Social adjustment over 10 years following diagnosis with bulimia nervosa

Combined oral contraceptive use and risk for binge eating in women: Potential gene × hormone interactions

Extant animal and human data suggest endogenous ovarian hormones increase risk for binge eating in females, possibly via gene × hormone interactions and hormonally induced increases in genetic influences. Approximately 85 % of women will take combined oral contraceptives (COCs) that mimic the riskiest hormonal milieu for binge eating (i.e., post-ovulation when both estrogen and progesterone are present). The purpose of this narrative review is to synthesize findings of binge eating risk in COC users. Few studies have been conducted, but results suggest that COCs may increase risk for binge eating and related phenotypes (e.g., craving for sweets), particularly in genetically vulnerable women. Larger, more systematic human and animal studies of COCs and binge eating are needed. The goal of this work should be to advance personalized medicine by identifying the extent of COC risk as well as the role of gene × hormone interactions in susceptibility.

A network approach can improve eating disorder conceptualization and treatment

Eating disorders are severe mental illnesses with the second highest mortality rate of all psychiatric illnesses. Eating disorders are exceedingly deadly because of their complexity. Specifically, eating disorders are highly comorbid with other psychiatric illnesses (up to 95% of individuals with an eating disorder have at least one additional psychiatric illness), have extremely heterogeneous presentations, and individuals often migrate from one specific eating disorder diagnosis to another. In this Perspective, we propose that understanding eating disorder comorbidity and heterogeneity via a network theory approach offers substantial benefits for both conceptualization and treatment. Such a conceptualization, strongly based on theory, can identify specific pathways that maintain psychiatric comorbidity, how diagnoses vary across individuals, and how specific symptoms and comorbidities maintain illness for one individual, thereby paving the way for personalized treatment.

Perceived Conflict and Support Among Women with Bulimia Nervosa Compared to Women with Depression and Healthy Controls: An Experimental Manipulation

Objective: Women with bulimia nervosa (BN) often present with interpersonal difficulties. It is unknown whether these difficulties primarily are based on distorted social perceptions, and whether they are unique to BN. The current study used a repeated-measures design to compare perceptions of interpersonal interactions for participants with BN, depression (DEP), and healthy controls (HCs). We hypothesized that women with BN would perceive more conflict and less support than HCs. Analyses comparing BN and DEP were exploratory.

Method: Participants with BN (n = 27) or DEP (n = 26) and HCs (n = 27) rated perceived conflict and support for 24 vignettes depicting social interactions that varied in levels of these two constructs. Participants also completed relationship quality/satisfaction questionnaires.

Results: Multilevel model analyses revealed that the BN group perceived greater conflict relative to HCs. There also were significant interactions, with BN participants more greatly impacted by high support. There were no differences between DEP and BN groups.

Discussion: Overall, BN participants perceived more conflict than HCs, but differences were attenuated when level of social support was high. Helping women with BN tolerate discomfort associated with any amount of perceived conflict and/or low support may be an important treatment target.

Bulimic symptoms and interpersonal functioning among college students

Integrating interpersonal theory and the stress generation hypothesis, two studies investigated the association between bulimic symptoms and interpersonal distress and the mechanism underlying this association. In Study 1, 36 pairs of female roommates completed self-report questionnaires in a laboratory while Study 2 recruited 539 undergraduate men and women to participate in a longitudinal online study by completing self-report measures at two time points. Multilevel modeling revealed that targets' bulimic symptoms predicted roommates' intention to continue living with them in Study 1. Greater bulimic symptoms predicted lower intention. In Study 2, bulimic symptoms had a direct and an indirect effect on interpersonal distress, with reassurance-seeking as a mediator in the indirect effect. Findings replicated previous studies showing that bulimic symptoms generate further distress and, in our studies, interpersonal distress specifically. Moreover, reassurance-seeking was a newly identified mechanism underlying this association. These findings provide support for the usefulness of interpersonal theory and the stress generation hypothesis as a framework for understanding bulimic symptomatology. Clinicians may find it useful to target reassurance-seeking behaviors during the treatment of bulimic symptoms in order to improve treatment outcomes.

