Gender differences in the progression of co-morbid psychopathology symptoms of eating disordered patients

Psychological features in male and female adolescents with eating disorders: is it the same condition?

PURPOSE

Eating disorders (EDs) are psychiatric disorders with a typical prevalence in adolescence. EDs have long been wrongly considered female gender-bound disorders, resulting in a systematic underrepresentation of males in EDs research. The main goal of the present study is exploring the clinical and psychological characteristics of adolescent males with EDs in comparison with females.

METHODS

In this observational and retrospective study, 14 males and 28 females hospitalized for eating disorders during the adolescent age (from 12 to 17.11 years) were recruited. Main clinical data (age, BMI, duration of illness), behavioural characteristic of the disorder (over-exercising, self-harm, purging-behaviours) and psychological symptoms (Eating Disorders Inventory-3rd edition-EDI-3, Symptom Checklist-90-Revised-SCL-90, Children's Global Assessment Scale-C-GAS) were collected and examined for significant correlations with severity of body mass index (BMI).

RESULTS

Adolescent males show a peculiar and more severe psychopathological profiles partially influenced by BMI and characterized by purging-behaviours, over-exercising, obsessive-compulsive behaviour, anxiety, and psychoticism.

CONCLUSION

This study suggests a gender-specific profile of adolescent males with EDs, which may be considered in diagnosis and treatment.

LEVEL III

Evidence obtained from retrospective well-designed case-control study.

Psychopathology Factors That Affect the Relationship Between Body Size and Body Dissatisfaction and the Relationship Between Body Dissatisfaction and Eating Pathology

Although high body mass index (BMI) alone does not invariably lead to body dissatisfaction (BD) and BD alone does not invariably lead to eating pathology (EP), research has suggested that there are clear relationships between each predictor and its respective criterion. We have a limited understanding of the factors that explain why some women at higher risk for BD (because of their BMI) do not report being dissatisfied with their bodies and why some women who are highly dissatisfied, do not engage in pathological eating behaviors. The present study examined such factors. A university sample of New Zealand women (N = 166) completed the Personality Assessment Inventory (Morey, 1991) and questionnaires measuring BD and EP. The tendency to report lower BD than would be predicted by one's BMI, and the tendency to report lower EP than would be expected based on one's BD, were characterized by lower overall distress (i.e., lower levels of anxiety and depression) and greater mood stability compared to those who followed the predicted outcome. Greater understanding of the factors that protect high-risk women from BD and EP may contribute to prevention and intervention strategies.

Psychiatric comorbidity in women and men with eating disorders results from a large clinical database

Psychiatric comorbidity is common in patients with eating disorders (ED), but prevalence estimates are heterogeneous, probably due to methodological differences between studies (population, diagnostic method, sampling procedure etc.) and a few studies include men. The aim of this study is to investigate psychiatric DSM-IV Axis I comorbidity in a large sample of adult patients, both males and females, with the whole spectrum of DSM-IV ED diagnoses. Initial presentation assessment data on 11,588 adult men and women presenting to specialist ED clinics in Sweden between 2008 and 2012 were extracted from a large clinical database. Diagnostics were based on semi-structured interviews (SCID-I) and the Structured Eating Disorder Interview (SEDI). Seventy-one percent of the patients with ED had at least one other Axis I disorder. The most common type of diagnosis was anxiety disorders (53%), where generalized anxiety disorder was the most common diagnosis. The highest levels of comorbidity were found for women with Binge Eating Disorder (BED) and men with Bulimia Nervosa (BN). Findings are consistent with previous research showing a high prevalence of psychiatric comorbidity in both men and women with ED. The small gender differences observed seem negligible compared to the general similarity in comorbidity.

Eating disorder symptoms and comorbid psychopathology among male and female veterans

OBJECTIVE

Eating disorder (ED) symptoms have gone mostly unexamined among veterans. The current study assessed rates of bulimia nervosa (BN) and binge eating disorder (BED) symptoms and diagnoses and their associations with common comorbidities among male and female veterans.

METHOD

Participants were US military veterans who screened positive for trauma histories and/or a probable Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) posttraumatic stress disorder (PTSD) diagnosis (n=499). Symptoms of PTSD were assessed using the Clinician-Administered PTSD Scale, and symptoms of EDs, mood, and substance use disorders were assessed using the Structured Clinical Interview for the DSM-IV.

RESULTS

Lifetime rates of BN and BED diagnoses were comparable to civilian populations, and a considerable range of lifetime and current BN and BED symptoms were identified. In multivariate models, PTSD and depression severity were most consistently associated with BN and BED symptom severity, with depression most strongly associated with EDs for women.

CONCLUSIONS

Findings highlight the importance of screening for ED symptoms among male and female veterans, particularly those that present with PTSD and depression symptomatology. Future examinations of the temporal order of such relationships and the degree to which ED symptoms and associated symptoms impact veteran functioning are warranted.

Do men with eating disorders differ from women in clinics, psychopathology and personality?

OBJECTIVE

To determine if male and female eating disorders differ in clinics, psychopathology and personality traits when compared with a healthy group.

