[The anorexia nervosa inventory for self-rating (ANIS) (author's transl)]

Patients' perspectives on prescription cannabinoid therapies: a cross-sectional, exploratory, anonymous, one-time web-based survey among German patients

Introduction

Since cannabinoids were partially legalized as prescription medicines in Germany in 2017, they are mostly used when conventional therapies do not suffice. Ambiguities remain regarding use, benefits and risks. This web-based survey explored the perspectives of patients whose experiences are not well enough known to date.

Methods

In an anonymous, exploratory, cross-sectional, one-time web-based observational study, participants receiving cannabinoid therapy on prescription documented aspects of their medical history, diagnoses, attitudes toward cannabinoids, physical symptoms, and emotional states. Participants completed the questionnaires twice here: first regarding the time of the survey and then, retrospectively, for the time before their cannabinoid therapy. Participants were recruited in a stratified manner in three German federal states.

Results

N = 216 participants (48.1% female, aged 51.8 ± 14.0) completed the survey, most of which (72%, n = 155) reported pain as their main reason for cannabinoid therapy. When comparing the current state with the retrospectively assessed state, participants reported greater satisfaction with their overall medical therapy (TSQM II: +47.9 ± 36.5, p < 0.001); improved well-being (WHO-5: +7.8 ± 5.9, p < 0.001) and fewer problems in PROMIS subscales (all p < 0.001). Patients suffering primarily from pain (72%, n = 155) reported a reduction of daily pain (NRS: -3.2 ± 2.0, p < 0.001), while participants suffering mainly from spasticity (8%, n = 17) stated decreased muscle spasticity (MSSS: -1.5 ± 0.6, p < 0.001) and better physical mobility (-0.8 ± 0.8, p < 0.001). Data suggests clinically relevant effects for most scores. Participants' attitudes toward cannabinoids (on a 5-point scale) improved (+1.1 ± 1.1, p < 0.001). Most patients (n = 146, 69%) did not report major difficulties with the cannabinoid prescription process, while (n = 27; 19%) had their cannabinoid therapy changed due to side effects.

Discussion

Most participants experienced their therapy with cannabinoids as more effective than their previous therapy. There are extensive limitations to this cross-sectional study: the originally intended representativeness of the dataset was not reached, partly due to the SARS-CoV-2 pandemic; the sample has a larger proportion of privately insured and self-paying patients. Results does not suggest that cannabinoid patients belong to a particular clientele. Effect sizes observed for pain reduction, quality of life, social participation, and other outcomes suggest a therapeutic potential, particularly in the treatment of chronic pain.

Patient Experiences With Prescription Cannabinoids in Germany: Protocol for a Mixed Methods, Exploratory, and Anonymous Web-Based Survey

BACKGROUND

Medical cannabinoids are controversial. Their use is comparatively rare, but it is rising. Since 2017, cannabinoids can be prescribed in Germany for a broader range of indications. Patient surveys on these drugs are hampered by the stigmatization of cannabinoids and their (still) low prevalence in medical contexts. Against this background, patients' willingness to provide information is limited. Moreover, it is logistically challenging to reach them with a survey. A thorough knowledge of currently ongoing therapies and their effects and side effects, however, is important for a more appropriate and effective use of cannabinoids in the future.

OBJECTIVE

This study is an exploratory data collection using a representative sample. The main goal is to provide a detailed picture of the current use of medical cannabinoids in Germany. It is intended to identify subgroups that may benefit particularly well or poorly.

METHODS

We are conducting a representative, anonymous, cross-sectional, one-time, web-based survey based on mixed methods in 3 German federal states. Health conditions under cannabinoid therapy and before are documented with validated, symptom-specific questionnaires. This allows an estimation of the effect sizes of these therapies. The selection of parameters and questionnaires was based on the results of independent qualitative interviews in advance. Representative samples of the hard-to-reach study population are obtained by cluster sampling via contracted physicians of the statutory health insurance companies.

RESULTS

Recruitment was ongoing until the end of June 2022, with 256 enrolled participants. Validated questionnaires on pain, spasticity, anorexia or wasting, multiple sclerosis, nausea or vomiting, depression, and attention deficit hyperactivity disorder (ADHD) were selected. Symptom scores are being assessed for both current conditions under cannabinoid therapy and conditions prior to this therapy (in retrospect). Validated questionnaires are also used for treatment satisfaction and general quality of life. These are supplemented by existing diagnoses, a detailed medication history, any previous experiences with cannabis or illegal substances, experiences with the prescription process, and sociodemographic data. Based on the results of the previous qualitative interviews, questions were added regarding prior experience with relaxation methods and psychotherapy, personal opinions about cannabinoids, pre-existing or symptom-related psychological trauma, and different experiences with different cannabis-based therapies.

CONCLUSIONS

The exploratory mixed methods approach of this project is expected to provide valid and relevant data as a basis for future clinical research. The study design may be representative for a large proportion of outpatients treated with cannabinoids in the German federal states studied. It may have less bias toward social desirability and may provide valuable information in addition to existing studies. Due to the observational and cross-sectional nature of this study, various limitations apply. Causal relations cannot be drawn.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00023344; https://drks.de/search/en/trial/DRKS00023344.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/38814.

The prevalence and risk factors of screen-based disordered eating among university students: a global systematic review, meta-analysis, and meta-regression

PURPOSE

The purpose of this review was to estimate the prevalence of screen-based disordered eating (SBDE) and several potential risk factors in university undergraduate students around the world.

METHODS

An electronic search of nine data bases was conducted from the inception of the databases until 1st October 2021. Disordered eating was defined as the percentage of students scoring at or above established cut-offs on validated screening measures. Global data were also analyzed by country, research measure, and culture. Other confounders in this review were age, BMI, and sex.

RESULTS

Using random-effects meta-analysis, the mean estimate of the distribution of effects for the prevalence of SBDE among university students (K = 105, N = 145,629) was [95% CI] = 19.7% [17.9%; 21.6%], I2 = 98.2%, Cochran's Q p value = 0.001. Bayesian meta-analysis produced an estimate of 0.24, 95% credible intervals [0.20, 0.30], τ = 92%. Whether the country in which the students were studying was Western or non-Western did not moderate these effects, but as either the mean BMI of the sample or the percentage of the sample that was female increased, the prevalence of SBDE increased.

