Early Onset Binge Eating and Purging Eating Disorders: Course and Outcome in a Population-Based Study of Adolescents

Relationships of eating behaviors with psychopathology, brain maturation and genetic risk for obesity in an adolescent cohort study

Unhealthy eating, a risk factor for eating disorders (EDs) and obesity, often coexists with emotional and behavioral problems; however, the underlying neurobiological mechanisms are poorly understood. Analyzing data from the longitudinal IMAGEN adolescent cohort, we investigated associations between eating behaviors, genetic predispositions for high body mass index (BMI) using polygenic scores (PGSs), and trajectories (ages 14-23 years) of ED-related psychopathology and brain maturation. Clustering analyses at age 23 years (N = 996) identified 3 eating groups: restrictive, emotional/uncontrolled and healthy eaters. BMI PGS, trajectories of ED symptoms, internalizing and externalizing problems, and brain maturation distinguished these groups. Decreasing volumes and thickness in several brain regions were less pronounced in restrictive and emotional/uncontrolled eaters. Smaller cerebellar volume reductions uniquely mediated the effects of BMI PGS on restrictive eating, whereas smaller volumetric reductions across multiple brain regions mediated the relationship between elevated externalizing problems and emotional/uncontrolled eating, independently of BMI. These findings shed light on distinct contributions of genetic risk, protracted brain maturation and behaviors in ED symptomatology.

Hypothalamic-pituitary-adrenal axis in anorexia nervosa; an underestimated endocrine dysfunction among adolescents

In patients affected by anorexia nervosa (AN) different endocrine abnormalities have been described, but, among them, hypothalamic-pituitary-adrenal (HPA) dysfunction, although associated to important side effects, is underestimated and has no therapeutical options. We present a narrative literature review to investigate the HPA axis in patients with AN, in order to highlight HPA dysfunction and its effects. We also described the crucial role of HPA monitoring, and to consider eventual therapeutic and preventive strategies in AN patients. The literature now available demonstrates that women and girls suffering from AN have higher measures of cortisol and lower levels of androgens as compared to controls. These endocrinological disturbances have deleterious effects on the subjects, both from the physical and from the psychological point of view. It's fundamental for physicians to consider these aspects when assessing AN patients. The mechanisms behind the adrenocortical dysfunctions in eating disorders patients remain an open question and there are no available treatments, thus research on this issue would be extremely useful and highly necessary, especially in the pediatric field.

The prospective relationship between anxiety symptoms and eating disorder symptoms among adolescents: a systematic review and meta-analysis of a bi-directional relationship

Anxiety symptoms and eating disorder symptoms commonly co-occur in adolescents. However, there is divergent evidence on the prospective relationship between the two factors. This systematic review and meta-analysis summarises the existing literature on the prospective and bi-directional relationship between anxiety symptoms and eating disorder symptoms in adolescence. A systematic search across six databases was conducted on the 11th June 2024. Studies were included if they assessed the prospective relationship between anxiety symptoms and eating disorder symptoms, or vice versa, in adolescence. 19,591 studies were screened, of which 54 studies met inclusion criteria and were included in the full review. Four meta-analyses were conducted. Anxiety symptoms were associated with subsequent eating disorder symptoms, increases in eating disorder symptoms, and higher odds of eating disorders, including their onset. Conversely, eating disorder symptoms were associated with subsequent anxiety symptoms, increases in anxiety symptoms, and higher odds of subsequent anxiety disorders. Current evidence suggests that anxiety symptoms and eating disorder symptoms do not merely co-occur during adolescence, but are prospectively and bi-directionally linked. Further research is needed to understand the underlying mechanisms of this relationship, as well as individual differences in symptom trajectories.

The natural course of binge-eating disorder: findings from a prospective, community-based study of adults

BACKGROUND

Epidemiological data offer conflicting views of the natural course of binge-eating disorder (BED), with large retrospective studies suggesting a protracted course and small prospective studies suggesting a briefer duration. We thus examined changes in BED diagnostic status in a prospective, community-based study that was larger and more representative with respect to sex, age of onset, and body mass index (BMI) than prior multi-year prospective studies.

METHODS

Probands and relatives with current DSM-IV BED (n = 156) from a family study of BED ('baseline') were selected for follow-up at 2.5 and 5 years. Probands were required to have BMI > 25 (women) or >27 (men). Diagnostic interviews and questionnaires were administered at all timepoints.

RESULTS

Of participants with follow-up data (n = 137), 78.1% were female, and 11.7% and 88.3% reported identifying as Black and White, respectively. At baseline, their mean age was 47.2 years, and mean BMI was 36.1. At 2.5 (and 5) years, 61.3% (45.7%), 23.4% (32.6%), and 15.3% (21.7%) of assessed participants exhibited full, sub-threshold, and no BED, respectively. No participants displayed anorexia or bulimia nervosa at follow-up timepoints. Median time to remission (i.e. no BED) exceeded 60 months, and median time to relapse (i.e. sub-threshold or full BED) after remission was 30 months. Two classes of machine learning methods did not consistently outperform random guessing at predicting time to remission from baseline demographic and clinical variables.

CONCLUSIONS

Among community-based adults with higher BMI, BED improves with time, but full remission often takes many years, and relapse is common.

Multiple marginalization, discrimination, and disordered eating among youth aged 10-11

OBJECTIVE

Although rates of weight discrimination are on-par with racial, ethnic, and gender discrimination, comparatively less work has examined impacts of weight-based discrimination in youth, including on disordered eating. Knowing whether experiences of weight-based discrimination, including in youth with multiply-marginalized identities, are associated with disordered eating could identify vulnerable youth and inform intervention efforts.