Perfectionism, emotion dysregulation, and affective disturbance in relation to clinical impairment in college-age women at high risk for or with eating disorders

Individuals with eating disorders (EDs) demonstrate impaired quality of life; however, less than one-third report severe clinical impairment. Thus, it is important to determine factors that may identify those who are most likely to report marked impairment. Perfectionism, emotion dysregulation, and aspects of affective disturbance, such as anxiety and depression, are independently associated with eating pathology and clinical impairment in eating and other disorders. However, little research has explored these three factors concurrently in relation to eating pathology. It is possible that the combined interaction effect of these constructs could be especially harmful. The current study examined the influence of these constructs and their interactions on clinical impairment in college-aged women at high risk for or with a DSM-5 clinical or subclinical ED. Although the three-way interaction of perfectionism, emotion dysregulation, and affective disturbance (i.e., anxiety or depression) was not significant, the two-way interaction between perfectionism and emotion dysregulation was significant such that those who were high in both perfectionism and emotion dysregulation reported the highest levels of clinical impairment. This suggests that the combination of perfectionism and emotion dysregulation may be especially problematic for those with or at high risk for EDs. Interestingly, perfectionism alone was not a predictor of clinical impairment when accounting for the other constructs, implying that perfectionism may have a greater impact when in conjunction with emotion dysregulation. Understanding the impact of combined perfectionistic tendencies and emotion dysregulation on clinical impairment may better inform treatment and more directly target contributors to impaired quality of life.

Does the interpersonal model apply across eating disorder diagnostic groups? A structural equation modeling approach

BACKGROUND

Interpersonal model has been validated with binge-eating disorder (BED), but it is not yet known if the model applies across a range of eating disorders (ED).

PURPOSE

The goal of this study was to investigate the validity of the interpersonal model in anorexia nervosa (restricting type; ANR and binge-eating/purge type; ANBP), bulimia nervosa (BN), BED, and eating disorder not otherwise specified (EDNOS).

PROCEDURE

Data from a cross-sectional sample of 1459 treatment-seeking women diagnosed with ANR, ANBP, BN, BED and EDNOS were examined for indirect effects of interpersonal problems on ED psychopathology mediated through negative affect.

RESULTS

Findings from structural equation modeling demonstrated the mediating role of negative affect in four of the five diagnostic groups. There were significant, medium to large (.239, .558), indirect effects in the ANR, BN, BED and EDNOS groups but not in the ANBP group. The results of the first reverse model of interpersonal problems as a mediator between negative affect and ED psychopathology were nonsignificant, suggesting the specificity of these hypothesized paths. However, in the second reverse model ED psychopathology was related to interpersonal problems indirectly through negative affect.

CONCLUSION

This is the first study to find support for the interpersonal model of ED in a clinical sample of women with diverse ED diagnoses, though there may be a reciprocal relationship between ED psychopathology and relationship problems through negative affect. Negative affect partially explains the relationship between interpersonal problems and ED psychopathology in women diagnosed with ANR, BN, BED and EDNOS. Interpersonal psychotherapies for ED may be addressing the underlying interpersonal-affective difficulties, thereby reducing ED psychopathology.

Relationship status predicts lower restrictive eating pathology for bisexual and gay men across 10-year follow-up

OBJECTIVE

Cross-sectional studies support that bisexual and gay (BG) men are at increased risk for eating pathology, and romantic relationships may buffer against risk; however, no studies have examined this association longitudinally. The current study examined how romantic relationships impact the trajectory of eating pathology in BG versus heterosexual men.

METHOD

BG (n = 51) and heterosexual (n = 522) men completed surveys of health and eating behaviors at baseline and 10-year follow-up.

RESULTS

For BG men, being single at baseline prospectively predicted an increase in Drive for Thinness scores over 10-year follow-up. Additionally, for BG men in relationships at baseline, lower relationship satisfaction predicted an increase in Drive for Thinness scores over time. Conversely, these relationship variables did not predict trajectory of eating pathology for heterosexual men.

