Core beliefs in anorexic and bulimic women

Maladaptive core beliefs and eating disorder symptoms

This study compared maladaptive core beliefs of eating-disordered groups (full and subthreshold syndrome) and healthy controls and investigated the association between eating disorder symptoms and core beliefs. Participants were compared on self-report measures of core beliefs (YSQ) and eating disorder psychopathology (BITE). Anorexia nervosa (AN; both subtypes) and bulimia nervosa (BN) patients had significantly more core beliefs than healthy controls. Binge eating disorder (BED) patients had intermediate scores between AN and BN on the one hand and healthy controls on the other hand. No correlation was found between core beliefs and frequency of binge eating. Frequency of vomiting, laxative misuse and fasting was positively associated with all domains of core beliefs. Patients with eating disorders have some core beliefs which are not directly related to eating, weight or shape. Frequency of purging and fasting behaviors is associated with more severe maladaptive core beliefs. Our data demonstrate the importance of identifying purging and fasting as significant clinical markers.

[A food cognition questionnaire]

BACKGROUND

Many authors evoke the role of cognition in the persistence of symptoms or in relapse. In pathology the cognitions produced by the patients are called dysfunctional or erroneous. The content of the cognitions are words or images issued from the treatment of information. In emotional disorders, the structure of thoughts named dysfunctional "schemata" involves a biased treatment of information and leads to erroneous cognitions. Several studies have attempted to elicit the most specific cognitions of different diseases. In this field, Hollon and Kendall found 36 cognitions specific to depression gathered in the automatic thoughts questionnaire (ATQ). In the same spirit, Beck et al. gathered 14 cognitions of anxiety and 12 depressed cognitions in the cognition check list (CCL). In the etiology and maintenance of eating disorders the cognitions take a large place. Around 1980 cognitive dysfunctioning was described and concerned food, interpersonal relationship and body shape. A few years later, some experimental studies explored these processes. The Stroop test, a categorization task, showed specific cognitive impairment in with patients eating disorders versus normal control subjects. It was then established that cognitive errors were based on food cognitions in restrictive patients, whereas they were based on body shape cognitions in bulimic patients. In several famous papers, Garner described typical cognitions of eating disorder patients and distinguished food-cognitions, eating-cognitions using case reports. As far as we know there is no clinical tool concerning such cognitions in France. That is the main motivation of the authors.

AIM OF THE STUDY

The aim of this paper was to determine the characteristic cognitions of anorexic, anorexic-bulimic and bulimic patients and to compare them with those of normal control subjects. The goal of the study was to create a food cognition questionnaire. FIRST STEP METHODS: In the first step, food cognitions were collected among female eating disorder patients and normal female control subjects during systematic investigation. Ninety-two women were assessed and provided more than 3 000 food cognitions. Two independent psychologists identified the most frequent cognition per group and thus retained 115 food items. These items were randomly assigned. This provided the questionnaire. To illustrate the latter, here are the first five items: 1) Apricots are good for the health because they are rich in vitamins. 2) Pears are big fruit, difficult to digest. 3) Canned fruit is soaked with sugar. 4) Banana is a fruit which makes one put on weight. 5) White coloured food give the impression that it is not alive... The list of possible answers was: never, rarely, sometimes, often enough, often, always. SECOND STEP METHODS: In the second step, the food cognition questionnaire was proposed to 217 women including 131 eating disorder patients (53 anorexic, 50 anorexic bulimic, 28 bulimic) and 86 normal control subjects. The values of body mass index and the eating attitude test differed when we compared the two groups, and the mean age was close to 26 years in both groups.

RESULTS

The statistic analysis highlighted six discriminative variables: two clinical criteria (weight and height) and four food-items given below: Q24: When I see food being fried, I feel the grease all over my body. Q76: When I start a cookie packet, I eat it up. Q102: When I feel anxious, I crave for food to fill my body. Q106: Eating pastry gives me heart-burn and makes me belch. The statistical model allowed us to differentiate eating disorder patients from normal control subjects. The content of the four food items is in agreement with experimental and clinical data. All these items included some aspects of the quality or quantity of food and also the negative consequences of food consumption on the body.