CONCLUSIONS

These findings support previous studies indicating that many undergraduate students are struggling with disordered eating or a diagnosable eating disorder, but are neither receiver effective prevention nor accessing accurate diagnosis and available treatment. It is particularly important to develop ever more valid ways of identifying students with high levels of disordered eating and offering them original or culturally appropriate and effective prevention or early treatment.

LEVEL OF EVIDENCE

I, systematic review and meta-analysis.

The prevalence of feeding and eating disorders symptomology in medical students: an updated systematic review, meta-analysis, and meta-regression

PURPOSE

Medical students have a higher risk of developing psychological issues, such as feeding and eating disorders (FEDs). In the past few years, a major increase was observed in the number of studies on the topic. The goal of this review was to estimate the prevalence risk of FEDs and its associated risk factors in medical students.

METHODS

Nine electronic databases were used to conduct an electronic search from the inception of the databases until 15th September 2021. The DerSimonian-Laird technique was used to pool the estimates using random-effects meta-analysis. The prevalence of FEDs risk in medical students was the major outcome of interest. Data were analyzed globally, by country, by research measure and by culture. Sex, age, and body mass index were examined as potential confounders using meta-regression analysis.

RESULTS

A random-effects meta-analysis evaluating the prevalence of FEDs in medical students (K = 35, N = 21,383) generated a pooled prevalence rate of 17.35% (95% CI 14.15-21.10%), heterogeneity [Q = 1528 (34), P = 0.001], τ2 = 0.51 (95% CI 0.36-1.05), τ = 0.71 (95% CI 0.59-1.02), I2 = 97.8%; H = 6.70 (95% CI 6.19-7.26). Age and sex were not significant predictors. Body mass index, culture and used research tool were significant confounders.

CONCLUSION

The prevalence of FEDs symptoms in medical students was estimated to be 17.35%. Future prospective studies are urgently needed to construct prevention and treatment programs to provide better outcomes for students at risk of or suffering from FEDs.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis.

Eating psychopathology in ballet dancers: a meta-analysis of observational studies

OBJECTIVE

To assess whether ballet dancers have higher eating psychopathology mean scores than the general population.

METHODS

Meta-analysis of cross-sectional observational studies comparing the scores of one or more of the validated eating psychopathological scales between ballet dancers and any control groups.

RESULTS

Twelve studies were included in the metanalysis. Ballet dancers had a significantly higher EAT score (12 studies retrieved, SMD 0.82 [95% CI 0.44-1.19], p < 0.00001, I² = 84)]; subgroup analysis suggested a possible role of control subjects' choice in explaining heterogeneity. Scores on the EDI subscales of Drive for Thinness, Bulimia, and Body dissatisfaction were available from four studies; Drive for Thinness was higher in ballet dancers (SMD 0.62 [0.01, 1.22]), as well as the Bulimia scale (SMD 0.38 [0.02, 0.73], p = 0.04) and the Body Dissatisfaction scale (SMD 0.34 [0.15, 0.53]). Data on Perfectionism, Interpersonal problems, Ineffectiveness, and Maturity fears, were available from three studies. Higher scores in Perfectionism (SMD 0.68 [0.24, 1.12] p = 0.02), Interpersonal problems (SMD 0.24 [0.02, 0.47], in Inefficacy, (SMD 2.18 [1.31, 3.06]) were found for ballet dancers; on the other hand, Maturity fears scores were not significantly different between ballet dancers and controls (IV-MD = 0.15 [- 0.07, 0.36]). Seven studies reported tests not performed elsewhere.

DISCUSSION

Ballet dancers show a higher level of restriction and drive for thinness than controls, and they may be, therefore, at higher risk for the development of eating disorders. Available studies do not allow the discrimination of dysfunctional eating attitudes and behaviors from adaptive responses.

LEVEL OF EVIDENCE

Level I (evidence obtained from systematic reviews and meta-analyses).

Eating disorder characteristics among Hungarian medical students: Changes between 1989 and 2011

BACKGROUND AND AIMS

There are contradictory findings on time changes in the prevalence of eating disorders (EDs). The first epidemiological studies in Hungary were carried out in the late 1980s. The objective of the present study was to follow the changes in the prevalence of EDs in medical students after a period of 22 years.

METHODS

A questionnaire survey was conducted in 1989 and in 2010. The sample comprised medical students: 538 subjects (248 males and 290 females) in 1989 and 969 subjects (261 males and 708 females) in 2010. The questionnaire contained sociodemographic and anthropometric items, the Eating Behaviour Severity Scale, the General Health Questionnaire, the Anorexia Nervosa Inventory for Self-Rating, and the Eating Disorder Inventory (EDI). In the second wave, three subscales of the EDI-2 and the SCOFF questionnaire were added.

RESULTS

Current and desired body mass index were significantly higher in the second study. Binge eating at least once a week was reported less frequently (2.7% vs 6.8% in males, 6.1% vs 13% in females) in 2010. The proportion of subclinical anorexia nervosa was higher among females in 2011 (2.5% vs 0.3%, P < 0.01). Among males, the proportion of counterregulatory behaviours increased significantly (from 8.9 to 14.6%).

DISCUSSION AND CONCLUSIONS

The increase of the proportion of subclinical anorexia nervosa and that of male EDs may relate to the importance of the changes in the sociocultural background. Further representative studies are proposed in other countries of Central and Eastern Europe among medical students and in the general population.

A five-item screening version of the Eating Disorder Inventory (EDI-3)

OBJECTIVE

The Eating Disorder Inventory (EDI) is used worldwide in research and treatment of eating disorders (EDs). Using the latest version (EDI-3: 91 items), we extracted the best screening items for a diagnosis of anorexia (AN) and bulimia (BN) nervosa.

METHOD

A patient sample of 561 women was recruited from an ED treatment centre in Denmark, and a comparison group of 878 women was randomly selected from the general population. An ED diagnosis was determined according to the Eating Disorder Examination Interview, yielding 84 AN and 202 BN patients.

RESULTS

Only two EDI items (Cronbach's α = .79) were needed to achieve a superior screening capability of BN (sensitivity = .94, specificity = .94). An adequate screening of AN was possible by using three items (α = .71; sensitivity = .91, specificity = .86).

DISCUSSION

The present study provides an even more economical and reliable screening of AN and BN compared with existing screening instruments. Implications for DSM-5 are also discussed.