DISCUSSION

Implications for theoretical models of risk, including objectification theory and sexual minority stress theory, and prevention, including peer-led cognitive dissonance based interventions, are discussed.

Anorexia nervosa: A fresh perspective

Anorexia nervosa is currently presented as a pathologised, psycho-medical feminine phenomenon through aetiological rationalisations and theories. Research results indicate that there have been no improvements in treatment outcomes for anorexia for over 50 years, except, possibly, with forms of family therapy for adolescents. This situation can be seen as critical and calls for alternative ways of understanding anorexia, and consequent different approaches to psychotherapy for persons in relationship with anorexia. This article critically explores these issues, and suggests that such circumstances offer opportunities for alternative post-structuralist approaches for informing different understandings of and working with anorexia in collaborative relational arrangements where the voices of persons in relationship with anorexia are honoured and heard.

What are we missing? The costs versus benefits of skip rule designs

Many research diagnostic interviews employ skip rules, such that some questions are only asked based on answers to prior questions. In the context of large-scale epidemiological studies, skip rules are important to study feasibility by reducing the time, money, and participant burden required for assessment. However, less is understood about information lost when questions are skipped. This study examines the relative prevalence, clinical significance, and additional time required to assess eating disorder symptom patterns skipped in the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to understand the costs and benefits of following skip rules. Data come from the second stage of a two-stage cohort sample (N = 400) in which the SCID-I eating disorders module was administered without following skip rules. Results were weighted to correct for the sampling framework. Over a third of subjects endorsed symptoms that would have been missed had skip rules been followed. Uncaptured symptom patterns were associated with increased psychosocial impairment, and the additional time required to assess all symptoms averaged 1.8 minutes per participant. Clinically significant symptom patterns are missed by the SCID-I and similar diagnostic tools, suggesting that epidemiologic studies using such instruments under-estimate the prevalence and public health impact of mental disorders.

Psicodinâmica dos transtornos alimentares: indicadores do Teste das Pirâmides Coloridas de Pfister

É amplamente reconhecida a influência de fatores emocionais na gênese e manutenção dos transtornos alimentares (TAs). Este estudo teve como objetivo analisar o funcionamento lógico e afetivo de pessoas com diagnóstico de TAs. Participaram do estudo 27 pacientes (23 mulheres, média de idade de 17,5 anos, a maioria com bulimia nervosa). O instrumento utilizado foi o Teste das Pirâmides Coloridas de Pfister. Os dados foram cotados segundo recomendações da literatura. Os resultados evidenciaram que os aspectos racionais apresentam um padrão de boa capacidade de organização. Quanto aos aspectos emocionais, observou-se uma desregulação dos mecanismos de controle eficiente dos afetos e impulsos. Por não suportarem os estados de ansiedade decorrentes do descontrole dos afetos, os participantes denegam seus impulsos, gerando uma estabilidade emocional precária que dificulta a elaboração dos conflitos. Evidenciou-se o comprometimento psíquico no grupo investigado e, por conseguinte, a necessidade de oferecer acompanhamento psicológico conjugado com reabilitação nutricional.

The impact of relationships, friendships, and work on the association between sexual orientation and disordered eating in men

Recent research has demonstrated increased eating pathology among single bisexual and gay (BG) men compared to BG men in relationships and all heterosexual men. BG men may be at elevated risk due to pressures to be lean to attract a male partner. No study has examined the specificity of this theory to relationship status or to eating pathology. BG (n = 23) and heterosexual (n = 326) men completed surveys to compare the impact of areas of life satisfaction on the association between sexual orientation and eating pathology, as well as another area of psychopathology (substance use problems). For BG men, but not heterosexual men, being single was associated with drive for thinness. Low friendship satisfaction was more strongly associated with drive for thinness and bulimic symptoms in BG men as compared to heterosexual men. Low work satisfaction was associated with substance use problems among BG men, but not among heterosexual men. Results suggest separate constellations of risk factors differentially impact BG men, depending upon the nature of clinical problems.