CONCLUSION

To conclude, the model can help clinicians identify the patients and then initiate treatment. We also insist on the fact that this study is new and empirical, and should be extended by determining some food items for example, which would clarify the difference of behaviour between anorexics and bulimics.

Core beliefs, recalled parental rearing and eating psychopathology across different age groups

This study explored and compared the patterns of core beliefs, recalled parental rearing behaviours and eating psychopathology in non-clinical females of different ages; university staff and university students. No differences were found between the two age groups except that younger women had higher Drive for Thinness scores. However, core beliefs were associated with eating attitudes and behaviours in younger women and with recalled parental rearing behaviours in older women. The results suggest that younger women tend to externalise their negative core beliefs in the form of disordered eating behaviour whereas older women appear to express their dysfunctional core beliefs in ways other than weight and shape-related issues. The possible mechanisms behind these findings require further investigation.

The relationship between different levels of cognition and behavioural symptoms in the eating disorders

BACKGROUND

Both disorder-specific cognitions and unconditional core beliefs have been associated with eating-disordered behaviours. This study examines whether these beliefs might provide competing or complementary explanations of those behaviours.

METHOD

The participants were 151 women with eating disorders. Each woman completed two self-report measures-the Eating Disorder Examination Questionnaire (measuring disorder-specific cognitions and reported behavioural frequency) and the Young Schema Questionnaire-Short version (measuring unconditional core beliefs). Objective height and weight were measured to give body mass index (BMI). Regression analyses were used to compare additive, mediator and moderator models of the cognition-behaviour link.

RESULTS

BMI and reported frequency of vomiting were best explained by models where the impact of disorder-specific cognitions was moderated by unhealthy core beliefs, but where neither form of belief had an independent effect. In contrast, the frequency of reported objective binge-eating was best explained by an additive effect of the two forms of cognition.

DISCUSSION

The findings indicate that both disorder-specific cognitions and unconditional core beliefs are necessary to explain the development and maintenance of disordered eating behaviours. This conclusion suggests that cognitive-behavioural approaches might be more effective if they address both levels of cognition. However, prospective research is required to confirm the causal hypothesis based on the present cross-sectional data.

Is comorbidity in the eating disorders related to perceptions of parenting? Criterion validity of the revised Young Parenting Inventory

BACKGROUND

Recent studies support the reliability and validity of the Young Parenting Inventory-Revised (YPI-R) and its use in investigating the role of parenting in the aetiology and maintenance of eating pathology. However, criterion validity has yet to be fully established. To investigate one aspect of criterion validity, this study examines the association between parenting and comorbid problems in the eating disorders (including general psychopathology and impulsivity).

METHOD

The participants were 124 women with eating disorders. They completed the YPI-R and the Brief Symptom Inventory (BSI; a measure of general psychopathology). They were also interviewed about their use of a number of impulsive behaviours.

RESULTS

YPI-R scales were significant predictors of one of the nine BSI scales, and distinguished those patients who did or did not use specific impulsive behaviours.

DISCUSSION

The criterion validity of the YPI-R is partially supported with regards to general psychopathology and impulsivity. The findings highlight the specificity of the parenting styles measured by the YPI-R, and the need for further research using this tool.