Assessment methods for eating disorders and body image disorders

The growing interest in the treatment and research of eating disorders has stimulated the development of assessment methods, and there are now many questionnaires for evaluating behavioral and attitudinal characteristics of eating pathology. The present article sets out to review the assessment tools that are widely used in clinical practice and research. In particular, it covers self-report measures with summaries of their psychometric properties. It also presents diagnostic questionnaires based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria. The instruments described include screening questionnaires, measurement tools for specific eating disorder symptoms, measurement of quality of life in eating disorders, and some tools for the measurement of body image disorder, a common feature of eating disorders. There is also a discussion of distorting factors that decrease the authenticity of assessment tools. These problems arise from the definition of some constructs and from the phenomena of denial and concealment, which are frequent among eating-disordered individuals. The frequent co-occurrence of other psychopathological features (e.g., multiimpulsive symptoms) shows that other psychological phenomena should also be evaluated in line with the assessment of eating disorders.

The prevalence of eating disorders in a Hungarian secondary school population over a period of 10 years

Az evészavarok sokféle, időnként irreverzíbilis és veszélyes szövődményekkel és jelentős pszichiátriai komorbiditással járó betegségek, amelyek elsősorban a fiatal nőket érintik. Ellentmondásos eredményeket közölnek azzal kapcsolatban, időben hogyan változik az evészavarok gyakorisága. Célkitűzés: annak meghatározása, hogyan változott az evészavarok és tüneteinek gyakorisága 10 év alatt. Módszerek: Az 1989-ben végzett vizsgálatot (Túry és mtsai, 1991; Szabó és Túry, 1991) ismételtük meg az 1998/1999-es tanévben. Mindkét vizsgálatban ugyanazokat a kérdőíveket alkalmaztuk az evészavarok vizsgálatára: az Evési attitűdök tesztjét, a Bulimia kognitív disztorziós skálát és az Evészavar-súlyossági skálát. A kérdőívet 6 város 9 középiskolájának tanulói töltötték ki. Eredmények: Összesen 2731 tanuló vett részt a vizsgálatban (2138 lány és 593 fiú, az 1. vizsgálatban 932, a másodikban 1799). A testsúly csökkentésére használt módszerek és az evészavar-patológiát jelző kérdőíves pontszám szerint a kóros jelenségek lényegesen gyakoribbak a lányok körében, emellett 10 év távlatában gyakoribbá is váltak. A klinikai és szubklinikai anorexia és bulimia gyakorisága is lényegesen nőtt a lányoknál a vizsgált időszakban (összesen 0,12%-ról 0,68%-ra). Következtetések: Eredményeink alapján az evészavarok tünetei és az evészavar-szindrómák gyakorisága lényegesen nőtt 10 év alatt a hazai középiskolás lányok csoportjában. Ebben nagy jelentőséget tulajdonítunk a külső megjelenés fontosságának és a karcsúságideál térnyerésének.

Eating disorder behaviors are increasing: findings from two sequential community surveys in South Australia

Background

Evidence for an increase in the prevalence of eating disorders is inconsistent. Our aim was to determine change in the population point prevalence of eating disorder behaviors over a 10-year period.

Methodology/Principal Findings

Eating disorder behaviors were assessed in consecutive general population surveys of men and women conducted in 1995 (n = 3001, 72% respondents) and 2005 (n = 3047, 63.1% respondents). Participants were randomly sampled from households in rural and metropolitan South Australia. There was a significant (all p<0.01) and over two-fold increase in the prevalence of binge eating, purging (self-induced vomiting and/or laxative or diuretic misuse) and strict dieting or fasting for weight or shape control among both genders. The most common diagnosis in 2005 was either binge eating disorder or other “eating disorders not otherwise specified” (EDNOS; n = 119, 4.2%).

Conclusions/Significance

In this population sample the point prevalence of eating disorder behaviors increased over the past decade. Cases of anorexia nervosa and bulimia nervosa, as currently defined, remain uncommon.

Eating Pattern Inventory for Children: a new self-rating questionnaire for preadolescents

A questionnaire on psychological dimensions of eating behavior in children is presented. Existing questionnaires for children specifically focus on symptoms of eating disorders only, whereas for adults, questionnaires assessing general psychological dimensions of eating behavior are also available. The development of the Eating Pattern Inventory for Children (EPI-C) was based on a sample of 373 fourth-grade students. Factor and item analysis led to a psychometrically sound 20-item questionnaire with the dimensions dietary restraint, external eating, parental pressure to eat, and emotional eating. These factors explain 62% of the total item variance. Subscale scores and emerging eating patterns were associated with children's body weight suggesting initial evidence of its validity. The EPI-C is proposed for research on eating behavior in clinical and non-clinical preadolescent samples.

Twelve-year course and outcome predictors of anorexia nervosa

OBJECTIVE

The current study presents the long-term course of anorexia nervosa (AN) over 12 years in a large sample of 103 patients diagnosed according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

METHOD

Assessments were made at the beginning of therapy, at the end of therapy, at the 2-year follow-up, at the 6-year follow-up, and at the 12-year follow-up. Self-rating and an expert-rating interview data were obtained.

RESULTS

The participation rate at the 12-year follow-up was 88% of those alive. There was substantial improvement during therapy, a moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 12 years posttreatment. Based on a global 12-year outcome score, 27.5% had a good outcome, 25.3% an intermediate outcome, 39.6% had a poor outcome, and 7 (7.7%) were deceased. At the 12-year follow-up 19.0% had AN, 9.5% had bulimia nervosa-purging type (BN-P), 19.0% were classified as eating disorder not otherwise specified (EDNOS). A total of 52.4% showed no major DSM-IV eating disorder and 0% had binge eating disorder (BED). Systematic-strictly empirically based-model building resulted in a parsimonious model including four predictors of unfavorable 12-year outcome explaining 45% of the variance, that is, sexual problems, impulsivity, long duration of inpatient treatment, and long duration of an eating disorder.

CONCLUSION

Mortality was high and symptomatic recovery protracted. Impulsivity, symptom severity, and chronicity were the important factors for predicting the 12-year outcome.

Time trends in eating disturbances in young Greek migrants

OBJECTIVE

The study intends to measure time trends in eating disorder psychopathology in Greek adolescents in Veria (Greece) and migrant Greek adolescents in Munich (Germany). For this purpose, large samples of students were assessed at both locations in the 1980s and about two decades later. Our research question was whether the frequency of eating disorder-related psychopathology had changed over time and that there were differences between migrants and nonmigrants. The present-day prevalence of eating disorders in the Greek population was established.