Does anger mediate between personality and eating symptoms in bulimia nervosa?

The goals of the study were to explore anger correlation with bulimic symptoms and to test the mediation power of anger between personality and eating psychopathology. A total of 242 bulimia nervosa (BN) outpatients and 121 healthy controls were recruited. Assessment was performed using Temperament and Character Inventory (TCI); State-Trait Anger Expression Inventory 2 (STAXI-2); Eating Disorder Inventory-2 (EDI-2); Body Shape Questionnaire (BSQ); Binge Eating Scale (BES); and Beck Depression Inventory (BDI). Mediation was tested on the whole BN group, on controls and on two BN subgroups based on a previous history of anorexia nervosa. Self-Directedness and Cooperativeness extensively relate to anger and psychopathology in bulimic group. Bulimic symptoms are related to Trait Reactive Anger. Trait Anger and Anger Expression fully mediate Cooperativeness effects on binge eating and Impulsiveness in the BN subjects. Anger Expression-In partially mediates between Harm Avoidance and Social Insecurity/Interpersonal Distrust in BN subjects. The comparison with controls and the analysis of subgroups underlines that these patterns are specific for BN. Anger mediation between Cooperativeness, and binge eating and impulsive behaviours confirm the relevance of relational dynamics in the expression of these core eating symptoms. Relational skills may represent a relevant target for the treatment of BN.

Subtypes in bulimia nervosa: the role of eating disorder symptomatology, negative affect, and interpersonal functioning

BACKGROUND

The aim of the study was to investigate whether patients with bulimia nervosa (BN) could be subdivided into clinically meaningful groups reflecting the complex patterns of eating disorder symptoms and personality characteristics that face the clinician.

METHODS

Seventy patients diagnosed with BN using the Eating Disorder Examination were assessed with measures of negative affect, attachment patterns, and interpersonal problems. An exploratory hierarchical cluster analysis was performed.

RESULTS

The study found two main subtypes differing primarily in terms of symptom severity and level of negative affect, but these subtypes were further subdivided into four clinically relevant subtypes: A dietary restraint/negative affect/high symptomatic group, an emotionally overcontrolled group, a low dietary restraint/emotionally underregulated group, and a high functioning/securely attached group.

CONCLUSIONS

The study indicates that cluster-analytic studies, including a broad range of instruments measuring eating disorder symptoms as well as negative affect, relational patterns, and other personality characteristics, may contribute to an integration of previously suggested models of subtypes in BN.

The impact of relationships on the association between sexual orientation and disordered eating in men

OBJECTIVE

Robust evidence supports that bisexual and gay (BG) men have increased eating pathology compared to heterosexual men. BG men may be at greater risk due to pressure to attract a male partner; however, the related implication that relationships serve as protective factors for BG men remains untested.

METHOD

BG (n = 42) and heterosexual men (n = 536) completed surveys to determine whether relationship status and satisfaction moderate sexual orientation's effect on disordered eating.

RESULTS

Single BG men had increased restrictive disordered eating compared to single heterosexual men, while few differences were found between BG and heterosexual men in relationships. Relationship satisfaction was not related to restrictive disordered eating; however, low relationship satisfaction was associated with increased bulimic symptomatology in BG men compared to heterosexual men.

DISCUSSION

Being in a relationship, independent of whether or not the relationship is satisfying, may be a protective factor for restrictive disordered eating in BG men.

Quality of life impairment in a community sample of women with eating disorders

OBJECTIVE

Studies of quality of life among individuals with eating disorders have relied almost exclusively on clinical samples. We examined impairment in quality of life in a community sample of women with eating disorders recruited as part of an epidemiological study.

METHODS

Measures of health-related quality of life (Medical Outcomes Study 12-item Short-Form Physical and Mental Component Summary scales) and subjective well-being (WHOQOL-BREF Psychological Functioning and Social Relationships subscales) were completed by women with eating disorders (n = 159), primarily variants of bulimia nervosa and binge eating disorder, and a comparison group of healthy women (n = 232).