METHOD

Youth (N = 11,875) ages 10-11 were recruited through the Adolescent Brain Cognitive Development (ABCD) study. Logistic regressions using cross-sectional data examined discrimination experiences (weight, perceived sexual orientation, race/ethnicity, national origin) and disordered eating (binge-eating, vomiting, weight-gain fear, weight self-worth). Models included race/ethnicity, age, sex, parental income, and degree of elevated weight. Raked poststratification weights were used.

RESULTS

Rates of weight-based discrimination (6.2%) were similar to rates of race/ethnicity (4.4%) and sexual orientation discrimination (4.5%). Weight-based discrimination was associated with more disordered eating. Youth reporting multiple experiences of discrimination had significantly increased disordered eating compared to youth who did not report discrimination.

DISCUSSION

Weight-based discrimination is common in youth and associated with disordered eating. Youth with elevated weight are more likely to be multiply marginalized and experience disordered eating. These findings suggest discrimination, including weight-based discrimination, is a critical intervention target to prevent and treat eating disorders.

PUBLIC SIGNIFICANCE

Experiences of discrimination contribute to poorer health; however, weight-based discrimination is relatively understudied. Data from a large sample of youth ages 10-11 showed that youth with elevated weight reported experiencing multiple types of discrimination, and multiply-marginalized youth had increased odds of disordered eating with each additional type of discrimination. Together, this suggests that weight-based discrimination is a critical target to prevent and treat eating disorders, especially in multiply-marginalized youth.

The United Kingdom Eating Disorders Genetics Initiative

OBJECTIVE

The United Kingdom Eating Disorders Genetics Initiative (EDGI UK), part of the National Institute for Health and Care Research (NIHR) Mental Health BioResource, aims to deepen our understanding of the environmental and genetic etiology of eating disorders. EDGI UK launched in February 2020 and is partnered with the UK eating disorders charity, Beat. Multiple EDGI branches exist worldwide. This article serves the dual function of providing an in-depth description of our study protocol and of describing our initial sample including demographics, diagnoses, and physical and psychiatric comorbidities.

METHOD

EDGI UK recruits via media and clinical services. Anyone living in England, at least 16 years old, with a lifetime probable or clinical eating disorder is eligible to sign up online: edgiuk.org. Participants complete online questionnaires, donate a saliva sample for genetic analysis, and consent to medical record linkage and recontact for future studies.

RESULTS

As of September 2022, EDGI UK recruited 7435 survey participants: 98% female, 93.1% white, 97.8% cisgender, 65.9% heterosexual, and 52.1% have a university degree. Over half (57.8%) of these participants have returned their saliva DNA kit. The most common diagnoses are anorexia nervosa (48.3%), purging disorder (37.8%), bulimia nervosa (37.5%), binge-eating disorder (15.8%), and atypical anorexia nervosa (7.8%).

CONCLUSION

EDGI UK is the largest UK eating disorders study and efforts to increase its diversity are underway. It offers a unique opportunity to accelerate eating disorder research. Researchers and participants with lived experience can collaborate on projects with unparalleled sample size.

PUBLIC SIGNIFICANCE STATEMENT

Eating disorders are debilitating and costly for society but are under-researched due to underfunding. EDGI UK is one of the largest eating disorder studies worldwide with ongoing recruitment. The collected data constitute a resource for secondary analysis. We will combine data from all international EDGI branches and the NIHR BioResource to facilitate research that improves our understanding of eating disorders and their comorbidities.

Identifying overcontrol and undercontrol personality types among young people using the five factor model, and the relationship with disordered eating behaviour, anxiety and depression

BACKGROUND

Overcontrol and undercontrol personality types have been associated with an increase in eating pathology, depression and anxiety. The aim of the research was to explore whether latent overcontrol and undercontrol personality types could be identified using cluster analysis of the facets of the five factor model (FFM). We further aimed to understand how these personality types were associated with eating pathology, depressed mood and anxiety.

METHODS

A total of 561 participants (394 women and 167 men), aged 16-30 years in Australia completed a survey designed to assess disordered eating, FFM personality traits, anxiety, depression and stress. A systematic four-step process using hierarchical, k-means, and random forest cluster analyses were used to identify a meaningful 3-cluster solution.

RESULTS

The results revealed a cluster solution that represented overcontrol, undercontrol and resilient personality types, and highlighted facets of the FFM that were associated with each type. Both overcontrol and undercontrol personality types were associated with increased clinical symptoms compared to the resilient types.

CONCLUSIONS

It was concluded that FFM facets may potentially be more meaningful than broad domains in identifying personality types, and that both overcontrol and undercontrol personality types are likely associated with increased clinical symptoms.

Psychometric properties of the Parent Eating Disorder Examination Questionnaire

OBJECTIVE

To examine the psychometric properties of the Parent Eating Disorder Examination Questionnaire (PEDE-Q), developed to improve eating disorder (ED) assessment among youth by including parents as informants.

METHODS

A multi-site, transdiagnostic sample of 355 adolescents with EDs completed the Eating Disorder Examination Questionnaire (EDE-Q) and their parents completed the PEDE-Q.

