale = YBC-EDS). Basal GLP-1 values were higher in patients than in controls only in the blood samples taken at 16.00h, whereas no difference between patients and controls was observed in GLP-1 concentrations in response to the test meal stimulation. GLP-1 levels correlated positively with bingeing–vomiting frequency, with B.I.T.E. scores and the “bulimia” subitem scores of the EDI-2 scale, and negatively with the “ascetism” subitem score of the same scale.

The Yale–Brown–Cornell eating disorder scale in women with anorexia nervosa: What is it measuring?

The Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) assesses eating disorder preoccupations, rituals, and symptom severity. This study examines the YBC-EDS in relation to eating disorder psychopathology, obsessionality, and impulsivity variables in women with anorexia nervosa (AN) and sensitivity of the YBC-EDS to change after psychotherapy. Participants were 56 women with "spectrum" AN (14.5 < BMI < 19). Variables examined in relation to the YBC-EDS were as follows: eating pathology, obsessionality (obsessive compulsive disorder and personality diagnoses, perfectionism), and impulsivity (borderline personality, impulsive traits, and behaviors). YBC-EDS scores were examined pre- and post-treatment. Eating Disorder Examination scores most strongly predicted the YBC-EDS. As expected, perfectionism was significantly associated, but so was impulsivity. YBC-EDS scores were significantly different in those with good versus poor global outcome after therapy. Unexpectedly, maximum lifetime BMI was correlated with the YBC-EDS. The YBC-EDS most strongly measured eating disorder severity and reflected change after psychotherapy for AN.

Central dopaminergic function in anorexia and bulimia nervosa: a psychoneuroendocrine approach.

Data on central dopamine (DA) function in patients with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are contradictory. To tentatively clarify the brain secretory state of the amine and its relationship with the nutritional impairments and/or the psychopathological aspects of the two disorders, we measured the responses of growth hormone (GH) to acute stimulation with apomorphine (APO), a selective D-1 and D-2 receptor agonist, in 16 AN patients, 8 restricted (AN-R) and 8 bingeing-purging (AN-BP), in 7 BN patients and in 8 healthy controls (CTR). Interference of impairment of the somatotropic axis in the GH response to APO stimulation was excluded by measuring the GH and insulin-like growth factor-1 (IGF-1) basal levels and GH responses to growth hormone-releasing hormone (GHRH) stimulation. Psychological aspects of patients and controls were investigated by the rating scales Eating Disorder Inventory (E.D.I.), Bulimic Investigation Test Edinburgh (B.I.T.E)., and Yale-Brown Cornell Eating Disorder Scale (YBC-ED). Basal GH levels were significantly higher and those of IGF-1 lower in AN-R than in AN-BP, BN and CTR subjects. GH responses to GHRH stimulation were significantly higher in AN-R than in AN-BP and BN patients and in CTR. GH responses to APO stimulation were significantly lower in AN-R and AN-BP than in BN and CTR subjects, suggesting that at the hypothalamic level there is a subsensitivity of postsynaptic D-2 receptors and possibly a presynaptic DA hypersecretion. The altered GH responses to APO stimulation did not correlate with the Body Mass Index, while they correlated negatively with E.D.I. scores.

The Yale-Brown-Cornell Eating Disorder Scale: a new scale to assess eating disorder symptomatology.

Anorectic and bulimic patients (n = 100) were interviewed using the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS). All patients reported preoccupations and rituals related to their eating disorder ranging from mild to severe symptomatology, with mean scores in the moderate range. The preoccupations were more severe than the rituals; however, the rituals were still time-consuming, distressing, and interfered with functioning. Both preoccupations and rituals were largely ego syntonic. The YBC-EDS is an easy to administer interview which characterizes and quantifies preoccupations and rituals associated with eating disorders. It is useful both for research and clinical purposes.

The Yale-Brown-Cornell eating disorder scale: Development, use, reliability and validity

Patients with eating disorders present with a wide range of eating-related preoccupations and/or rituals. Yet, eating disorder assessments traditionally have measured a finite number of specific eating-disordered thoughts or actions. The current work presents a new instrument, the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS), that does not limit assessment to a particular set of eating-related concerns or behaviors. Rather, it assesses the severity of illness associated with individual's unique symptomatology. Reliability and validity of this new, clinician-rated instrument was tested in two independent samples of DSM-III-R eating disorder patients. The YBC-EDS eight-item scale assessing severity of preoccupations and rituals, and a set of six provisional items for assessing motivation for change were both frequently endorsed and found to have excellent interrater reliability. Internal consistency was shown to be good for the set of eight core items and the set of six items related to motivation for change. The eight-item scale demonstrated aspects of convergent validity with other assessments of eating disorder symptomatology. The set of six provisional items for assessing motivation for change was inversely related to measures to diet restriction, drive for thinness, and body dissatisfaction. This paper presents the eight-item Yale- Brown-Cornell Eating Disorder Scale for assessing illness severity in eating-disordered patients with an extensive range of symptomatology. An accompanying set of six provisional items for assessing motivation for change are also presented. Initial findings showed excellent reliability and indications of validity for both the eight-item YBC-EDS and the set of six provisional items.