Les cognitions et leur évaluation dans les troubles des conduites alimentaires

Cognitions are of crucial importance in the -aetiology and the maintenance of eating disorders. Dysfunctional cognitions in eating disorders are related to body image, self-esteem and feeding. The aim of this paper is to review the actual knowledge in this area. First, we will display -cognitive models in eating disorders. Cognitive factors in -eating disorders are logical errors, cognitive slippage and conceptual complexity. Eating disorder patients seem to have a deficient cognitive development. Some cognitive models stipulate that eating disorder patients may develop organised cognitive structures schemas concerning the issues of weight and its implications for the self. These schemas can account for the persistence and for the understanding the "choice of the eating disorder symptomatology. Cognitive pheno-mena of interest are self-schema, weight-related schema and weight-related self-schema. The maintenance model of ano-rexia nervosa argued that, initially there is an extreme need to control eating which is supported by low self-esteem. The maintenance of the disorder is reinforced by three mechanisms: dietary restriction enhances the sense of being in control; aspects of starvation encourage further dietary restriction; concerns about shape and weight encourage restriction. The development and maintenance of bulimic symptomatology are explained by placing a high value on attaining an idealised weight and body shape accompanied by inaccurate beliefs. The cognitive model of specific family of origin experiences puts forward the development of -maladaptative expectancies for eating and thinness. Second, we discuss distortions in information processing. a) In feeding laboratories, bulimics show a wide range of caloric intake and a disruption of circadian feeding patterns. In overeating bulimics, large meals occurred mainly during afternoon and evening with high fat and carbohydrate intake, but the majority of meals were of normal size and frequency. Responsivity to food cues indicates that bulimics were more responsive to sight, smell and taste of their favourite binge food, and a greater responsivity was associated with increasing -cue salience. Eating disorder patients appear to have internalised a mediated social rule concerning "good food" and make drastic selections thus removing the possibility of choice of foodstuffs. b) Experimental processes: temporal factors in the processing of threat seem to be of importance in patients with high levels of eating psychopathology. There is no evidence for preattentive processing biases among anorectics. Changes in information processing speed after treatment were not linked to treatment condition or treatment response. c) Judgement and emotions: in eating disorder patients, distortions of depressogenic nature are found that influence the cognitive style; thoughts about eating, weight and shape are characterised by negative affective tone; negative emotions could account for bulimic behaviour; anxiety and distress are correlated to thought control strategies. Information treating seems to be impaired in a non-homogeneous way. d) Cognitive schemas are seriously maladaptive and not well investigated. In eating disorder patients, core beliefs are absolute, unconditional and dichotomous cognitions about oneself and the world. There are only few studies in this field moreover showing controversial results. Core beliefs can explain links between personality disorders and eating psychopathology. Pathological core beliefs have to be taken in to account because they influence the outcome and the efficacy of cognitive behavioural therapy. Third, the last part of this paper summarises actually available rating scales eva-luating distorted cognitions in eating disorders. There are different methods for evaluation: specific and non-specific self-report questionnaires, thought-sampling procedures, -methods derived from cognitive psychology. The Mizes Anorectic Cognition questionnaire (MAC) is a well-known self-rating scale with good psychometric properties. The revised form of the MAC appears to be an improvement in the area of internal consistency, sensitivity, and reliability. It is obvious that there is no particular rating scale referring to specific cognitions on food.

IN CONCLUSION

the main result of this literature review reflects that the cognitive treatment in eating disorders is altered in a specific way on an emotional basis and on self-representation.

Parental rearing behaviours and eating disorders: the moderating role of core beliefs

OBJECTIVE

Core beliefs have been shown to mediate between eating psychopathology and dysfunctional parent-daughter interactions. However, the possible moderating role of core beliefs has been neglected. This study aimed to explore the hypothesis that core beliefs serve as moderator variables in the relationship between recalled parental rearing behaviours and eating psychopathology.

METHOD

Sixty-six women with a current eating disorder completed self-report measures of parental rearing behaviours, core beliefs, and eating psychopathology.

RESULTS

Three core beliefs were found to moderate the relationship between paternal rejection and aspects of eating psychopathology. The predictive validity of paternal rejection on aspects of eating symptomatology was found to decrease as dysfunctional core beliefs increased.