RESULTS

When compared with healthy women, women with eating disorders reported substantial impairment in aspects of quality of life relating to mental health, although item-level analysis indicated considerable variation in the extent to which specific aspects of emotional well-being were affected. Impairment in social relationship and in physical health was less pronounced and due, at least in part, to between-group differences in age, body weight and demographic characteristics. Impairment in certain aspects of perceived physical health was, however, apparent among women with eating disorders, even after controlling for between-group differences in body weight.

CONCLUSIONS

Community cases of women with eating disorders experience marked impairment in quality of life as this relates to mental health functioning and at least some impairment in physical health functioning. Personality characteristics and ego-syntonic aspects of eating-disordered behaviour may complicate the interpretation of findings relating to impairment in specific aspects of quality of life.

Avaliação psicológica de pacientes com anorexia e bulimia nervosas: indicadores do Método de Rorschach

Este estudo teve por objetivo avaliar o funcionamento lógico, afetivo e a adaptação social de pacientes com Anorexia Nervosa (AN) e Bulimia Nervosa (BN). A amostra foi composta por 27 participantes. Para coleta dos dados foi utilizado o Método de Rorschach. Os dados foram codificado e interpretados segundo as normas da Escola Francesa. Os resultados indicaram que os participantes apresentam capacidade produtiva e desejo de estabelecerem relacionamentos afetivos. Todavia, são facilmente invadidos por uma carga de afetos que não conseguem modular, o que os predispõe ao isolamento social, que gera acúmulo de inquietações e ansiedades introjetadas. A incapacidade de elaborar a tensão interna resultante os leva a escoar a ansiedade pela via somática. Evidenciou-se o comprometimento das funções psíquicas dos pacientes com AN e BN, o que indica a necessidade de acompanhamento psicoterapêutico integrado à assistência da equipe multiprofissional.

Current and emerging directions in the treatment of eating disorders

Eating disorders are a significant source of psychiatric morbidity in young women and demonstrate high comorbidity with mood, anxiety, and substance use disorders. Thus, clinicians may encounter eating disorders in the context of treating other conditions. This review summarizes the efficacy of current and emerging treatments for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Treatment trials were identified using electronic and manual searches and by reviewing abstracts from conference proceedings. Family based therapy has demonstrated superiority for adolescents with AN but no treatment has established superiority for adults. For BN, both 60 mg fluoxetine and cognitive behavioral therapy (CBT) have well-established efficacy. For BED, selective serotonin reuptake inhibitors, CBT, and interpersonal psychotherapy have demonstrated efficacy. Emerging directions for AN include investigation of the antipsychotic olanzapine and several novel psychosocial treatments. Future directions for BN and BED include increasing CBT disseminability, targeting affect regulation, and individualized stepped-care approaches.

Testing a maintenance model for eating disorders in a sample seeking treatment at a tertiary care center: a structural equation modeling approach

Fairburn et al (Fairburn, CG, Cooper, Z, Shafran, R. Behav Res Ther 2003;41:509-528) proposed additional maintenance mechanisms (ie, interpersonal difficulties, mood intolerance, low self-esteem, and perfectionism) for some individuals with eating disorders in addition to core eating disorder psychopathology (ie, overevaluation of eating, weight, and shape and their control). This is the first study to both elaborate and test this maintenance model as a structural model. Adults seeking treatment of an eating disorder (N = 1451) at a specialized tertiary care center were included in this cross-sectional study. In the first part of the study, diagnostically heterogeneous participants (n = 406) were randomly selected to test a structural model based on the maintenance model. In the second part of the study, remaining participants (n = 1045) were grouped according to eating disorder diagnosis to test for invariance of the structural paths of the final model across diagnoses. Overall, the structural model with core and additional mechanisms fit the data well and, with 1 exception, represented maintenance processes for each of the diagnostic groups. Treatment models based on both core and additional maintenance factors for those seeking therapy at a specialized tertiary care center may result in improved treatment outcomes for these patients with eating disorders.