METHOD

Greek adolescents were assessed in Munich and Veria in the 1980s (N = 2,631) and almost two decades later (N = 2,920). At both times, the Anorexia Nervosa Inventory for Self-Rating (ANIS) was used to assess eating disorder pathology and the General Health Questionnaire (GHQ-28) was used to assess mental health status. In the second wave, persons at risk for an eating disorder were interviewed using the Structured Interview for Anorexic and Bulimic Syndromes (SIAB-EX).

RESULTS

At both times and both locations, adolescent girls in comparison to boys had higher, more pathologic scores on the GHQ-28 and on all ANIS self-rating subscales. Females in Munich reported an increase over time in figure consciousness and their fear of negative effects of meals. In the 1980s, significantly higher scores of bulimic behavior were found in Veria as compared with Munich. In the second wave, bulimic behavior was considerably decreased in Veria for both girls and boys, and for bulimic behavior no significant differences were found between locations. The percentage of girls with a low body weight (<5th percentile) increased significantly over time in Veria and Munich. In the second wave, the current prevalence for girls with anorexia nervosa was 0.00% in Munich and 0.59% in Veria (lifetime 1.26% and 1.18%, respectively). For bulimia nervosa, current prevalence was 1.89% in Munich and 1.18% in Veria.

CONCLUSION

Differences between locations diminished over time. Bulimic syndromes are prevalent in both locations.

A retrospective study of SSRI treatment in adolescent anorexia nervosa: insufficient evidence for efficacy

Although selective-serotonin-reuptake-inhibitors (SSRI) have been of limited efficacy in the treatment of eating disorder psychopathology and comorbid symptoms of malnourished patients with anorexia nervosa (AN), there is recent data suggesting that SSRI may play a role in preventing relapse among weight-restored patients. Though some previous studies included patients in late adolescence, the vast majority of investigated subjects have been adults. The aim of our retrospective study was to assess the effects of SSRI treatment in partially weight-restored children and adolescents with AN. Thirty two females with AN (mean 14.5+/-1.4 years) were investigated three times during inpatient treatment and at 3- and 6-month follow-up for BMI, eating disorder psychopathology, depressive symptomology, and obsessive-compulsive symptomology. Medication history during inpatient and outpatient treatment was reconstructed at the 6-month follow-up. Nineteen patients received SSRI treatment, while 13 subjects were non-medicated. In comparison to the non-SSRI group, the SSRI group had similar BMI and obsessive-compulsive scores, but higher levels of core eating disorder psychopathology and depressive symptoms at the start of medication. Rates of re-admissions were similar in both groups (SSRI group: 36%, non-SSRI group: 31%, Phi: p=0.72). Repeated measures ANOVA revealed no significant group with time interactions for BMI-SDS (p=0.84), core eating disorder symptoms (ANIS, p=0.79), depression (DIKJ, p=0.75), and obsessive-compulsive (CY-BOCS, p=0.40) scores indicating minimal or no effects of SSRI medication on the course of these variables. In conclusion, our results challenge the efficacy of SSRI medication in the treatment of eating disorder psychopathology as well as depressive and obsessive-compulsive comorbidity in adolescent AN. Clinicians should be chary in prescribing SSRI in adolescent AN unless randomized controlled trials have proofed the benefit of these drugs.

Eating disorder symptomatology and gender role orientation

OBJECTIVE

The aim of the current study was to investigate associations between gender role orientation and eating pathology in a sample of females with eating disorders (ED).

METHODS

Sixty-eight women with anorexia nervosa and 123 women with bulimia nervosa completed the Bem Sex Role Inventory (BSRI), the Eating Disorders Inventory, and the Sexual Anxiety subscale of the Anorexia Nervosa Inventory for Self-Rating.

RESULTS

All three subscales of the BSRI--femininity, masculinity, and social desirability--correlated negatively with self-reported ED behavior and attitudes. Individuals with high levels of androgyny (i.e., those scoring high on femininity and masculinity) reported lower levels of ED symptomatology compared with undifferentiated individuals (i.e., those scoring low on femininity and masculinity), who showed higher levels of ED symptoms.

DISCUSSION

Femininity and masculinity, although independent traits, should not be considered isolated from each other in the context of ED. In females with ED, androgyny appears to be associated with lower levels of ED symptoms. Self-esteem may play a mediating role in this association.

Depression, anxiety, and obsessionality in long-term recovered patients with adolescent-onset anorexia nervosa

Anorexia nervosa (AN) is frequently associated with symptoms of depression, anxiety, and obsessive-compulsive behavior which also develop secondary to semistarvation. It is less certain if these symptoms persist after recovery. A few studies have already reported on high prevalence rates of anxious, depressive, and obsessive features in long-term recovered patients with AN, but several of these so called "long-term" recovered patients had only maintained weight restoration for six to twelve months. The aim of this study was to determine whether depressive, anxious, and obsessive-compulsive symptoms persist in truly long-term recovered patients (BMI 20.3+/-2.5 kg/m(2)) who no longer had any eating disorder symptoms (including weight phobia) for at least 3 years. Seventeen subjects of an AN sample (n=39) previously described in a 10-year follow-up met our strict criteria of at least 3 years of complete recovery of AN. In comparison to 39 age-, sex-, and occupation-matched healthy subjects without a history of psychiatric or eating disorder, long-term recovered patients had higher levels of depressive (p=0.002), anxious (p=0.006), and obsessive-compulsive (p=0.015) features but did not differ with regard to psychiatric morbidity and psychosocial adaptation. In conclusion, depressive, anxious, and obsessive-compulsive symptoms may be personality traits in subjects with former adolescent anorexia nervosa.

Nonlinear and linear EEG complexity changes caused by gustatory stimuli in anorexia nervosa

The objective of the present study was to investigate the effects of pleasant and unpleasant gustatory stimuli on nonlinear and linear complexity measures of the EEG in healthy controls and in anorexia nervosa (AN) patients. The subjects were exposed to unpleasant (bitter tea) and pleasant (chocolate) gustatory stimuli for 2 min. Multichannel EEG was recorded and the dimensional complexity (point-correlation dimension) and Omega complexity were calculated from the EEG epochs corresponding to the above taste conditions. In AN patients lower-dimensional complexity was observed in the majority of recording sites than that seen in controls, independent of taste conditions. Higher Omega complexity was seen in control subjects in the left side irrespective of taste effects. No such hemispheric difference was observed in AN. The lower-dimensional complexity seen in AN patients may be caused by long-lasting effects of malnutrition. The lack of a significant Omega complexity change in response to exposure of sweet taste in the left side seen in AN patients may correspond to a decreased sensitivity to such stimuli in these subjects.