DISCUSSION

When levels of social isolation, vulnerability to harm, and self-sacrifice core beliefs were high, recalled parental relationships were no longer relevant to current eating psychopathology. The findings provide further evidence that core beliefs are important factors in eating disorder psychopathology and may be clinically useful in identifying targets for treatment.

Cognitive theory in anorexia nervosa and bulimia nervosa: Progress, development and future directions

Important developments have taken place in cognitive theory of eating disorders (EDs) (and also in other disorders) since the review paper published by M.J. Cooper in 1997. The relevant empirical database has also expanded. Nevertheless, cognitive therapy for anorexia nervosa and bulimia nervosa, although helpful to many patients, leaves much to be desired. The current paper reviews the relevant empirical evidence collected, and the theoretical revisions that have been made to cognitive models of eating disorders, since 1997. The status and limitations of these developments are considered, including whether or not they meet the criteria for "good" theory. New theoretical developments relevant to cognitive explanations of eating disorders (second generation theories) are then presented, and the preliminary evidence that supports these is briefly reviewed. The lack of integration between cognitive theories of EDs and risk (vulnerability) factor research is noted, and a potential model that unites the two is noted. The implications of the review for future research and the development of cognitive theory in eating disorders are then discussed. These include the need for study of cognitive constructs not yet fully integrated (or indeed not yet applied clinically) into current theories and the need for cognitive theories of eating disorders to continue to evolve (as they have indeed done since 1997) in order to fully integrate such constructs. Treatment studies incorporating these new developments also urgently need to be undertaken.

Stability and discriminative power of the Young Schema-Questionnaire in a Dutch clinical versus non-clinical population

In this study the temporal stability and general discriminative and classifying ability of the Young Schema-Questionnaire (YSQ) was examined in a clinical and non-clinical sample. To be able to cross-validate on the variables, two parallel subtests, drawn from the YSQ item pool, were utilized. Results suggest adequate rank order stability. However, mean scores tended to drop systematically over time, most likely caused by transient error. Therefore, to assess progress in therapy, the alternate utilization of the parallel parts is advised. Findings from discriminant analysis suggest high sensitivity of the YSQ and its subscales in predicting the presence or absence of psychopathology.

Schema and parental bonding in overweight and nonoverweight female adolescents

OBJECTIVE

To investigate whether family functioning and cognitions in a group of overweight female adolescents differ significantly from those in a group of normal weight female adolescents.

DESIGN

Cross-sectional study.

SUBJECTS

In all, 23 overweight female adolescents (mean age: 17.6 y, mean body mass index (BMI: 27.8 kg/m2), and 23 normal weight female adolescents (mean age: 17.7 y, mean BMI: 20.2 kg/m2).

MEASUREMENTS

The following self-report measures were completed: the Parental Bonding Inventory, the Young Schema Questionnaire-short version, the Eating Attitudes Test, the Beck Depression Inventory and the Eating Disorder Belief Questionnaire.

RESULTS

Overweight female adolescents reported more negative self-beliefs and greater belief in schema relating to emotional deprivation, fears of abandonment, subjugation and insufficient self-control. They also perceived their fathers as being significantly more overprotective and significantly less caring. Within this group perceived level of maternal care correlated negatively with negative self-beliefs and schema.

CONCLUSIONS

Overweight female adolescents show some of the cognitive features associated with the development of an eating disorder. However, positive parent-child relationships may serve to protect overweight adolescents from developing clinical eating disorders and from psychological distress later in life.