RESULTS

The internal consistencies of the PEDE-Q subscales were on par with established EDE-Q ranges (.73 to .90), both when examined using the original four-factor EDE-Q subscales and the seven-item, three-factor subscales of the brief EDE-Q. Statistically significant medium- to large-sized correlations and poor to moderate levels of agreement were found between the corresponding EDE-Q and PEDE-Q subscales. Receiver-operator characteristic (ROC) curves showed that the PEDE-Q had a statistically significant area under the curve (AUC) to maximize sensitivity and specificity in diagnosing full-syndrome AN, whereas the EDE-Q did not. Based on chi-square analyses, the PEDE-Q identified a statistically significantly greater number of AN cases than the EDE-Q. The EDE-Q yielded a BN diagnosis more frequently than the PEDE-Q, although this difference was not statistically significant.

DISCUSSION

Results suggest that the PEDE-Q has good psychometric properties and provides incremental information that can aid in the assessment and diagnosis of adolescents with EDs, particularly those with AN.

PUBLIC SIGNIFICANCE

There exist complex challenges to identifying clinically significant eating disorders among youth. The PEDE-Q is a questionnaire measure that improves eating disorder assessment among children and adolescents by asking parents to report on the symptoms and behaviors they have observed in their child and that youth may not fully disclose. The PEDE-Q can aid in the diagnosis of adolescents with eating disorders, particularly those with anorexia nervosa.

Aberrant functional connectivity between reward and inhibitory control networks in pre-adolescent binge eating disorder

BACKGROUND

Behavioral features of binge eating disorder (BED) suggest abnormalities in reward and inhibitory control. Studies of adult populations suggest functional abnormalities in reward and inhibitory control networks. Despite behavioral markers often developing in children, the neurobiology of pediatric BED remains unstudied.

METHODS

58 pre-adolescent children (aged 9-10-years) with BED (mBMI = 25.05; s.d. = 5.40) and 66 age, BMI and developmentally matched control children (mBMI = 25.78; s.d. = 0.33) were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development (ABCD) Study. We investigated group differences in resting-state functional MRI functional connectivity (FC) within and between reward and inhibitory control networks. A seed-based approach was employed to assess nodes in the reward [orbitofrontal cortex (OFC), nucleus accumbens, amygdala] and inhibitory control [dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)] networks via hypothesis-driven seed-to-seed analyses, and secondary seed-to-voxel analyses.

RESULTS

Findings revealed reduced FC between the dlPFC and amygdala, and between the ACC and OFC in pre-adolescent children with BED, relative to controls. These findings indicating aberrant connectivity between nodes of inhibitory control and reward networks were corroborated by the whole-brain FC analyses.

CONCLUSIONS

Early-onset BED may be characterized by diffuse abnormalities in the functional synergy between reward and cognitive control networks, without perturbations within reward and inhibitory control networks, respectively. The decreased capacity to regulate a reward-driven pursuit of hedonic foods, which is characteristic of BED, may in part, rest on this dysconnectivity between reward and inhibitory control networks.

Eating disorder outcomes: findings from a rapid review of over a decade of research

BACKGROUND

Eating disorders (ED), especially Anorexia Nervosa (AN), are internationally reported to have amongst the highest mortality and suicide rates in mental health. With limited evidence for current pharmacological and/or psychological treatments, there is a grave responsibility within health research to better understand outcomes for people with a lived experience of ED, factors and interventions that may reduce the detrimental impact of illness and to optimise recovery. This paper aims to synthesise the literature on outcomes for people with ED, including rates of remission, recovery and relapse, diagnostic crossover, and mortality.

METHODS

This paper forms part of a Rapid Review series scoping the evidence for the field of ED, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/MEDLINE were searched for studies published between 2009 and 2022 in English. High-level evidence such as meta-analyses, large population studies and Randomised Controlled Trials were prioritised through purposive sampling. Data from selected studies relating to outcomes for people with ED were synthesised and are disseminated in the current review.

RESULTS

Of the over 1320 studies included in the Rapid Review, the proportion of articles focused on outcomes in ED was relatively small, under 9%. Most evidence was focused on the diagnostic categories of AN, Bulimia Nervosa and Binge Eating Disorder, with limited outcome studies in other ED diagnostic groups. Factors such as age at presentation, gender, quality of life, the presence of co-occurring psychiatric and/or medical conditions, engagement in treatment and access to relapse prevention programs were associated with outcomes across diagnoses, including mortality rates.

CONCLUSION

Results are difficult to interpret due to inconsistent study definitions of remission, recovery and relapse, lack of longer-term follow-up and the potential for diagnostic crossover. Overall, there is evidence of low rates of remission and high risk of mortality, despite evidence-based treatments, especially for AN. It is strongly recommended that research in long-term outcomes, and the factors that influence better outcomes, using more consistent variables and methodologies, is prioritised for people with ED.

Evaluating the predictive validity of purging disorder by comparison to bulimia nervosa at long-term follow-up

OBJECTIVE

The current study sought to examine the predictive validity of the purging disorder diagnosis at long-term follow-up by comparing naturalistic outcomes with bulimia nervosa.

METHOD

Women with purging disorder (N = 84) or bulimia nervosa (N = 133) who had completed comprehensive baseline assessments as part of one of three studies between 2000 and 2012 were sought for follow-up assessment. Nearly all (94.5%) responded to recruitment materials and 150 (69% of sought sample; 83.3% non-Hispanic white; 33.40 [7.63] years old) participated at an average of 10.59 (3.71) years follow-up. Participants completed the Eating Disorder Examination, the Structured Clinical Interview for DSM-IV, and a questionnaire battery. Diagnostic groups were compared on eating disorder (illness status, recovery status, and eating pathology) and related outcomes. Group differences in predictors of outcome were explored.

