Quality of life and bulimic eating disorder behaviors: findings from a community-based sample

OBJECTIVE: The aims were to test relationships between bulimic eating disorder behaviors, and measures of quality of life, and to replicate previous findings with respect to their prevalence and distribution in a representative sample. METHOD: Data were obtained from 3010 interviews of a randomly selected sample of 4400 adult households. Quality of life was assessed with the SF-36 Health Status Measure and the Australian Quality of Life Survey. RESULTS: Eating disorder behaviors were associated with significantly lower quality of life scores. On MANOVA, regular current binge eating explained 23% (p < 0.001) of the variance in SF-36 physical and mental health component scores, and extreme weight control behaviors explained 5% (p = 0.001). The main findings of the former South Australian survey were replicated. The mean duration of behaviors since onset was 6.6 (SD, 9.2; median 3) years. CONCLUSIONS: Eating disorder behaviors were associated with poorer quality of life and were often chronic.     

Disordered eating attitudes and behaviors in ballet students: examination of environmental and individual risk factors

OBJECTIVE: The current study compared the prevalence of disordered eating attitudes and behaviors among adolescent ballet dancers at national, regional, and local schools. METHOD: Female ballet students (N = 239; mean age = 15.0 +/- 1.5 years) from five geographically disparate summer programs completed the Eating Dis-order Inventory (EDI) and answered questions regarding eating disorder symptoms. RESULTS: Students from both national and local schools reported significantly higher EDI total, Drive for Thinness, and Perfectionism scores compared with regional students. In contrast, national students reported significantly greater dieting scores and lifetime histories of self-induced vomiting compared with regional and local students. CONCLUSION: Eating pathology among adolescent ballet dancers may be a function of both genetic and environmental risk. Dancers who exhibit high levels of perfectionism and, perhaps consequently, place themselves in highly competitive environments, may exhibit a significantly increased risk for disordered eating in comparison to dancers who are less perfectionistic and/or place themselves in less competitive environments.     

Different methods for assessing the features of eating disorders in patients with binge eating disorder: a replication.

OBJECTIVE: To compare different methods for assessing the features of eating disorders in patients with binge eating disorder (BED). RESEARCH METHODS AND PROCEDURES: A total of 47 participants with BED were administered the Eating Disorder Examination (EDE) Interview and completed the EDE-Questionnaire (EDE-Q) at baseline. A total of 37 participants prospectively self-monitored their eating behaviors daily for 4 weeks and then completed another EDE-Q. RESULTS: At baseline, the EDE and the EDE-Q were significantly correlated on frequencies of objective bulimic episodes (binge eating), overeating episodes, and on the dietary restraint, eating concern, weight concern, and shape concern subscales. Mean differences in the EDE and EDE-Q frequencies of objective bulimic episodes and overeating were not significant but scores on the four subscales differed significantly, with the EDE-Q yielding higher scores. At the 4-week point, the EDE-Q retrospective 28-day assessment was significantly correlated with the prospective daily self-monitoring records for frequency of objective bulimic episodes and the mean difference between the methods was not significant. The EDE-Q and self-monitoring findings for subjective bulimic episodes and objective overeating differed significantly. DISCUSSION: In patients with BED, the three assessment methods showed some areas of acceptable convergence.     

Eating attitudes, health-risk behaviors, self-esteem, and anxiety among adolescent females in a suburban high school.

In order to determine whether adolescent females with abnormal eating attitudes display lower levels of self-esteem and higher levels of anxiety than their peers, and whether these adolescents participate in health-risk behaviors to a greater or lesser degree than their peers, we administered a series of questionnaires to the females attending a suburban high school in New York State. The questionnaires, completed by 268 students (mean age, 16.2 years), included data on health-risk behaviors and weight attitudes, an Eating Attitudes Test, a self-esteem scale, and an anxiety inventory. Results indicated that almost two-thirds of the students described themselves as overweight, almost three-quarters felt they were above the healthiest weight for their age and height, and almost four-fifths were above the weight at which they would be most happy; 18% of the students scored 30 or more on the Eating Attitudes Test, a score suggestive of an eating disorder. Use of Spearman-rank correlation coefficients and multiple linear regression analysis revealed that those with more unhappiness with their weight and higher scores on the eating attitudes test were more likely to have lower self-esteem and higher anxiety and to participate more in health-risk behaviors, including cigarette smoking, alcohol use, drug use, and sexual activity with more total partners. The data from this study further corroborate the growing belief that health-risk behaviors tend to cluster together in vulnerable adolescents and demonstrate that abnormal eating attitudes and behaviors may be part of this cluster, especially in females with low self-esteem and high levels of anxiety.     