Étude du processus de catégorisation chez des patientes aux troubles des conduites alimentaires : une nouvelle approche cognitive de la psychopathologie

Anorexic and bulimic patients have a highly distorted relationship with food and eating, even though they tend to be knowledgeable about diet and nutrition. The progress of this disease, as well as its complications and associated difficulties, are increasingly understood, while the etiopathogeny of eating disorders remains obscure. The approach that we are proposing involves the study of one of the most fundamental cognitive functions of human reasoning--the cognitive process of categorization. The purpose of this study is to understand the procedures used by these patients to construct representations of food. Categorization, one of the basic features of human cognition, allows individuals to organize their subjective experience of the surrounding environment by structuring its contents. This ability to group different objects into the same category based on their common characteristics is important for explaining the major cognitive activities of planning, memorization, communication and perception. Indeed, our categories reflect our conceptions of the world. They depend on our experiences and representations, as well as the expertise acquired in a specific field. The differences that appear in the categories created by subjects when they are asked to classify objects reveal the properties that are most salient to them and, as a result, the interests, values and ideas associated with these properties. There are three types of properties: perceptive properties, which describe the object's shape, color, odor and texture; structural properties, which relate to the object's components; and functional properties, which specify the way in which the object is used and provide an answer to the question, "What is it used for?". Subjects attribute these functional properties by means of knowledge or inference according to their representation of the object's role; such properties are especially likely to emerge during top-down (theory-driven) processing. The type of processing used (bottom-up or top-down) is dependent on a certain number of factors. We hypothesize, within the context of food product categorization, that patients suffering from eating disorders largely resort to processing based on acquired information or beliefs about the objects, i.e. top-down processing. We present two studies: a naturalistic and exploratory pilot study whose goal is to identify whether the various categorization processes used by eating disorder patients differ from those employed by subjects not suffering from an eating disorder. A second study aims to identify the different categorization procedures. During the first experiment, 68 women (17 control subjects, 17 anorexics, 17 anorexic bulimics and 17 bulimics) aged 18-39 (average age: 26.6) verbalize all representations that come to mind during a limited time period as the name of a food item is read. Eighty-nine food items are presented in alphabetical order. The list is read out loud and all comments are recorded. The data is processed in three ways : an analysis based on the positive or negative valence of each representation, an analysis based on each categories of food and an analysis of representations based on themes expressed. The three analyses (valence, categories of food and theme assigned to the representations) show differences between the representations of the four experimental groups. In fact, the anorexics and anorexic bulimics mainly express strongly negative representations about food, whereas bulimics and control produce representations whose positive and negative valences balances. These negative cognitions concern mainly meat for the control subjects and cakes for the subjects reached of TCA. Concerning theme assigned to the representations, the control subjects produce mainly cognitions relating to the hedonism, the flavor of food and their purpose on health. The anorexics and anorexics-bulimics evoke mainly the fat and sugar content of the foods. The bulimics evoke mainly cognitions relating to the effect on health and the intestinal transit time of food. These results lead one to believe that it is not the bulimic binging and purging of these patients, but rather their restrictive behavior that is the determining factor in the differences in food representations observed between the two experimental groups. During the second experiment, 60 women (15 controls, 15 anorexics, 15 anorexic bulimics and 15 bulimics) aged 18-32 (average age: 25.6) classified 27 food names according to their similarities and differences, and then explained the reasons for their categorizations. The data were analyzed in terms of similarity/difference, and the verbalizations were analyzed by content. The results indicate that 10 of the 27 foods were categorized differently by the controls and the subjects with eating disorders. Subjects classified the following foods: camembert cheese, cold cuts, cheese spread, fruit in syrup, whole milk, mayonnaise, bread, fresh fish, potatoes and plain yogurt. Bulimics and controls use similar classifications for food names, while anorexics and atypical bulimics classify foods in a similar way. Examining the categorization criteria used during verbalizations allows us to better understand these differences. The control group's major criterion seems to be the succession of dishes. These subjects group into separate categories entry foods (beef, eggs, fish, etc.), vegetables, cheese or dairy foods, and finally desserts. Additional foods, like bread and mayonnaise, belong to the same category. Other categories are nutritional criteria (for example, dairy products contain calcium) and biological criteria (for example, bananas and apples are fruits). These categorization criteria include structural properties (which describe what the object is made of) and functional, "academic" properties, those which describe how foods are used, "as in cookbooks or diet books." On the other hand, the categorization criteria expressed by anorexic patients are very different from those used by control subjects: foods that are hard to eliminate, rich, high-fat and therefore indigestible are considered to be similar. Some examples are cold cuts, potatoes, mayonnaise and prepared desserts. A second categorization criterion involves the concept of natural foods : certain foods "are unhealthy because they're processed, so they're bad for you"--one such example is cheese spread. A third criterion concerns the notion of familiar foods: poultry and eggs, for example, are "familiar to us." We are clearly seeing here the importance of functional properties in the categorization of food names: certain foods are indigestible, hard to eliminate, cause heartburn or reflux, are not natural, and thus are avoided. The categorization criteria mentioned by bulimic patients also clearly take into account the functional properties of foods. The criteria are of the following type: "it's filling, it relieves a bulimic attack, it helps prevent heartburn and constipation, etc." It appears that bulimics' categorization criteria are solely associated with these foods' imagined or real effect on the body. The categorization criteria used by anorexic bulimics seem to be especially associated with weight gain or the consumption of such foods during bulimia attacks because "they make you feel full." On the other hand, light foods, which patients allow themselves to eat, are placed in the same category. This study, which seeks to understand the cognitive functioning of eating disorder patients with anorexia and bulimia, has brought new elements to light. All patients exhibit food categorization processes that differ greatly from those displayed by control subjects. Patients also attribute greater significance to the functional properties of foods as compared to controls, who give priority to structural properties. Anorexic and bulimic patients base their food categorizations on the consequences of ingestion, in terms of health, digestion and weight gain. Their processing of food stimuli is therefore radically different and gives a dominating place to top-down processes. Additional studies should supplement these findings in order to gain a better understanding of patients' disturbed processing of information.