Messung des Therapieerfolgs

Zusammenfassung. Theoretischer Hintergrund: In der Psychotherapieforschung haben sich Prä-Post-Effektstärken zur Erfassung des Therapieerfolgs weitgehend als Standard durchgesetzt. Als Alternative lassen sich retrospektive Erfolgsmaße diskutieren, bei denen Therapieerfolg rückblickend am Ende der Behandlung eingeschätzt wird. Fragestellung: Lassen sich retrospektive Erfolgsmaße empirisch von den Effektstärkemaßen unterscheiden? Methode: An drei Stichproben ambulanter Patienten (Angstpatienten [N = 583], Patienten mit Affektiven Störungen [N = 95] und diagnostisch heterogene Restgruppe [N = 97]) wurden Effektstärkemaße für die störungsspezifische und störungsübergreifende Symptomatik sowie Störungsfolgen berechnet. Außerdem wurden fünf retrospektive Erfolgsmaße erhoben (Fragebogen zur Veränderung des Erlebens und Verhaltens [VEV], Globalurteile und Zielerreichungsskalierungen von Patienten und Therapeuten). Die acht Erfolgsmaße gingen in eine explorative Faktorenanalyse ein. Ergebnisse: In allen drei Stichproben ergab sich jeweils eine zweifaktorielle Struktur. Auf dem Faktor “Veränderungsmessung“ luden die Effektstärkemaße, auf dem Faktor “Retrospektive Erfolgsbeurteilung“ die Globalurteile und Zielerreichungsskalierungen. Schlussfolgerungen: Eine Beschränkung auf lediglich eine Erfolgsdimension erscheint weder im Forschungs- noch im Praxiskontext gerechtfertigt.

Unterschiede zwischen jugendlichen Patientinnen mit Anorexia und Bulimia nervosa im Hinblick auf psychologische und psychosoziale Merkmale

Zusammenfassung: Fragestellung: Die Studie widmet sich der Frage, inwieweit sich jugendliche Patientinnen mit Anorexia und Bulimia nervosa in psychologischen Merkmalen und Lebensverhältnissen unterscheiden. Methode: Die Krankengeschichten von 140 Patientinnen (110 mit Anorexia nervosa und 30 mit Bulimia nervosa), die in den Jahren 1982 bis 1992 in der Klinik für Kinder- und Jugendpsychiatrie der Universität Würzburg stationär behandelt wurden, wurden im Rahmen einer retrospektiven Studie ausgewertet. Alle Patientinnen erfüllen die Kriterien nach ICD-10 für Anorexia- oder Bulimia nervosa. Daten aus der Basis-Dokumentation und aus der multiaxialen Klassifikation (MAS) wurden herangezogen, standardisierte Verfahren wie der Anis-32, MMPI, BDI, HAWIK-R und HAWIE kamen zur Auswertung. Die Ergebnisse zeigen signifikante Unterschiede zwischen den beiden Stichproben. Das häufigste Alter bei erster stationärer Aufnahme war bei anorektischen Patientinnen 14,5 und bei bulimischen Patientinnen 16,5 Jahre. Die störungsspezifischen Symptome betreffend unterschieden sich die beiden Stichproben hinsichtlich ihres Essverhaltens im Faktor Bulimie des Anis-32. Beim Vergleich der Persönlichkeitsmerkmale beschrieben sich die anorektischen Patientinnen im MMPI weniger psychopathisch als die Bulimia nervosa Patientinnen. Im BDI war die depressive Symptomatik bei Anorexia nervosa als klinisch relevant einzustufen. Andere Charakteristika der anorektischen Patientinnen waren ein überdurchschnittlicher IQ, Überfürsorglichkeit innerhalb der familiären Beziehungen, vermehrte Trennungsängste und Kontaktstörungen in der Schule. Im Vergleich dazu zeigten die bulimischen Patientinnen häufiger Leistungs- und Disziplinierungsschwierigkeiten in der Schule, innerhalb der Familie wurde das Kontaktverhalten und die Kommunikation beeinträchtigter als bei Familien anorektischer Patientinnen erlebt.

Six-year course and outcome of anorexia nervosa

OBJECTIVE

Since there are discrepant findings in the literature, we studied the longer-term course in a large sample of 103 DSM-IV anorexia nervosa (AN) patients.

METHOD

Assessments were made at four points of time: beginning of therapy, end of therapy, 2-year follow-up, and 6-year follow-up. Self-rating scales as well as expert-rating interview data were used. Eating disorder-specific and general psychopathology were assessed. These data were also compared with data on the 6-year course of patients with bulimia nervosa and binge eating disorder, respectively, who were treated at the same institution at about the same time.

RESULTS

The participation rate at the two follow-ups was high (97.9% of those alive). The general pattern of results over time of those alive at 6-year follow-up was as follows: substantial improvement during therapy, moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 6 years posttreatment. At the time of the 6-year follow-up, 26.8% had AN, 9. 9% had bulimia nervosa-purging type (BN-P), 2.0% were classified as eating disorder not otherwise specified (ED-NOS), all diagnosed according to DSM-IV criteria; more than one half (55.4%) showed no major DSM-IV eating disorder. Based on an operationalized global outcome score at 6-year follow-up, 34.7% had a good outcome, 38.6% an intermediate outcome, 20.8% a poor outcome, and 6 of 101 persons (5.9%) were deceased. Body mass index was 17.9 +/- 2.8 at the 6-year follow-up; amenorrhea was still found in 23.9%.

DISCUSSION

In comparison to samples with bulimia nervosa or binge eating disorder, the 6-year course of anorexia nervosa was less favorable. Mortality was rather high and symptomatic recovery protracted; predictors of unfavorable 6-year course were the presence of binges during 4 weeks before index treatment, psychiatric comorbidity, and low body weight at discharge from index treatment.