Overeating among seriously overweight children seeking treatment: results of the children's eating disorder examination

OBJECTIVE: We sought to examine rates of eating disorder symptoms among seriously overweight children seeking treatment using the Eating Disorder Examination for Children (ChEDE) and to provide initial data about their association with treatment outcome. METHOD: Overweight children (N = 27) 8-13 years old were interviewed using the ChEDE before participating in a family-based behavioral treatment program. Height and weight were measured pretreatment, posttreatment, and approximately 8 months posttreatment. RESULTS: Fifteen percent of children reported subjective bulimic episodes (SBE). Weight loss did not differ for children with and without SBEs, but concerns about body shape were related to larger weight losses during treatment. CONCLUSION: A considerable minority of treatment-seeking overweight children report an episodic sense of loss of control over eating. Loss of control is related to other disordered eating attitudes and behaviors, but does not appear to affect treatment outcome. Future studies are needed to replicate these initial findings.     

Eating pathology in bulimia nervosa

Degree of eating pathology in bulimia nervosa was assessed using the Eating Behavior Rating Scale (EBRS) across three videotaped eating sessions. Twelve bulimic and 12 non-eating disordered subjects participated in this study. All subjects were filmed during a baseline meal (ad libitum), a high-calorie meal, and a low-calorie meal (both fixed amounts). Mean EBRS scores were significantly higher for bulimics (12.6 ± 1.7) than for controls (3.9 ± 0.9), suggesting a higher degree of eating pathology in these patients. Affect during eating was significantly more negative in the bulimic patients. EBRS and affect scores were significantly correlated [r (11) = .813, p < .01]. Bulimics had a slower rate of eating than controls and took significantly longer to initiate eating. Scores of pathological eating correlated with scores on the Eating Attitudes Test and the Bulimic Investigatory Test-Edinburgh, indicating a relationship between objective measures of pathological eating and self-report measures of eating disorder symptoms. © 1993 by John Wiley & Sons, Inc.     

Fear of negative evaluation and the development of eating psychopathology: a longitudinal study among nonclinical women

OBJECTIVE: We replicated the cross-sectional relationship between restrictive eating attitudes and a fear of being negatively evaluated by others and tested whether negative evaluation fears longitudinally predict changes in eating attitudes over a 7-month period. METHOD: During the first week of an academic year, and again during Week 33, 143 female students completed the Fear of Negative Evaluation Scale (FNE), the Rosenberg Self-Esteem Scale (RSE), the Hospital Anxiety and Depression Scale (HADS), and the three eating scales of the Eating Disorders Inventory (EDI). RESULTS: The exclusive link between heightened negative evaluation fears and restrictive eating attitudes was replicated cross-sectionally. However, the longitudinal model predicting the development of restriction was nonsignificant. In contrast, alongside depression, negative evaluation fears predicted an increase in bulimic attitudes, whereas self-esteem predicted an increase in body dissatisfaction. DISCUSSION: The findings support a model whereby individuals with heightened fears of negative evaluation may use restrictive pathology to raise their status among peers. If this mechanism of dealing with negative evaluation fears is not sufficient in the long term, individuals may develop bulimic symptoms to deal with their negative evaluation fears.     

Two-three-year stability and interrelations of bulimotypic indicators and depressive and anxious symptoms in middle-aged women

OBJECTIVE: There is a paucity of research examining eating disorder symptoms among middle-aged women. METHOD: This prospective study assessed the stability of bulimic symptoms and 5 associated variables (perfectionism, depressive symptoms, self-esteem, anxiety symptoms, and perceived weight status) in a sample of 150 middle-aged women (mean age = 45.19 years) over a 2.5-year time period. In addition, interrelations among bulimic, anxiety, and depressive symptoms were assessed. RESULTS: Results suggested that all 6 bulimia-related variables remained significantly stable over 2.5 years. In addition, notable relations between Time 1 and Time 2 variables emerged (e.g., anxious symptoms at Time 1 predicted bulimic symptoms at Time 2). CONCLUSION: Thus, the results indicate that bulimic symptoms exist in middle-aged women, and that they remain relatively stable over a 2.5-year time period. Clinical implications for middle-aged women with eating disorder symptoms are discussed.     