An experimental analysis of the role of schema compensation in anorexia nervosa

It has been suggested that the relatively poor effectiveness of treatments for anorexia nervosa is due to a poor conceptualisation of the disorder. One hypothesis is that current models are mistakenly targeting superficial, instead of deeper level, cognitions and cognitive processes. A schema-based cognitive-behavioural model of eating disorder pathology suggests that the process of schema compensation is key to restrictive pathology-when there is the threat of experiencing negative affect, compensatory schemas are activated, reducing that affect. The current experimental study aimed to provide support for such a process. Eating-disordered and control women completed a computer-based task, measuring the compensation process in terms of speed and accuracy in response to subliminal threat cues. The results did not fully support the hypothesis, suggesting that the model and methodology need some amendment. Improvements to the methodology are discussed.

The role of core beliefs in the specific cognitions of bulimic patients

Cognitive models of bulimia nervosa have stressed the importance of self-beliefs in the maintenance of the disorder. However, new findings show a deeper and more general level of beliefs also to play a role in eating disorders. These beliefs are long-standing, absolute, and unconditional. In the present study, the relations between such core beliefs and specific cognitions regarding eating, shape, and weight were examined. The sample consisted of 75 bulimic outpatients who started treatment. The patients completed the Schema Questionnaire, the Eating Disorders Inventory-2, the SCL-90-R, and the Mizes Anorectic Cognitions Questionnaire at intake. Strong relations between some core beliefs and the specific cognitions regarding shape, weight, and eating were found. The modification of core beliefs appears to be a very important issue to incorporate into treatment.

Cognitive content in bulimic disorders: core beliefs and eating attitudes

Recent clinical and research reports have demonstrated that cognitive work with bulimia nervosa might benefit from addressing core beliefs (unconditional negative representations of the self), rather than simply focusing on the impact of beliefs and assumptions regarding food, shape, and weight. However, while links have been established between core beliefs and bulimic psychopathology, it remains to be established how these beliefs have their specific impact on different aspects of eating disturbance. This study investigates the links between core beliefs and "ego-dysfunction" characteristics (e.g., perfectionism, self-esteem), since those characteristics are potential mediators of that link. In a group of 75 bulimics, core beliefs were related to both eating psychopathology and ego-dysfunction characteristics. It is proposed that many of the ego-dysfunction characteristics might serve as mediators of the already-established link between core beliefs and eating pathology, although testing this model fully would require larger-scale prospective research. Clinical work with bulimics is likely to be more effective if it addresses a range of cognitive structures, as well as behaviours.