Eating disorders and depression in Hungarian women with menstrual disorders and infertility

Menstrual disorders are among the most frequent somatic complications and symptoms of eating disorders. This study was designed to assess the prevalence of eating disorders connected to menstrual disorders of a non-organic origin in women at two gynecological out-patient departments. We performed a survey via questionnaires (ANIS: Anorexia Nervosa Inventory Scale; BCDS: Bulimic Cognitive Distortions Scale; BITE: Bulimia Investigation Test, Edinburgh; EDI: Eating Disorders Inventory; BDI: Beck Depression Inventory). Among 75 women tested we found a prevalence figure of 4% for anorexia nervosa (AN) and 12% for bulimia nervosa (BN). The total prevalence of clinical and subclinical eating disorders syndromes was 44%. The prevalence of depression was 64% for all respondents, whilst severe depression accounted for 11%. This study demonstrates the (relatively) higher frequency of bulimia nervosa in Hungary, compared with other countries.

Binge eating disorder: treatment outcome over a 6-year course

Little is known about the long-term course of binge eating disorder (BED). The aim of the study was to assess the 3- and 6-year course and outcome of 68 consecutively treated females with BED. Their mean age was 29.3 years and they were assessed longitudinally at four timepoints: (1) beginning of therapy; (2) end of therapy; (3) 3-year follow-up; and (4) 6-year follow-up. Self rating as well as expert ratings were used for assessment. Symptoms of specific eating disorder as well as general psychopathology were measured. The general pattern of results over time was as follows: substantial improvement during therapy; slight (in most cases nonsignificant) decline during the first 3 years after the end of treatment, and further improvement and stabilization in years 4, 5, and 6 after the end of treatment. At the 6-year follow-up, the majority showed no major DSM-IV eating disorder, 5.9% had BED, 7.4% had shifted to bulimia nervosa (purging type) (DSM-IV), 7.4% were classified as ED-NOS, and one patient died. Based on an operationalized global outcome score for the complete sample, 57.4% had good outcome, 35.3% intermediate outcome, 5.9% poor outcome, and one person (1.4%) died. BED and BNP patients showed very similar intermediate and long-term course in self ratings as well as expert ratings.

Alexithymia in patients with eating disorders: an investigation using a new projective technique

The concept of alexithymia was scrutinized in a group of female patients with eating disorders: 15 anorectics and 13 bulimics (mean age of 27 yr.), plus a control group of 21 (mean age 38 yr.). Subjects were interviewed and tested. In the main test an ambiguous face was flashed briefly on a screen opposite the viewer who had to describe her impressions. To enhance the ego-involvement, subliminal words (I, I ILL, I WELL) were presented before each exposure. Contrary to expectations the present patients used more emotional words than controls. Instead, they employed alternative strategies to avoid empathizing. The results were interpreted as indicating a pronounced incapacity for emotional understanding.

Psychotherapy and bulimia nervosa: evaluation and long-term follow-up of two conflict-orientated treatment conditions

Analytic in-patient therapy (n = 32) and systemic out-patient therapy (n = 39) were applied to patients with bulimia nervosa, and the effects were evaluated 14, 26 and 38 months after the start of the treatments. Our assumptions about the general efficacy of both conflict-orientated techniques were confirmed: both therapies satisfactorily reduced the symptomatic behaviour, as well as secondary factors related to bulimia nervosa, in the long term. However, we could not identify differential effects of the two treatment regimes, which we had expected with regard to the very different therapeutic approaches. The similarities of outcome of both therapies predominate, with slightly better results in the case of the analytic in-patient treatment. The results are discussed with regard to the assumption that specific healing factors are involved in conflict-orientated treatments in addition to the "common factors' of psychotherapy.

Prevalence of eating disorders and minor psychiatric morbidity in central Europe before the political changes in 1989: a cross-cultural study

The prevalence of culture-bound syndromes such as eating disorders in the countries of Central and Eastern Europe is unclear and comparative epidemiological studies are lacking. Before the political changes in 1989 we therefore investigated eating disorders, eating attitudes and psychological health in two Eastern European countries and in one Western democracy. A total of 1225 female and male medical students in Hungary, the German Democratic Republic (GDR) and Austria were surveyed. The instruments included the Eating Disorder Inventory and the GHQ. The prevalence of eating disorders was calculated on the basis of simulated DSM-III-R diagnosis. In females, bulimia nervosa prevalence rates of 0.6% (95% CI 0.02, 3.46), 1% (0.2, 2.95) and 0% (0, 2.07) were calculated for Austria, Hungary and the GDR, respectively. For subclinical bulimia nervosa, the rate for Hungary (3.8%; 1.95, 6.72) was twice as high as for Austria (1.9%; 0.39, 5.5) and the GDR (1.7%; 0.36, 4.88). Hungarian subjects indicated more psychiatric 'caseness' than their GDR or Austrian counterparts. We conclude that eating disorders represented at least as common a problem in Eastern as Western Europe before the changes in political organization. This may be due to an identification process with Western values. A further increase of eating disorders in these countries induced by the recent changes may be possible.

The predictive value of depression in anorexia nervosa. Results of a seven-year follow-up study

This study investigated the predictive value of depression in patients with adolescent anorexia nervosa. Thirty-four anorectic inpatients were assessed for DSM-III-R comorbid major depression at admission and at 3-year and 7-year follow-ups. Two standardized instruments, the Zung Self-rating Depression Scale and the Hamilton Depression Rating Scale, were applied to improve objective rating of depression. The findings suggest that severity of depressive symptoms at admission does not correlate with the severity of depression at follow-up, initial depressive psychopathology is not a valid prognostic indicator for the outcome of the eating disorder and at follow-up there is a highly significant relationship between depression and the outcome of anorexia nervosa. Patients with persisting eating disorder are also very likely to suffer from comorbid depression.

Convergent validity of the eating disorder inventory and the anorexia nervosa inventory for self-rating in an Austrian nonclinical population

This study assesses the convergent and divergent validity of the Eating Disorder Inventory (EDI--German version) and the Anorexia Nervosa Inventory for Self-Rating (ANIS) in a German-speaking nonclinical population. One hundred fifty-five female and 224 male Austrian medical students were surveyed. Validity was studied at a dimensional level, separately for both sexes, by correlating with conceptually related as well as distinct scales. These instruments included the General Health Questionnaire (GHQ). The intercorrelation coefficients of the EDI and the ANIS were similar to the original samples. In women, the convergent validity of the EDI and the ANIS was confirmed, especially for the subscales measuring the specific psychopathology (r = .43 to .84) and for ineffectiveness/feelings of inadequacy (r = .63). The EDI subscales Maturity Fears and Interpersonal Distrust and the ANIS subscales Obsessive-Compulsive Traits and Sexual Anxiety address traits not included in the other test and these showed divergent validity. Divergent validity of the ANIS and to a lesser degree the EDI with the GHQ was established. Both tests can be equally recommended for female subjects. In males however, the validity indices of both tests were generally lower and convergent and divergent validity was not established.