METHODS

Sixty male and 60 female eating disorder individuals (16% anorexia nervosa, 42% bulimia nervosa and 42% eating disorder not otherwise specified), matched for age and diagnostic, were compared with 120 healthy-eating participants (60 male and 60 female participants). All were diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Assessment measures included Eating Disorder Inventory--2, Symptom Checklist--Revised and Temperament and Character Inventory--Revised, as well as other clinical and psychopathological indices.

RESULTS

Male eating disorder participants reported significant lower laxative abuse (p = 0.020) and significant higher vomiting episodes (p = 0.019) than female eating disorder participants. Differences on drive for thinness, body dissatisfaction and some Symptom Checklist--Revised scales were found across genders in eating disorder participants. Male eating disorder participants scored significantly lower than female participants with eating disorders on harm avoidance, reward dependence and cooperativeness.

CONCLUSIONS

Although eating disorder clinical features were similar across genders, male eating disorder participants had less body image concern and general psychopathology than female eating disorder participants.

The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM

Eating disorder not otherwise specified (EDNOS) is the most prevalent eating disorder (ED) diagnosis. In this meta-analysis, the authors aimed to inform Diagnostic and Statistical Manual of Mental Disorders revisions by comparing the psychopathology of EDNOS with that of the officially recognized EDs: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). A comprehensive literature search identified 125 eligible studies (published and unpublished) appearing in the literature from 1987 to 2007. Random effects analyses indicated that whereas EDNOS did not differ significantly from AN and BED on eating pathology or general psychopathology, BN exhibited greater eating and general psychopathology than EDNOS. Moderator analyses indicated that EDNOS groups who met all diagnostic criteria for AN except for amenorrhea did not differ significantly from full syndrome cases. Similarly, EDNOS groups who met all criteria for BN or BED except for binge frequency did not differ significantly from full syndrome cases. Results suggest that EDNOS represents a set of disorders associated with substantial psychological and physiological morbidity. Although certain EDNOS subtypes could be incorporated into existing Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) categories, others-such as purging disorder and non-fat-phobic AN-may be best conceptualized as distinct syndromes. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Psychological Factors Associated With Weight Loss in Obese and Severely Obese Women in a Behavioral Physical Activity Intervention

The behavioral processes of weight reduction are poorly understood, and responses to treatments based primarily on caloric restriction have been unfavorable. A theory-based path derived from proposed relations of physical activity, changes in psychological factors, and weight loss was separately tested with women with Class I and Class II obesity (body mass index [BMI] from 30 to 39.9 kg/m2; n = 116), and Class III (BMI ≥ 40.0 kg/m2; n = 57) obesity. Participation in a cognitive-behavioral exercise support treatment along with nutrition education was significantly associated with changes in measures of self-efficacy, body satisfaction, and mood. Changes did not significantly differ by BMI group. Multiple regression analyses indicated that changes in the psychological factors explained 14% (Class I/II obesity group) and 22% (Class III obesity group) of the variance in exercise session attendance, and attendance was strongly related to weight loss. Implications for weight loss theory and treatment are discussed.

Contribution of the serotoninergic system to anxious and depressive traits that may be partially responsible for the phenotypical variability of bulimia nervosa

Eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN), are complex psychiatric phenotypes influenced by both genetic and environmental factors. We investigated the genetic contribution of four single nucleotide polymorphisms (SNPs) within the serotonin receptor 5HT2C and two sequence variants within the serotonin transporter SLC6A4 to different ED-related psychopathological symptoms in a total sample of 82 ED patients. All patients were diagnosed according to DSM-IV criteria and underwent diagnostic and psychopathological assessments by means of structured clinical interviews and rating scales. We detected significant evidence of association between the -995A/-759T/-697C/Cys23 haplotype of the 5HT2C gene and different anxious and depressive subscales of the SCL90-R instrument, that included Somatization (p = 0.029), Obsessive-Compulsiveness (p = 0.021), Depression (p = 0.032), Anxiety (p = 0.004), Hostility (p = 0.028), Phobic Anxiety (p = 0.029) and Paranoid Ideation (p = 0.008), in BN patients. We also observed a strong association between the 5HTTLPR polymorphism of the SLC6A4 gene and Anxiety in the same group of BN patients (p = 0.004). However, no epistatic effects between the 5HT2C and SLC6A4 genes on the different anxious and depressive subscales were observed. Our preliminary data suggest that the serotoninergic system contributes to the different psychopathological symptoms that may be partially responsible for the phenotypical variability within the bulimic phenotype.

The combined presence of obsessive compulsive behaviors in males and females with eating disorders account for longer lengths of stay and more severe eating disorder symptoms

The goal of this study was to analyze the impact of obsessive compulsive behaviors (OCB) in eating disorder males and females admitted for residential treatment in terms of length of stay and severity of symptoms. Patients (N=384) were separated into four groups based on gender and the score obtained for the Maudsley Obsessive-Compulsive Inventory at admission. The instrument used to assess severity of eating disorder symptoms was the Eating Disorder Inventory (EDI-2) at admission and discharge. The results showed that the presence of comorbid OCB in eating disordered males and females account for longer length of stay (LOS) and an increased severity of eating disorder symptoms. Clinically, these findings point to the need for development of more targeted residential programs that are equipped for and adept at treating the comorbid eating disorder/OCB patient population.