Disordered eating behaviors and sleep disturbances

The aim of the present study was to investigate if disordered eating behaviors predicted the development of sleep disturbances. A total of 870 students participated at baseline, 592 one year later (T1) and 305 two years later (T2). The Eating Attitudes Test-40 was used to assess global disordered eating behaviors, dietary concerns (DC), bulimic behaviors (BB) and social pressure to eat (SPE). Sleep disturbances were assessed by two items related to difficulties initiating sleep (DIS) and maintaining sleep (DMS). A sleep disturbance index (SDI) was calculated by summing DIS and DMS scores. Results revealed that global disordered eating behaviors at baseline predicted DIS, DMS and SDI at T1 and T2. Students with increased BB and SPE scores at baseline were more likely to experience sleep onset and sleep maintenance difficulties in the long term. These results suggest that assessment and correction of eating behaviors might prevent sleep disturbances.     

Eating Disorders and Disturbance in Children and Adolescents With Cystic Fibrosis

People with cystic fibrosis are considered at risk for developing anorexia (Raymond et al., 2000), but studies have used methodologically flawed measures. Using improved methodology, the current study examines the prevalence of eating disorders/disturbance in adolescents with CF. Method: 55 adolescents with CF, age range 11-17 years (mean 14.2 years) randomly selected were administered the Child Eating Disorder Examination (Bryant-Waugh, Cooper, Taylor, & Lask, 1996). Results: No participant met full criteria for a diagnosis of anorexia or bulimia. Of those with a BMI ≤ 17.5, 5% avoided weight gain. Fifty-three percent demonstrated disturbed eating attitudes and 16% disturbed eating behaviours. Discussion: The study finds that gold standard diagnostic methods indicate the prevalence of disturbed eating attitudes and behaviors in CF.     

Bulimic symptoms, cognitions, and body dissatisfaction in women with major depressive disorder

OBJECTIVE: The goals of this study were to assess eating disorder symptoms in depressed women with no history of eating disturbance and to evaluate the clinical significance of these symptoms relative to those reported by women with bulimia spectrum disorder. METHOD: Participants were 63 women with major depressive disorder (MDD) (n = 19), bulimia spectrum disorder (n = 20), or no history of MDD or eating disorder (n = 24). Measures included diagnostic interviews and self-report questionnaires designed to assess diagnostic criteria for bulimia nervosa, subthreshold eating disorder symptoms, dysfunctional attitudes about appearance, and body dissatisfaction. RESULTS: There were no significant differences between depressed and bulimic women on shape concerns, appearance overvaluation, or body dissatisfaction. Depressed women endorsed significantly more subthreshold eating disorder symptoms, dysfunctional attitudes about appearance, and body dissatisfaction than did control subjects. DISCUSSION: Eating disorder symptoms may be associated with depression in women in the absence of comorbid eating disorder diagnoses.     

Relations of bulimic symptom frequency and intensity to psychosocial impairment and health care utilization: results from a community-recruited sample

OBJECTIVE: To determine the frequency and intensity of bulimic symptoms related to psychosocial impairment and health care utilization. METHOD: Females (N = 1231, M age = 17.7, range 13-55) from four community-recruited samples varying in bulimic pathology completed the eating disorder examination, social adjustment scale, and health survey utilization scale. RESULTS: Co-occurrence of binge eating and compensatory behaviors and solely compensatory behaviors >or=1 time/month were associated with elevations in psychosocial impairment. Co-occurrence of both binge eating and compensatory behaviors and solely compensatory behaviors >or=8 times/month were related to greater service utilization. Solely binge eating and duration of bulimic behaviors were unrelated to these functional outcomes. Overvaluation of body shape and weight showed significant linear relations to the functional outcomes. CONCLUSION: Results suggest that current diagnostic thresholds for bulimia nervosa may be too high when considering functional impairment and service utilization and that different cut-points need to be considered for different bulimic symptoms.     

Do eating attitudes predict early change in eating behaviors among women with bulimic disorders who are treated with cognitive behavioral therapy?

Objective:

This study examined the eating attitudes that are associated with a reduction in bulimic behaviors during the key early stage of cognitive behavioral therapy (CBT).

Method:

A case series of 41 patients with bulimia nervosa (full or partial syndrome) took part. They were drawn from the case loads of CBT therapists working in an outpatient specialist eating disorders team. Each patient completed the Eating Disorder Examination‐Questionnaire and recorded the frequency of objective binges, the frequency of vomiting and the number of laxatives taken between Sessions 1 and 6.