The impact of perceived social support and negative life events on bulimic symptoms

OBJECTIVE

The purpose of the current study was to evaluate the relationship between social support, negative life events, and disordered eating using a longitudinal design. More specifically, we examined whether the interaction between perceived social support and occurrence of negative life events would predict symptoms of eating disorders.

METHOD

Two hundred seventy female undergraduate students completed self-report questionnaires at two time points to assess perceived social support, negative life events experienced, and current psychopathology.

RESULTS

Low social support and a greater number of negative life events interacted to predict increased bulimic symptoms, but not restrictive eating tendencies or symptoms of depression or anxiety.

DISCUSSION

Low perceived social support in the face of negative events may exacerbate bulimic symptoms. Management of interpersonal problems and the enhancement of social skills may be important targets in the treatment of eating disorders.

Defining recovery from an eating disorder: Conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity

Conceptually, eating disorder recovery should include physical, behavioral, and psychological components, but such a comprehensive approach has not been consistently employed. Guided by theory and recent recovery research, we identified a "fully recovered" group (n = 20) based on physical (body mass index), behavioral (absence of eating disorder behaviors), and psychological (Eating Disorder Examination-Questionnaire) indices, and compared them with groups of partially recovered (n = 15), active eating disorder (n = 53), and healthy controls (n = 67). The fully recovered group was indistinguishable from controls on all eating disorder-related measures used, while the partially recovered group was less disordered than the active eating disorder group on some measures, but not on body image. Regarding psychosocial functioning, both the fully and partially recovered groups had psychosocial functioning similar to the controls, but there was a pattern of more of the partially recovered group reporting eating disorder aspects interfering with functioning. Regarding other psychopathology, the fully recovered group was no more likely than the controls to experience current Axis I pathology, but they did have elevated rates of current anxiety disorder. Results suggest that a stringent definition of recovery from an eating disorder is meaningful. Clinical implications and future directions regarding defining eating disorder recovery are discussed.

Depression and eating pathology: prospective reciprocal relations in adolescents

The association between disordered eating and depression has been established, but less is known about the temporal relations between these two disturbances. Accordingly, the current study examined the reciprocal relations between depressive and bulimic symptoms over an 8-year period, with longitudinal data from a community sample of 496 female adolescents. Depressive symptoms predicted future increases in bulimic symptoms, and bulimic symptoms likewise predicted increases in depressive symptoms, controlling for earlier levels of symptoms for each outcome. These results provide evidence consistent with the hypothesis that the two disorders contribute reciprocally to each other, and indicate that successful prevention or treatment of one disorder may yield effects for the other. However, the relatively small predictive effect sizes imply that some third variable may contribute to both conditions (e.g., temperamental negative affectivity).

The validity of virtual environments for eliciting emotional responses in patients with eating disorders and in controls

This article explores the efficacy of virtual environments representing situations that are emotionally significant to patients with eating disorders (ED) to modify depression and anxiety levels both in these patients and in controls. Eighty-five ED patients and 108 students were randomly exposed to five experimental virtual environments (a kitchen with low-calorie food, a kitchen with high-calorie food, a restaurant with high-calorie food, a restaurant with low-calorie food, and a swimming-pool) and to one neutral environment. In the interval between the presentation of each situation, anxiety and depressed mood were assessed. Results of several repeated measures analyses demonstrated that patients show higher levels of anxiety and a more depressed mood after eating, especially high-calorie food, and after visiting the swimming pool than in the neutral room. In contrast, controls only show higher levels of anxiety in the swimming pool. In the rest of the situations they presented a similar mood state as in the neutral room. We concluded that virtual reality is a useful vehicle for eliciting similar emotional reactions to those one would expect in real life situations. Thus, this technology seems well suited for use in experimental studies as well as in evaluative and therapeutic contexts.