RESULTS

There were no significant differences in eating disorder presence (p = .70), recovery status (p = .87), and level of eating pathology (p = .17) between diagnostic groups at follow-up. Post hoc equivalence tests indicated group differences were smaller than a medium effect size (p's ≤ .005). Groups differed in diagnosis at follow-up (p = .002); diagnostic stability was more likely than cross-over to bulimia nervosa for women with baseline purging disorder (p = .004).

DISCUSSION

Although purging disorder and bulimia nervosa do not differ in long-term outcomes, the relative stability in clinical presentation suggests baseline group differences in clinical presentation may be useful in augmenting treatments for purging disorder.

PUBLIC SIGNIFICANCE STATEMENT

While purging disorder is classified as an "other specified" eating disorder, individuals who experience this disorder have comparable negative long-term outcomes as those with bulimia nervosa. This highlights the importance of screening for and treating purging disorder as a full-threshold eating disorder.

Development of evidence-informed bridge programming to support an increased need for eating disorder services during the COVID-19 pandemic

Over the course of the COVID-19 pandemic, rates of eating disorders have increased, further straining systems of care that were already overburdened. The current paper describes novel interventions, largely informed by Family-Based Treatment (FBT), that were implemented by a tertiary specialist adolescent eating disorders service. In response to the pandemic, programming was designed to bridge access to care while waiting for availability of evidence-based therapy. The Brief Psychology Consultation Clinic provides several sessions to patients and families, focused on psychoeducation and problem-solving informed by FBT and other evidence-based therapies. Two groups, the FBT Caregiver Workshop Series and FBT Caregiver Support Group, provide psychoeducation and support for caregivers of youth with eating disorders. Perceived strengths and benefits of these services, as well as barriers to implementation and future research directions are discussed.

A Network Analysis Investigation of Disordered Eating Across Demographic and Developmental Subpopulations Using a National Epidemiological Sample of High School Students

Disordered eating (DE) poses a large societal burden, yet limited research has examined DE from a developmental epidemiological perspective. It is important to consider how demographics influence DE symptoms to inform prevention and early intervention programs across diverse subpopulations. Therefore, we conducted network analyses using a large nationally representative epidemiological sample of high school students (Youth Risk Behavior Survey, United States; n = 59,582) to identify the most important symptoms and symptom relationships among six DE behaviors. We compared networks by sex, grade, and race to identify differences in symptom networks. Dieting for weight loss was highly central across networks. Networks significantly differed across sex, grade, and race. Our results suggest that dieting for weight loss may be an early intervention target for eating disorders, regardless of demographic and developmental factors. In addition, sex, race, and age should be accounted for when researching and developing prevention programs for DE and eating disorders. Public health officials, as well as mental health professionals, should present a more balanced message about dieting and weight loss to high school students to prevent the detrimental impact of DE on physical and mental health. Notably, this study is the first large, nationwide epidemiological sample using DE symptoms in network analysis.

Gender-based clinical differences in evidence-based treatment for adolescent anorexia nervosa: analysis of aggregated randomized controlled trials

PURPOSE

Boys represent a small proportion of samples in randomized clinical trials (RCT) investigating evidence-based treatment for adolescents with anorexia nervosa (AN). Consequently, knowledge of potential gender differences in clinical characteristics and treatment response in adolescents is considerably limited.

METHODS

Secondary analyses of aggregated data from two RCTs were used to characterize baseline and end-of-treatment clinical features in male and female adolescents with AN (n = 228, 10.53% male). Mixed analyses of variance were used to investigate potential gender differences in treatment response relative to weight outcomes (% median BMI) and eating disorder cognitions (Eating Disorder Examination Global scores; EDE).

RESULTS

There were no significant gender differences in prior inpatient care, illness duration, psychiatric comorbidity, or psychotropic medication use at baseline. Nor were there significant gender differences in binge eating, purging, or driven exercise at baseline or end-of-treatment. Girls reported elevated weight and shape concern compared to boys at baseline but overall reduction in EDE Global scores over the course of treatment did not differ according to gender. Boys gained more relative weight during treatment than girls, but this difference was statistically non-significant.

CONCLUSION

Overall findings do not suggest significant differences in treatment outcome relative to weight or ED cognitions, by gender. Current evidence suggests that, with the exception of shape and weight concerns, boys present with cognitive and behavioral symptoms as severe as their female counterparts which underscores the need for increased accuracy in assessment of these disorders in boys and young men.

LEVEL OF EVIDENCE

Level 1, secondary data analysis of randomized controlled trials.

Food Addiction in Eating Disorders: A Cluster Analysis Approach and Treatment Outcome

Background: A first approach of a phenotypic characterization of food addiction (FA) found three clusters (dysfunctional, moderate and functional). Based on this previous classification, the aim of the present study is to explore treatment responses in the sample diagnosed with Eating Disorder(ED) of different FA profiles. Methods: The sample was composed of 157 ED patients with FA positive, 90 with bulimia nervosa (BN), 36 with binge eating disorder (BED), and 31 with other specified feeding or eating disorders (OSFED). Different clinical variables and outcome indicators were evaluated. Results: The clinical profile of the clusters present similar characteristics with the prior study, having the dysfunctional cluster the highest ED symptom levels, the worse psychopathology global state, and dysfunctional personality traits, while the functional one the lowest ED severity level, best psychological state, and more functional personality traits. The dysfunctional cluster was the one with lowest rates of full remission, the moderate one the higher rates of dropouts, and the functional one the highest of full remission. Conclusions: The results concerning treatment outcome were concordant with the severity of the FA clusters, being that the dysfunctional and moderate ones had worst treatment responses than the functional one.