A randomized controlled study of cognitive behavior therapy and behavioral family therapy for anorexia nervosa patients

Very few studies have examined the role of cognitive behavior therapy (CBT) in the outpatient treatment of anorexia nervosa. This study used a randomized, controlled design to evaluate a 12-month, manual based program of CBT, with behavioral family therapy as the comparison group. Twenty-five adolescents and young adults with anorexia nervosa, currently living with their families, were recruited into the study with both treatment groups receiving 21-25 sessions of therapy. Outcome measures included nutritional status, eating behaviors, mood, self-esteem, and family communication. Sixty percent of the total sample and 72% of treatment completers had "good" outcome (defined as maintaining weight within 10% of average body weight and regular menstrual cycles) at post-treatment and at six months follow-up. No significant differences between treatment groups were found and the majority of patients did not reach symptomatic recovery. While limited by the small sample size, the findings compliment and extend previous research.

The Relationship Between Core Beliefs and a History of Eating Disorders: An Examination of the Life Stories of University Students

The goal of the current study was to examine the relationship between core beliefs and a history of eating disorders using a retrospective design. Sixty-three university students completed self-report measures assessing current depressive symptoms. They also completed a semistructured interview assessing current and past histories of eating disorders. The presence of core beliefs was identified through an examination of participants’ life stories. Core beliefs were associated with past histories of both anorexia and bulimia nervosa, even after controlling for current depressive symptoms and eating disorders. Further analyses revealed that core beliefs centering around themes of disconnection and rejection, other-directedness, and overvigilance and inhibition were associated with past histories of anorexia nervosa, whereas core beliefs centering around themes of disconnection and rejection, impaired limits, and overvigilance and inhibition were associated with past histories of bulimia nervosa. These findings provide preliminary support for recent theoretical models highlighting the potential importance of core beliefs in the etiology of eating disorders.

Anger and core beliefs in the eating disorders

OBJECTIVE

The link between emotion and eating pathology has long been established, but relatively little is known about the role of anger, partly because the existing literature has tended to concentrate on anger as a unitary construct. Nor is there any understanding of the cognitive factors that drive this affect in the eating disorders. This study had two aims: to determine levels of different facets of anger across eating disorder diagnoses and behaviors; and to investigate whether facets of anger are related to the individual's negative core beliefs.

METHOD

The sample consisted of 140 women who met DSM-IV criteria for eating disorders, and 50 female control participants (university undergraduates). The women completed self-report questionnaires of anger levels and unhealthy core beliefs, and the presence of bulimic behaviors was recorded at assessment.

RESULTS

The eating-disordered women had higher levels of state anger and anger suppression, particularly if the diagnosis included bulimic symptoms. Different aspects of anger were associated with specific bulimic behaviors. Unhealthy core beliefs were associated with higher levels of trait anger in both groups but with anger suppression in the clinical women only.

DISCUSSION

Suggestions are made regarding ways in which state anger and anger suppression might be understood and treated in women with eating disorders.

Anorexia nervosa: obsessive-compulsive disorder, obsessive-compulsive personality disorder, or neither?

Anorexia nervosa (AN) is a severe and often chronic disorder with uncertain aetiology and poor prognosis. New approaches to the understanding of the disorder are needed in order to aid the development of more effective treatments. Several authors have suggested that AN has a considerable overlap with obsessive-compulsive disorder (OCD) and that this may reflect common neurobiological, genetic, or psychological elements. However, more recent studies have suggested that AN may have a closer relationship with obsessive-compulsive personality traits such as those found in obsessive-compulsive personality disorder (OCPD). In this paper, evidence for links between the three conditions is reviewed, suggestions for further research are outlined and possible implications for the treatment of AN are presented.