Results:

The participants' reduction in behaviors suggested that the early part of CBT was effective. Correlational analyses showed that those with poorer eating attitudes at the outset of therapy were likely to show the greatest behavioral change by Session 6, in keeping with findings relating to the full duration of CBT.

Discussion:

Patients with relatively unhealthy eating attitudes are more likely to show positive behavioral change in the early part of course of CBT. Clinicians might need to encourage patients with bulimic disorders to work harder on behavioral change when the individual has less pathological eating attitudes at the outset. © 2011 by Wiley Periodicals, Inc.     

Temporal stability of the Eating Disorder Examination Questionnaire

OBJECTIVES: The current study examined the stability and internal consistency of the Eating Disorder Examination Questionnaire (EDE-Q) in a general population sample. METHODS: The EDE-Q was administered to a community sample of women aged 18-45 on two occasions, with a median test-retest interval of 315.0 days. RESULTS: Pearson correlations between items of the EDE-Q assessing attitudinal features of eating disorder psychopathology ranged from 0.57 for the Restraint subscale to 0.77 for the Eating Concern subscale. The stability of items addressing eating disorder behaviors was much lower, with phi coefficients for the occurrence of objective bulimic episodes, subjective bulimic episodes, and use of exercise as a compensatory behavior of 0.44, 0.24, and 0.31, respectively, and Kendall's tau b correlations of 0.44, 0.28, and 0.31, respectively, for the frequency of these behaviors, across occasions. The internal consistency of the EDE-Q was high, with a Cronbach alpha coefficient for the global scale of 0.93, compared with a value of 0.90 for the Eating Disorder Examination interview. DISCUSSION: Items of the EDE-Q assessing attitudinal features of eating disorder psychopathology demonstrate a high degree of temporal stability, whereas the stability of items addressing eating disorder behaviors is much lower. In the case of compensatory eating disorder behaviors, low stability is likely to reflect actual trait variation, whereas the low stability of binge eating behaviors, in particular subjective bulimic episodes, is likely to reflect both trait variation and measurement error. The high internal consistency of EDE-Q items supports its use as a screening instrument in two-phase epidemiologic studies.     

Aspects of the media and their relevance to bulimic attitudes and tendencies among female college students

We examined whether media pressures would mediate the association between two dimensions of the media (source of information and internalization) and bulimic attitudes/tendencies. The study sample consisted of 106 female college students (M age=19.9; range=18-22). Participants completed anonymous, self-report measures on media influences on body image and appearance as well as disordered eating attitudes/behaviors. Findings showed that the association between two dimensions of the media (source of information and internalization) and bulimic attitudes/tendencies was mediated by perceived media pressures. Such findings highlight the significant influence of media pressures on bulimic attitudes/tendencies. Future research and prevention implications are discussed.     

Influence of sexual orientation and age on disordered eating attitudes and behaviors in women

OBJECTIVE: We evaluated the influence of age on the association between sexual orientation and disordered eating attitudes and behaviors in women. METHOD: Heterosexual (n=47) and homosexual (n=45) women recruited from the community completed self-report questionnaires including the Body Esteem Scale, the Eating Disorders Inventory-2, the Reasons for Exercise Inventory, and the Self Esteem Scale. RESULTS: A multivariate analysis of variance of eating disorder variables revealed a main effect for sexual orientation on drive for thinness and exercise to control weight and a main effect for age on body mass index (BMI) and body dissatisfaction, but it did not reveal a significant interaction between sexual orientation and age. DISCUSSION: Sexual orientation may influence certain types of disordered eating attitudes and behaviors in women such as endorsing an extreme ideal of thinness. However, homosexual and heterosexual women reported more similarities than differences.     