Predictors of Symptom Trajectories After Cognitive-Behavioral Therapy in Adolescents With an Age-Adapted Diagnosis of Binge-Eating Disorder

Although evidence demonstrated efficacy of cognitive-behavioral therapy (CBT) in adolescents with binge-eating disorder (BED), treatment response is heterogeneous. This study uniquely examined baseline predictors of symptom trajectories in N = 73 adolescents (12-20 years) with an age-adapted diagnosis of BED (i.e., based on objective and subjective binge-eating episodes). Based on evidence from adult BED, dietary restraint, overvaluation of weight/shape, and depressive symptoms were used to predict changes in abstinence from binge eating and eating disorder psychopathology after 4 months of individual, face-to-face CBT using growth models. Longitudinal trajectories of abstinence from objective and subjective binge eating and global eating disorder psychopathology assessed via the Eating Disorder Examination were modeled for five time points (pre- and posttreatment, 6-, 12-, and 24-month follow-up). Beyond significant, positive effects for time, no significant predictors for abstinence from binge eating emerged. In addition to significant decreases in eating disorder psychopathology over time, higher pretreatment dietary restraint and overvaluation of weight/shape significantly predicted greater decreases in eating disorder psychopathology over time. Consistent with research in adult BED, adolescents with higher than lower eating disorder-specific psychopathology especially benefit from CBT indicating that restrained eating and overvaluation of weight/shape may be BED-specific prognostic characteristic across developmental stages. Future predictor studies with an additional focus on potential age-specific predictors, such as family factors, and within-treatment processes may be critical in further evaluating treatment-related symptom trajectories in adolescent BED.

A naturalistic, long-term follow-up of purging disorder

BACKGROUND

The DSM-5 introduced purging disorder (PD) as an other specified feeding or eating disorder characterized by recurrent purging in the absence of binge eating. The current study sought to describe the long-term outcome of PD and to examine predictors of outcome.

METHODS

Women (N = 84) who met research criteria for PD completed a comprehensive battery of baseline interview and questionnaire assessments. At an average of 10.24 (3.81) years follow-up, available records indicated all women were living, and over 95% were successfully located (n = 80) while over two-thirds (n = 58) completed follow-up assessments. Eating disorder status, full recovery status, and level of eating pathology were examined as outcomes. Severity and comorbidity indicators were tested as predictors of outcome.

RESULTS

Although women experienced a clinically significant reduction in global eating pathology, 58% continued to meet criteria for a DSM-5 eating disorder at follow-up. Only 30% met established criteria for a full recovery. Women reported significant decreases in purging frequency, weight and shape concerns, and cognitive restraint, but did not report significant decreases in depressive and anxiety symptoms. Quality of life was impaired in the physical, psychological, and social domains. More severe weight and shape concerns at baseline predicted meeting criteria for an eating disorder at follow-up. Other baseline severity indicators and comorbidity did not predict the outcome.

CONCLUSIONS

Results highlight the severity and chronicity of PD as a clinically significant eating disorder. Future work should examine maintenance factors to better adapt treatments for PD.

Self-reported symptoms of binge-eating disorder among adolescents in a community-based Danish cohort-A study of prevalence, correlates, and impact

OBJECTIVE

Binge-eating disorder (BED) was established as a diagnosis in 2013 with the DSM-5 and has been included in the ICD-11 in 2018. In adulthood, BED is prevalent and correlated with somatic and mental health problems. Less is known about BED in adolescence, although this age period could represent a window of opportunity for early intervention. This study aimed to investigate the 1-year prevalence, correlates, and impact of BED symptoms in a community sample of adolescents.

METHOD

We included 1,404 girls and 1,105 boys from the 16-years-follow-up of the Copenhagen Child Cohort study, CCC2000. The adolescents self-reported on BED symptoms, weight-status, body perception, mental health problems, and self-rated impact of food and weight-related thoughts and behaviors. Information about socio-economic factors and hospital diagnosed psychiatric disorders were obtained from national registries.

RESULTS

A total of 8.5% reported weekly overeating with loss of control (10.9% of girls, 4.8% of boys), and 2.6% (3.6% of girls, 1.2% of boys) reported symptoms consistent with BED according to the DSM-5. Regardless of sex, BED was correlated with concurrent overweight, body-dissatisfaction, low self-esteem, and mental health problems, especially emotional, but also with problems of behavior, inattention, and peer-relations, and with high self-rated impact on everyday life. Immigrant background and lower socio-economy were potential risk factors for BED in boys in this sample.

DISCUSSION

BED was prevalent and correlated with mental health problems and overall impact among adolescents in this community sample, indicating the need for clinical attention and intervention towards binge-eating disorder in the adolescent period.