Individual psychotherapy for children and adolescents with an eating disorder from historical precedent toward evidence-based practice

This article reviews the place of individual therapy in the suite of treatment services required by children and adolescents with an eating disorder. Individual therapy is defined and traced from historical origins in psychoanalytic practice with later important modifications by Hilda Bruch and Arthur Crisp. More recent developments, based primarily on cognitive and learning theory are discussed, as is the timing of individual therapy with respect to illness stage and patient motivation. Evidence for therapy effectiveness is reviewed where possible. At present, treatment evidence in the pediatric mental health field must be inferred from adult research.

Core beliefs and bulimic symptomatology in non-eating-disordered women: the mediating role of borderline characteristics

OBJECTIVE

To establish whether borderline personality disorder symptoms play a mediating role in the relationship between early maladaptive schemata and bulimic symptomatology, using a nonclinical sample.

METHOD

Sixty-one female undergraduate students completed the Bulimic Investigatory Test, Edinburgh (BITE), the Borderline Syndrome Index (BSI), and the short form of the Young Schema Questionnaire (YSQ).

RESULTS

Borderline symptoms were found to be a perfect mediator in the relationship between defectiveness/shame beliefs and bulimic symptomatology.

CONCLUSIONS

A model is proposed suggesting that the functional utility of bulimic behaviors might be in counteracting the negative emotions associated with borderline symptoms.

The psychopathology of bulimic women who report childhood sexual abuse: the mediating role of core beliefs

Although reported sexual abuse in childhood is associated with bulimic behaviors, less is known about the cognitive factors that explain this association. This study examined the potential role of core beliefs as a mediator in the abuse-bulimia link. Sixty-one bulimic women were interviewed regarding any history of childhood sexual abuse and completed measures of bulimic behaviors, dissociation, depression, and core beliefs. The 21 women who reported a history of childhood sexual abuse had significantly higher levels of several core beliefs and greater levels of psychopathology. Different core beliefs acted as mediators in the relationships between sexual abuse and individual symptoms. The findings support the suggestion that schema-focused cognitive therapy may be useful in working with bulimics, particularly if they have been sexually abused in childhood. Further research is needed to determine the role of core beliefs in mediating the impact of other forms of trauma and how traumas relate to other "escape" behaviors.

Eating disorders: recognition, evaluation, and implications for obstetrician/gynecologists(1)

Eating disorders are a common finding in adolescent females. The lifetime prevalence of anorexia nervosa and bulimia nervosa is as high as 3.7% and 4.2%, respectively. The disease is much more common in females than males and is often associated with depression and other mood disorders. Complications from eating disorders can include amenorrhea, osteoporosis with pathologic fractures, electrolyte disturbances, dehydration, cardiac arrhythmias, and even death. Eating disorders appear not only to increase the risk of miscarriage, but also are associated with preterm delivery and lower infant birth weights. Treatment for eating disorders can be lifesaving and is more effective when instituted before the patient becomes severely underweight. Evaluation of patients with suspected eating disorders includes a thorough history and physical examination as well as baseline screening laboratory tests. A high index of suspicion is needed to detect patients with eating disorders because many are in denial about their illness. Inpatient hospitalization is recommended for significant metabolic abnormalities and for patients who weigh <85% of their estimated healthy body weight. Treatment for eating disorders includes nutritional rehabilitation, behavioral therapy, and often antidepressant therapy. The obstetrician/gynecologist is one of the few health care providers that young, otherwise healthy women who are at risk for eating disorders will see on a regular basis, and they must be diligent to recognize the signs and symptoms of these diseases so that appropriate and timely interventions can be made.