Validation of eating and dieting expectancy measures in two adolescent samples

OBJECTIVE: To demonstrate the validity of two measures of eating and dieting expectancies (The Eating Expectancy Inventory [EEI] and the Thinness and Restricting Expectancy Inventory, [TREI]) for use with adolescents. METHOD: Seventh (N = 392) and tenth graders (N = 300) completed the Bulimia Test-Revised (BULIT-R), the Eating Disorder Inventory (EDI-II), and two factors of the Three-Factor Eating Questionnaire (TFEQ). RESULTS: Findings replicated for the two adolescent samples. The expectancy that thinness leads to overgeneralized life improvement correlated with measures of "successful" dieting, dieting plus disinhibition, and bulimic symptomatology. Expectancies for negative reinforcement from eating (e.g., eating helps manage negative affect and alleviate boredom) correlated with dieting plus disinhibition and bulimic symptoms, but not with successful dieting. Negative reinforcement from eating and reinforcement from thinness expectancies accounted for different bulimic symptom variance than that accounted for by the personality factors of perfectionism, interpersonal distrust, and ineffectiveness. DISCUSSION: Results were consistent with prior work on college and clinical samples, thus supporting use of the expectancy measures with adolescents.     

Predictive effects of mother and peer influences on increases in adolescent eating disorder risk factors and symptoms: a 3-year longitudinal study

Objective:

To investigate the relation of maternal and peer attitudes and behaviors to changes in eating disorder risk factors and symptoms in adolescent females.

Method:

We tested whether maternal and peer eating attitudes, behaviors, and deficits in social support at baseline predicted subsequent increases in eating disorder risk factors and symptoms among 483 late adolescent females followed over 3 years.

Results:

Data provide partial support for hypotheses, as eating disorder risk factors and symptoms increased over time and maternal thin ideal internalization significantly predicted a future increases in adolescent bulimic symptoms. There were no significant predictors of adolescent thin ideal internalization or body dissatisfaction.

Discussion:

Findings only partially support the hypothesis that unhealthy attitudes and behaviors of mothers increase risk for eating disorder symptoms in their late adolescent daughters. These results underscore why eating disorder prevention programs should be based on risk factor research that has used prospective and rigorous designs. © 2011 by Wiley Periodicals, Inc.     

Factors Associated with Maladaptive Eating Behaviors,Social Anxiety,and Quality of Life in Adults with Celiac Disease

A gluten-free diet (GFD), which is the only treatment for celiac disease (CeD), is challenging and associated with higher levels of anxiety, disordered eating, and lower quality of life (QOL). We examined various demographic and health factors associated with social anxiety, eating attitudes and behaviors, and QOL. Demographics and health characteristics, QOL, eating attitudes and behaviors, and social anxiety of adults with CeD were acquired using validated measures. The mean scores for QOL, SAQ, and CDFAB were compared across various demographic groups using the Z statistical test. The mean QOL score was 57.8, which is in the moderate range. The social anxiety mean scores were high: 78.82, with 9% meeting the clinical cutoff for social anxiety disorder. Those on a GFD for a short duration had significantly higher SAQ scores (worse anxiety), higher CDFAB scores (worse eating attitudes and behavior), and lower QOL scores. Those aged 23–35 years had lower QOL scores (p < 0.003) and higher SAQ scores (p < 0.003). Being single (p < 0.001) and female (p = 0.026) were associated with higher SAQ scores. These findings suggest that the development of targeted interventions to maximize QOL and healthy eating behaviors as well as to minimize anxiety is imperative for some adults with CeD.     

Comparison of assessments of children's eating-disordered behaviors by interview and questionnaire

OBJECTIVE: In adults, interview methods may detect eating-disordered behaviors more accurately than self-report methods. However, no studies have investigated the relationships between interview and self-report assessments in children. We compared results from the Eating Disorder Examination adapted for Children (ChEDE) with the Adolescent version of the Questionnaire on Eating and Weight Patterns (QEWP-A) and with the Children's Eating Attitude Test (ChEAT) in a nontreatment sample of overweight and normal weight children. METHOD: The ChEDE, QEWP-A, and ChEAT were administered to 46 overweight (body mass index [BMI] at or above the 85th percentile) and 42 normal weight (BMI at the 15th-85th percentile) children, 10 +/- 1.8 years, recruited from the community. RESULTS: The ChEDE and QEWP-A were not concordant for the number or type of eating episodes that occurred in the past month. Compared with the ChEDE, the QEWP-A was reasonably specific, but it was not sensitive for the presence of objective (17 % sensitivity, 91% specificity) or subjective bulimic episodes (0 % sensitivity, 89 % specificity) during the past month. ChEDE and ChEAT global scores were significantly related (Kendall's tau = 0.286, p <.001), but specific items assessing guilt in relation to eating and preoccupation with food were not. DISCUSSION: Although self-report methods of eating disorder assessment in children may provide some general information regarding eating psychopathology in non-treatment-seeking children, they do not accurately reflect the results of a structured interview.