Gender identity, race/ethnicity and eating pathology in a treatment-seeking community sample

Despite the wide-reaching impact of eating disorders (EDs), less is known about eating pathology among individuals across racial/ethnic groups whose gender identity differs from the binary categorization. Examining ED pathology both across binary and minority-gender groups, and relative to racial/ethnic identification is necessary to inform screening and culturally-sensitive intervention efforts. This study investigated patterns of ED symptomology among youth and adults (N = 13658) who telephoned treatment centers in the United States when seeking clinical support for ED symptoms. Analyses examined data from participants who completed a semi-structured clinical interview. Results indicated that Anorexia nervosa was the most common diagnosis in each gender category and for a majority of race/ethnic groups; Black individuals had elevated rates of binge eating disorder. Compared to females, males were less likely to endorse all ED symptoms (ps < .001); gender minority status was also associated with decreased report of a majority of ED symptoms. Asian and Black individuals were less likely than Whites to endorse most ED symptoms. When compared to Whites, Hispanic/Latinx and Bi/Multi-racial participants did not demonstrate significant differences in presentation across a majority of ED symptoms. Overall findings suggest individuals with female gender and White race may seek treatment from an ED treatment facility with greater frequency than other demographic groups. Noted exceptions include Hispanic/Latinx and Bi/Multi-racial individuals, for whom ED pathology may be represented comparably to Whites. While findings confirm traditional patterns in gender and racial/ethnic representation in EDs, current study findings also underscore that EDs are not culture bound.

Cumulative lifetime stress exposure predicts greater impulsivity and addictive behaviors

The study investigated whether lifetime stress exposure is associated with greater impulsivity and addictive behavior. We also examined whether stress and impulsivity interactively predicted food addiction and alcohol-related behavior. Greater lifetime stress exposure was related to more impulsivity and food addictive behaviors, but not alcohol-related consequences. There were no interactions between lifetime stress exposure and impulsivity in predicting addictive behaviors. Exploratory analyses revealed that early and adulthood stress exposure predicted food addiction, whereas only adulthood stress predicted alcohol-related consequences. Therefore, lifetime stress exposure is related to impulsivity and addiction, but these effects differ by addiction outcome and specific timing of stress exposure.

Eating Disorders in Males

Eating disorders are serious psychiatric disorders, associated with significant psychiatric and medical consequences. Although traditionally considered a female disorder, more recent evidence has determined that EDs among males are not uncommon and are equally severe in symptom presentation. Among youth and adolescent males, certain factors increase the risk for ED, including muscularity-focused body image concerns and sexual orientation. Future study of these and other factors that may increase the risk for or maintain EDs among adolescent males is critical to improving screening, assessment, and precision treatment efforts.

Fifteen-Year Prevalence, Trajectories, and Predictors of Body Dissatisfaction From Adolescence to Middle Adulthood

Body dissatisfaction is common in adolescence and associated with negative outcomes (e.g., eating disorders). We identified common individual trajectories of body dissatisfaction from mid-adolescence to adulthood, and predictors of divergent patterns. Participants were 1,455 individuals from four waves of Project EAT (Eating and Activity in Teens and Young Adults), a population-based, 15-year longitudinal study. Aggregate body dissatisfaction increased over 15 years, which was largely attributable to increases in weight. Growth mixture modeling identified four common patterns of body dissatisfaction, revealing nearly 95% of individuals experienced relatively stable body dissatisfaction from adolescence through adulthood. Baseline depression, self-esteem, parent communication/caring, peer dieting, and weight-based teasing predicted differing trajectories. Body dissatisfaction appears largely stable from mid-adolescence onward. There may be a critical period for body image development during childhood/early adolescence. Clinicians should intervene upon body dissatisfaction before it becomes chronic, and target depression, self-esteem, parent/child connectedness, and responses to teasing and peer dieting.

Prevalence of eating disorders over the 2000-2018 period: a systematic literature review

BACKGROUND

Eating disorders (EDs) lead to multiple psychiatric and somatic complications and thus constitute a major public health concern.

OBJECTIVES

The aim of this study was to give an exhaustive view of the studies reporting the prevalence of the different EDs or total EDs and to study their evolution.

METHODS

A literature search following PRISMA Guidelines and limited to studies in English or French published between 2000 and 2018 was performed and relevant studies were included in this systematic review on the prevalence of EDs. The literature search revealed 94 studies with accurate ED diagnosis and 27 with broad ED diagnosis.

RESULTS

In 94 studies with accurate ED diagnosis, the weighted means (ranges) of lifetime ED were 8.4% (3.3-18.6%) for women and 2.2% (0.8-6.5%) for men. The weighted means (ranges) of 12-month ED prevalence were 2.2% (0.8-13.1%) for women and 0.7% (0.3-0.9%) for men. The weighted means (ranges) of point prevalence were 5.7% (0.9-13.5%) for women and 2.2% (0.2-7.3%) for men. According to continents, the weighted means (ranges) of point prevalence were 4.6% (2.0-13.5%) in America, 2.2% (0.2-13.1%) in Europe, and 3.5% (0.6-7.8%) in Asia.In addition to the former, 27 other studies reported the prevalence of EDs as broad categories resulting in weighted means (ranges) of total point prevalence of any EDs of 19.4% (6.5-36.0%) for women and 13.8% (3.6-27.1%) for men.

CONCLUSIONS

Despite the complexity of integrating all ED prevalence data, the most recent studies confirm that EDs are highly prevalent worldwide, especially in women. Moreover, the weighted means of point ED prevalence increased over the study period from 3.5% for the 2000-2006 period to 7.8% for the 2013-2018 period. This highlights a real challenge for public health and healthcare providers.