Depression in anorexia nervosa at follow-up

This study set out to investigate the correlation between depressive symptomatology and the eating disorder psychopathology at a 3-year follow-up after discharge of 34 adolescent anorexia nervosa patients. Three standardized rating instruments were employed to assess depression and two defined outcome criteria were used to assess the eating disorder. Correlation analysis revealed that there was a consistent and significant association between the severity of eating disorder symptoms and the degree of depression at follow-up. According to the subscales of the average outcome score of Morgan and Russell (Psychological Medicine 5:355-371, 1975), depression was related more to social maladaptation than to the specific eating disorder psychopathology.

Depression and psychosocial adjustment in adolescent anorexia nervosa. A controlled 3-year follow-up study

This study investigated depressive psychopathology and psychosocial functioning in adolescent anorexia nervosa patients at a three year follow-up in comparison to healthy age-matched controls. Three standardized rating instruments (HRSD, SDS, BDI) were used for assessing depression and the Morgan-Russell scales for defining the outcome of the eating disorder. Our findings suggest 1) a highly positive correlation between eating disorder and depressive psychopathology; 2) recovered anorectics score higher on depression scales than healthy controls; 3) recovered and unrecovered anorectics are similar to age-matched controls in terms of occupational adjustment, social contacts and dependency on family, but differ significantly in psychosexual functioning.

Detection of eating disorders in a small rural town: an epidemiological study

The occurrence of eating disorders among 517 school girls (11 to 20 years of age) in a small rural Italian town was studied using a three-stage prospective procedure. The screening stage was aimed at defining risk and sub-risk groups. One year later, the risk group (N = 44) and a random sample of the sub-risk (N = 25) and of the screen-negative group (N = 32) were interviewed to detect cases of anorexia/bulimia nervosa. The case registers of four hospitals over a period of 3 years were investigated to detect any additional cases that may have been overlooked in the survey. A minimum point prevalence rate of 1.30% clinical anorexia nervosa, 1.30% sub-clinical anorexia nervosa and 0.87% sub-clinical bulimia nervosa was found for age 15 and above. No case of clinical bulimia nervosa was detected. For age 15 and below no clinical or sub-clinical cases were found. All cases of (sub-)clinical eating disorder initially belonged to the predefined sub-risk and risk groups. Because of the low positive predictive value of any single risk factor, this study shows that early case detection can be improved by using multiple risk indices. In this rural area the prevalence was as high as in metropolitan or urban areas. Urban-rural differences should be assessed in further studies.

Predictors of short-term treatment outcome in bulimia nervosa inpatients

Recent studies, mostly performed on bulimic outpatients, did not find consistent predictors of treatment outcome in bulimia nervosa. This is the first study to investigate anamnestic and clinical factors predictive of the short-term outcome of hospital treatment in 31 female bulimia nervosa patients with a mean age of 22.9 yr. Treatment outcome was assessed by several self-rating instruments measuring different features of the specific and unspecific psychopathology of bulimia nervosa. The most relevant predictors of the outcome of the 8-week hospital treatment were duration of previous inpatient treatments for bulimia, the intensity of anorexic tendency and the pretreatment level of depression. The majority of predictors tested did not show a strong relationship to treatment outcome. The findings are discussed in relation to results of other studies as well as to possible implications for treatment and research.

Mood and orthostatic norepinephrine response in anorexia nervosa

The relationship between mood and noradrenergic activity, measured by orthostatic norepinephrine response (delta NE), was investigated in 24 patients with anorexia nervosa during inpatient treatment. Mood and delta NE correlated significantly at four out of five measurement points. Group comparisons identified significantly worse mood in patients with pathologically low delta NE values. Thus, biological consequences of altered eating behavior may also affect such psychological symptoms as depressed mood.

Mental illness in Greek and Turkish adolescents

Samples of 867 Greek adolescents in Munich, 2,702 Greek adolescents in Greece and 2,780 Turkish adolescents in Turkey were assessed concerning mental health in a two-stage procedure. In the first stage the General Health Questionnaire (GHQ) was used for screening. Significant age differences in the GHQ 28-item scale and most of its subscales were observed mainly for the samples in the homeland. Male adolescents had lower scores than female adolescents in the GHQ 28-item scale and its sub-scales while social class appeared to be of little influence. Significantly higher GHQ-28 scores were obtained for Greeks and Turks in their homeland as compared to Greeks in Turks in their homeland as compared to Greeks in Munich. The GHQ-28 correlations with the Anorexia Nervosa Inventory for Self-Rating were fairly high. A principal component analysis with Varimax rotation showed fairly consistent results for this age group when compared with the results of Goldberg and Hillier (1979). With the exception of the GHQ factor social dysfunction Greek adolescents in their homeland had significantly higher scores in the total GHQ-28 and its sub-scales than Greeks in Germany. Thus, our data do not confirm the acculturation-stress hypothesis. The data would be consistent with the hypothesis of selective migration which states that Greek adolescents in Germany constitute a positive selection with respect to risk for mental illness.

Modifications and problems of behavioural inpatient management of anorexia nervosa: a "patient-suited" approach?

Several treatment modalities, especially behaviour therapy, had been successfully administered in order to normalize body weight in anorexia nervosa inpatients. However, improvement in affective, cognitive and psychosocial features and associated psychopathologic symptoms was rather poor. It is hypothesized that the limited effect of behaviour therapy may be also due to therapeutic shortcomings of the behavioural treatment programme. In the present study of 16 anorectic inpatients a behavioural treatment programme, which had been applied in a former investigation at the same unit, was modified and yielded the following results: rapid increase in weight, good improvement of anorectic and depressive symptoms and a treatment duration of less than 3 months. Although the short-term outcome of the modified treatment programme is encouraging, the therapeutic difficulties encountered in this programme deserve special attention and its long-term effects on the course and prognosis of anorexia nervosa have to be established.

Symptomatology, psychosexual development and gender identity in 42 anorexic males

Forty-two male patients with an anorexic syndrome were assessed. Twenty-nine of them had a primary anorexia nervosa (most of them also had bulimic symptoms). They were compared with a series of 23 female anorexia nervosa patients. The males scored more highly than female patients on a number of symptoms, but generally more similarities than differences in symptomatology were apparent. Male patients with primary anorexia nervosa also showed several signs of a disturbed psychosexual and gender identity development. The data support the hypothesis that males with atypical gender role behaviour have an increased risk for developing anorexia nervosa or bulimia in adolescence.