Pathoplasticity of bulimic features and interpersonal problems

OBJECTIVE

Recent research suggests that interpersonal problems and some forms of psychopathology are pathoplastic, or that they mutually affect one another in nonetiological ways. In the current study, the pathoplasticity of bulimic features and interpersonal problems was tested.

METHOD

Inventory of Interpersonal Problems-64 data from 130 women with scores in the top quartile on the Bulimia scale of the Eating Disorder Inventory-2 from a sample of 517 college undergraduates were cluster analyzed. Age, weight, and scores on psychopathology scales were tested for mean differences across the four quadrants of the interpersonal problems circumplex.

RESULTS

Consistent with the pathoplasticity hypothesis, cluster means did not differ on external variables. Furthermore, bulimic features and interpersonal problems independently predicted depression in the total sample.

CONCLUSION

The interpersonal problems reported in the current study suggest differential treatment process that could inform the therapeutic relationship and help prevent premature termination.

Relational-Interdependent self-construal as a function of bulimic symptomatology

The present study compares differences in the levels of relational-interdependent self-construal among asymptomatic, symptomatic, and bulimic participants in a natural groups' design. Asymptomatic (n = 169), symptomatic (n = 73), and bulimic (n = 21) participants completed the Questionnaire for Eating Disorder Diagnoses (Q-EDD). Contrast tests were conducted to examine group differences in relational-interdependent self-construal as a function of bulimic symptomatology. Findings indicate significantly lower levels of relational-interdependent self-construal among bulimic participants. Results imply disruptions in the interpersonal relationships of bulimic individuals are reflected at the level of the relational self. The present study compares differences in the levels of relational-interdependent self-construal among asymptomatic, symptomatic, and bulimic participants in a natural groups' design. Asymptomatic (n = 169), symptomatic (n = 73), and bulimic (n = 21) participants completed the Questionnaire for Eating Disorder Diagnoses (Q-EDD) and the Relational-Interdependent Self-Construal Scale (RISC). Contrast tests were conducted to examine group differences in relational-interdependent self-construal as a function of bulimic symptomatology. Findings indicate significantly lower levels of relational-interdependent self-construal among bulimic participants. Results imply disruptions in the interpersonal relationships of bulimic individuals are reflected at the level of the relational self.

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.

Assessing quality of life in eating disorder patients

OBJECTIVE

To examine quality of life among subgroups of eating disorder patients.

METHOD

Self-report questionnaires which included two quality of life measures were completed by 87 individuals referred for treatment to the Australian Capital Territory Eating Disorders Day Program. Health-related quality of life, as measured by the Medical Outcomes Study 12-item Short Form Mental Component Summary scale, and subjective quality of life, as measured by subscales of the World Health Organization Brief Quality of Life Assessment Scale (WHOQOL-BREF), were compared among individuals who received the diagnosis of anorexia nervosa purging subtype (n = 15), anorexia nervosa restricting subtype (n = 19), bulimia nervosa (n = 40) and binge eating disorder (n = 10), and among a general population sample of young adult women employed as a control group (n = 495).

RESULTS

Eating disorder patients, when considered together, showed marked impairment in both health-related and subjective quality of life relative to normal control subjects. However, in both domains, restricting anorexia nervosa patients reported significantly better quality of life than other patient groups, after controlling for levels of general psychological distress. Scores on the Social Relationships subscale of the WHOQOL-BREF among individuals in this subgroup were similar to those of normal control subjects.

CONCLUSIONS

Reliance on any one instrument is likely to be misleading in assessing the quality of life of eating disorder patients. Careful consideration needs to be given to the assessment of restricting anorexia nervosa patients in particular.

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.

Sociotropy and bulimic symptoms in clinical and nonclinical samples

OBJECTIVE

The purpose of this study is to examine the relation between sociotropy and bulimic symptoms. Studies of interpersonal functioning among individuals with bulimia nervosa consistently reveal issues of social dependency, need for approval, and fear of rejection. These themes are conceptually related to sociotropy, a cognitive-personality factor that has been implicated in the development and maintenance of depression. Individuals high in sociotropy are keenly invested in attaining others' approval and avoiding social rejection.