A review of purging disorder through meta-analysis

Although a growing body of research has examined Purging Disorder (PD), there remains a lack of conclusive evidence regarding the diagnostic validity of PD. This meta-analysis compared PD to DSM-5 eating disorders (i.e., Anorexia Nervosa [AN], Bulimia Nervosa [BN], and Binge Eating Disorder [BED]) and controls. A comprehensive literature search identified 38 eligible studies. Group differences on indicators of course of illness and both general and eating psychopathology were assessed using standardized effect sizes. Results supported the conceptualization of PD as a clinically significant eating disorder, but findings were less clear regarding its distinctiveness from other eating disorder diagnoses. More specifically, PD significantly differed from BN and BED in natural course of illness (g = .40-.54), and PD significantly differed from AN in treatment outcome (g = .27), with PD characterized by a better prognosis. Overall, PD was more similar to AN and BED on many dimensional measures of general and eating-related psychopathology, though PD was less severe than BN in most of these domains. PD, BN, and BED groups also evidenced similar frequencies of subjective binge episodes (SBEs), yet PD evidenced less frequent SBEs than AN. There is a clear need for future studies of PD to assess validators that have not been reported comprehensively in the literature, such as mortality, medical morbidity, and course of illness. Additionally, empirical classification studies are needed to inform future classifications of PD, particularly with regard to categorical differences between PD and other eating disorders. (PsycINFO Database Record

A narrative review of binge eating disorder in adolescence: prevalence, impact, and psychological treatment strategies

Binge eating disorder (BED) represents one of the most problematic clinical conditions among youths. Research has shown that the developmental stage of adolescence is a critical stage for the onset of eating disorders (EDs), with a peak prevalence of BED at the age of 16–17 years. Several studies among adults with BED have underlined that it is associated with a broad spectrum of negative consequences, including higher concern about shape and weight, difficulties in social functioning, and emotional-behavioral problems. This review aimed to examine studies focused on the prevalence of BED in the adolescent population, its impact in terms of physical, social, and psychological outcomes, and possible strategies of psychological intervention. The review of international literature was made on paper material and electronic databases ProQuest, PsycArticles, and PsycInfo, and the Scopus index were used to verify the scientific relevance of the papers. Epidemiological research that examined the prevalence of BED in adolescent samples in accordance with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition showed a prevalence ranging from 1% to 4%. More recently, only a few studies have investigated the prevalence of BED, in accordance with the Diagnostic and Statistical Manual of Disorders, Fifth Edition criteria, reporting a prevalence of ~1%–5%. Studies that focused on the possible impact that BED may have on physical, psychological, and social functioning showed that adolescents with BED have an increased risk of developing various adverse consequences, including obesity, social problems, substance use, suicidality, and other psychological difficulties, especially in the internalizing area. Despite the evidence, to date, reviews on possible and effective psychological treatment for BED among young population are rare and focused primarily on adolescent females.

[Transitional and Adolescent Psychiatry in Austria: A Pilot Study on the Attitudes of Experts]

Transitional and Adolescent Psychiatry in Austria: A Pilot Study on the Attitudes of Experts Abstract.

OBJECTIVE

This pilot study establishes baseline data on the current situation of transitional processes in Austrian psychiatry. We sought to gather information on the specific problems and needs occurring during the transition of mentally ill adolescents from child and adolescent to adult psychiatry.

METHOD

Professionals (psychiatrists, psychologists, psychotherapists) working in child and adolescent psychiatry and adult psychiatry (N = 86) were assessed by means of an online survey concerning their experience with the transition of young adults.

RESULTS

Almost all of the subjects queried (98.8 %) considered the current system inappropriate, and the majority (70.9 %) thought that patients would not tolerate transition from youth to adult psychiatric institutions very well. Only 16.3 % reported having a structured transition protocol at their workplace. Further 83.7 % expressed the need to improve collaboration between adolescent and adult psychiatry.

CONCLUSIONS

This sample of Austrian healthcare professionals describes large deficits regarding transitional issues in psychiatry. There is an urgent need to establish structured protocols for transition, especially since experiences occurring during this vulnerable period are crucial to the mental health of young people later in life.

The Daily Frequency, Type, and Effects of Appearance Comparisons on Disordered Eating

Using experience sampling methodology, we examined the effects of frequency and occurrence of appearance-based comparisons on disordered eating behaviors (binge eating, restrictive behaviors, and weight-related exercise). A total of 161 Australian women (aged 18–48) completed a baseline measure of eating pathology. An iPhone application prompted participants 6 times daily for 7 days to self-report on appearance comparisons and disordered eating behaviors since the last assessment. We hypothesized that contemporaneously reported occurrences of both upward and downward appearance comparisons, when compared to noncomparison situations, and frequency of upward comparisons would predict disordered eating behaviors. In prospective (lagged) analyses, only upward comparisons (relative to noncomparison situations) significantly predicted the likelihood of disordered eating outcomes. Trait eating pathology had a direct effect on each disordered eating variable and also moderated the influence of upward appearance comparisons (relative to noncomparison assessments) on binge-eating episodes. The lack of a differentiated effect between contemporaneously reported occurrences of upward and downward comparisons suggests that both forms of comparison increase the likelihood of disordered eating. Women may benefit from preventive programs that focus on the detrimental consequences of appearance comparisons on disordered eating; such programs may equip women with strategies to help reduce the frequency of these comparisons.