Clonidine stimulation in anorexia nervosa: growth hormone, cortisol, and beta-endorphin responses

Clinical and biochemical findings link anorexia nervosa (AN) and primary effective disorders (PAD). Clonidine, an alpha 2-adrenoceptor agonist, has been shown to blunt growth hormone (GH) response and greatly lower plasma cortisol in PAD patients. We examined the GH, cortisol, and beta-endorphin (beta-EP) responses to an acute clonidine challenge (150 micrograms i.v. as a bolus) before and after 30 days of treatment with desmethylimipramine in 14 women with AN. Both before and after treatment, the AN patients showed normal plasma GH and cortisol responses, but an increased plasma beta-EP response. The increased beta-EP response in AN was independent of weight and depressive symptomatology. Our data indicate that alpha 2-adrenoceptors involved in the control of GH and adrenocorticotropic hormone are not altered in AN. The increased beta-EP response may indicate elevated opioid activity in the hypothalamo-pituitary system of AN patients.

The principal component structure of the General Health Questionnaire among Greek and Turkish adolescents

The 28-item version of the General Health Questionnaire was administered to Greek and Turkish school pupils in their mother country as well as to Greeks in Munich. Principal component analysis with varimax rotation was carried out separately for both the individual populations and sexes separately. Visual inspection of the matrices suggested overall agreement with the sub-scales obtained by Goldberg and Hillier (1979). The coefficient of factor similarity, calculated between matrices, suggested a highly similar principal component structure between the population samples as a whole and separately for the sexes living in their own country, but not between male and female Greek pupils in Germany. Highly similar component matrices were obtained for Greek males living in Greece with those in Germany, but not for females.

Neuroendocrine and psychopathological measures in anorexia nervosa: resemblances to primary affective disorders

Clinical and biochemical data suggest a link between anorexia nervosa (AN) and primary affective disorders (PAD). In 14 female patients, aged 15-40 years, with 7-month to 11-year histories of AN, we studied circadian cortisol periodicity, response to the dexamethasone suppression test (DST), and plasma levels of beta-endorphin and beta-lipotropin before and after desimipramine therapy. Possible correlations were sought among neuroendocrine impairments, weight loss, and depressive symptomatology. Impaired circadian cortisol periodicity, blunted DST response, and increased beta-endorphin plasma levels, observed in a subgroup of patients, could not be related to weight loss, either before or after therapy. Instead, a trend toward a relationship between neuroendocrine impairments and depressive symptoms was observed before and after treatment.

The discriminative value of psychological characteristics in anorexia nervosa. Clinical and psychometric comparison between anorexia nervosa patients, ballet dancers and controls

The present controlled study examined anorexic and psychological characteristics of female ballet dancers, who by career choice must focus on thinness, and anorexia nervosa patients. Anorexia nervosa (AN) patients, female ballet (BA) students as well as asymptomatic female controls (AF) were compared with respect to the psychological characteristics: the Drive to Achieve, the Motive to Avoid Failure (Negative Fear of Failure) and the Motive to Achieve (Positive Fear of Failure). The results confirmed previous empirical and clinical findings that the AN group and the BA group can be differentiated from a control group with respect to a heightened Drive to Achieve. However, the Drive to Achieve of AN patients was found to originate in an avoidance of failure (the Negative Fear of Failure), while in BA students this drive was found to stem from a motive to achieve (the Positive Fear of Failure). The findings underline the importance of an evaluation of psychological characteristics in subjects with anorexic symptoms.

Transcultural comparison of eating attitudes in young females and anorectic patients

Eating attitudes were assessed by use of the Eating Attitude Test (EAT) in two samples of normal German female adolescents and young adults. In addition scores from clinical samples of anorectic patients were available. The EAT contributed to an adequate differentiation between normal controls and clinical patients. There were marked transcultural differences with regard to mean and cut-off scores obtained in Anglo-Saxon studies where the present samples scored lowest. Reliability in terms of internal consistency and stability was more satisfactory. Neither age nor SES were significantly related to the total score. Subjects with extreme obesity had significantly increased scores on the EAT.

Behavior, attitude, nutrition and endocrinology in anorexia nervosa

Twenty-four anorexia nervosa patients participated in an inpatient broad spectrum behavior therapy program. The changes in body weight, anorectic behaviors and attitudes and endocrine variables (24-h plasma cortisol, dexamethasone suppression test, 24-h plasma luteinizing hormone) were measured. Data indicate that specific anorectic behaviors and attitudes showed significant improvement during inpatient treatment, while attitudes of a more general neurotic scope such as the feeling of insufficiency, general distress, (sexual) anxieties and anancasm did not. On admission 24-h plasma cortisol levels were elevated, episodic secretory spikes occurred at unusual times and the number was increased, cortisol plasma half-life was increased and non-suppression of cortisol secretion following the application of dexamethasone was observed. All these parameters normalized already after 10% weight gain. 24-h plasma LH pattern showed a close relationship with body weight. Our data suggest that the dysfunctions in anorexia nervosa patients in the hypothalamo-pituitary-adrenal and -gonadal axis have little specificity for this disease and are mainly a consequence of nutritional factors and starvation. The relationship between cortisol and HL-secretion, behavioral and attitudinal variables and weight gain was more complex than previously suggested by others and a positive relationship between the LH secretory pattern and anorectic symptomatology could be established.

The eating attitudes test: psychometric features and clinical correlates

Psychometric and clinical correlates of the Eating Attitudes Test (EAT) are described for a large sample of female anorexia nervosa (N = 160) and female comparison (N = 140) subjects. An abbreviated 26-item version of the EAT (EAT-26) is proposed, based on a factor analysis of the original scale (EAT-40). The EAT-26 is highly correlated with the EAT-40 (r = 0.98) and the three factors form subscales which are meaningfully related to bulimia, weight, body-image variables and psychological symptoms. Whereas there are no differences between bulimic and restricter anorexia nervosa patients on the total EAT-26 and EAT-40 scores, these groups do indicate significant differences on EAT-26 factors. Norms for the anorexia nervosa and female comparison subjects are presented for the EAT-26, EAT-40 and the EAT-26 factors. It is concluded that the EAT-26 is a reliable, valid and economical instrument which may be useful as an objective measure of the symptoms of anorexia nervosa.