METHODS

The relationship between sociotropy and bulimic symptoms was examined in two samples of women: undergraduate women and community women seeking treatment at a private eating disorder facility.

RESULTS

In both samples, sociotropy was significantly associated with bulimic symptoms beyond the shared relation with depressed mood.

DISCUSSION

Findings are discussed in terms of the maintenance and treatment of bulimia nervosa.

Validation of the Portuguese version of the Social Adjustment Scale on Brazilian samples

BACKGROUND

Social dysfunction is reported in several psychiatric diseases and its evaluation is becoming an important measure of treatment outcome. The aim of this study was to obtain normative data, to test the validity and the ability of the Portuguese version of the Self-Report Social Adjustment Scale (SAS-SR) to detect different clinical conditions.

METHODS

The Portuguese version of the SAS-SR was applied to a carefully selected non-psychiatric sample, and to depressed, panic, bulimic and cocaine-dependent patients. Depressed and panic patients were evaluated in two different clinical conditions: acutely symptomatic and in remission.

RESULTS

SAS overall and sub-scale scores of the normal sample were consistently lower than all patient groups, indicating better social adjustment in all areas. Panic patients were impaired to a lower level than depressed and cocaine-dependent patients in overall adjustment. Depressed patients in remission, although in better condition, were still impaired in relation to normal subjects in overall social functioning, leisure time and marital areas. In panic patients in remission, normalization was not achieved in overall functioning, work and marital areas.

LIMITATIONS

Sample size was small in some groups and the evaluation was cross-sectional.

CONCLUSIONS

The Portuguese version of SAS-SR is a useful instrument for detecting differences between psychiatric patients and normal subjects and for the evaluation of different clinical conditions, recommending its use in outcome studies.

Prävention von Essstörungen

Zusammenfassung. In den letzten Jahren hat das Forschungsinteresse an der Prävention von Essstörungen aufgrund steigender Prävalenzraten bei diesen Störungen stark zugenommen. Unter Berücksichtigung der Kritik an bisher durchgeführten Präventionsprogrammen ist ein Training zur primären Prävention von Essstörungen entwickelt und evaluiert worden. Zielgruppe für das fünfstündige Programm waren Schüler der sechsten Klasse, denen nicht nur Wissen, sondern auch soziale Kompetenzen vermittelt werden sollte. In einem Kontrollgruppendesign mit Prä- und Posttestmessung sowie einem dreimonatigen Follow-Up wurde überprüft, ob Veränderungen in Bezug auf das Selbstwertempfinden, Essverhalten und Wissen über gesunde Ernährung und Essstörungen bei den Teilnehmern des Programms erreicht werden konnten. Über die Zeit hinweg konnte ein signifikanter Zuwachs an Wissen nachgewiesen werden; auf den beiden anderen Evaluationskriterien zeigten sich jedoch aufgrund der zeitlichen Begrenzung der Studie keine Effekte. Diese Ergebnisse, die im Einklang mit vorangegangenen Untersuchungen stehen, werden abschließend im Hinblick auf die Notwendigkeit primärer Prävention diskutiert.

Impact of definitions on the description and prediction of bulimia nervosa outcome

OBJECTIVE

The authors sought to compare definitions of eating disorder outcome found in the bulimia nervosa literature and to determine the impact of definitions on the description and prediction of outcome.

METHOD

Definitions of outcome were identified from studies involving a follow-up duration of at least 5 years. Definitions were applied to a sample of women (N = 173) assessed more than 10 years following presentation with bulimia nervosa.

RESULTS

Across definitions, the percentage of women considered fully recovered ranged from 38% to 47% in the follow-up sample. Associations between eating disorder outcome and other measures of outcome were relatively unaffected by differences in definitions. Conversely, the significance of various prognostic variables differed substantially among definitions.

DISCUSSION

Our findings suggest that differences in definitions influence the description and prediction of eating disorder outcome significantly. Consistency in defining recovery is needed in order to explore other areas of outcome such as relapse.