Stability and change in patterns of eating disorder symptoms from adolescence to young adulthood

Using a community adolescent sample, we aimed to (a) empirically derive eating disorder (ED) symptom groups, (b) examine the longitudinal stability of those groups over 10 years, and (c) identify risk factors associated with ED group stability and transition through young adulthood. Young people (N = 2,287) from the Project EAT cohort participated at baseline (1998-1999) and at 10-year follow-up (2008-2009). Participants completed anthropometric measures at baseline and self-report surveys on disordered eating symptoms and risk factors at both time points. Latent transition modeling was used to test the first two aims and multinomial logistic regression was used for the third aim. Three groups emerged and were labeled as: (a) asymptomatic, (b) dieting, (c) disordered eating (e.g., binge eating, compensatory behaviors). Stability of group membership over 10 years was highest for those in the asymptomatic group, while those in the dieting group showed equal likelihood of transitioning to any group. There was a 75% chance that those in the disordered eating group would continue to belong to a symptomatic group 10 years later. We found that these transitions could be predicted by baseline risk factors. For example, adolescents with one standard deviation higher depressive symptoms than their peers had 53% higher odds (OR = 1.53, 95% CI 1.09-2.16) of transitioning from the asymptomatic group to the disordered eating group. Transition among ED groups is relatively common during adolescence and early adulthood. By targeting risk factors such as self-esteem and familial factors in early adolescence, prevention efforts may be improved.

Binge eating and binge drinking among adolescents: The role of drinking and eating motives

This study aimed to investigate the motivations underlying binge eating and binge drinking in a sample of 302 adolescents. Our findings showed that binge eating was significantly correlated with gender, environmental, emotional, and social eating. Hierarchical multiple regression analysis indicated that emotional and environmental eating were significant positive predictors of binge eating, whereas binge drinking was significantly correlated with enhancement, social, and coping motives. Only enhancement motives were significant predictors of binge drinking. Our results support the argument that the reasons underlying binge eating and binge drinking in adolescents may be similar and may perform the same function.

Hispanic maternal influences on daughters' unhealthy weight control behaviors: The role of maternal acculturation, adiposity, and body image disturbances

This study examined whether maternal adiposity, acculturation, and perceived-ideal body size discrepancy for daughters were associated with daughters' engagement in unhealthy weight control behaviors. A total of 97 Hispanic mother-daughter dyads completed surveys, rated a figure scale, and had their height, weight, and adiposity assessed. Mothers (M_age=39.00, SD=6.20 years) selected larger ideal body sizes for their daughters (M_age=11.12, SD=1.53 years) than their daughters selected for themselves. Mothers had a smaller difference between their perception of their daughters' body size and ideal body size compared to the difference between their daughters' selection of their perceived and ideal body size. More acculturated mothers and those mothers with larger waist-to-hip ratios were more likely to have daughters who engaged in unhealthy weight control behaviors. These findings highlight the relevant role that maternal acculturation and adiposity may have in influencing daughters' unhealthy weight control behaviors.

Testing for interactive and non-linear effects of risk factors for binge eating and purging eating disorders

Almost no research has tested whether risk factors interact in the prediction of future eating disorder onset, which might suggest qualitatively distinct etiologic pathways. Accordingly, this prospective study tested for possible interactions between risk factors in the prediction of binge eating and purging eating disorders in adolescents. It also examined sex differences in pathways to risk. Two analytical approaches were used: (1) classification tree analysis (CTA), which is ideally suited to identifying non-linear interactions and the optimal cut-points for defining risk, with follow-up random forest analyses; and (2) two-way interaction terms in a series of logistic regression models. Data were drawn from the Western Australian Pregnancy Cohort (Raine) Study, a population-based study that followed participants from pre-birth to young adulthood. This study involved 1297 adolescents (49% male), 146 (11%) of whom developed bulimia nervosa, binge eating disorder or purging disorder in late adolescence. In CTA, sex was the first and most potent predictor of eating disorder risk with females showing a 5-fold increase in risk relative to males. For males and females, weight and eating concerns were the next most potent predictor of risk and three risk groups emerged, reflecting non-linear risk. For females with intermediate weight and eating concerns, externalizing problems emerged as an additional predictor. Interaction terms in logistic regression models did not produce significant results after correcting for multiple testing. Findings advance knowledge on risk pathways to eating disorder onset, highlight non-linear risk processes, and provide cut-points for prospectively identifying high-risk youth for prevention programs.

Predictors of initiation and persistence of recurrent binge eating and inappropriate weight compensatory behaviors in college men

OBJECTIVE

The transition to college is considered as a risk period for the development of behavioral symptoms of eating disorders (BSEDs) and some evidence suggests that, amongst men, these symptoms occurring on a regular basis remain relatively stable over the college period. Nevertheless, little is known about factors associated with persistent engagement in and initiation of recurrent (or regular) binge eating and inappropriate weight compensatory behaviors in this population. The objective of this report was to address these research gaps.

METHOD

Data were examined from 2,555 male first-year college students who completed an assessment of potential vulnerability factors and BSEDs at the beginning of the autumn semester (baseline) and nine months later (end of the spring semester; follow-up).

RESULTS

Elevated negative affectivity, body dissatisfaction, self-objectification, and lower self-esteem at baseline were predictive of persistent engagement in regular binge eating and four compensatory behaviors (self-induced vomiting, laxative/diuretic abuse, fasting, exercise) at follow-up, as well as initiation of all these behaviors occurring regularly (i.e., at least weekly for 3 months). Self-objectification (thinking and monitoring the body's outward appearance from a third-person perspective) emerged as the largest contributor of both the initiation and persistence of all behavioral symptoms.

DISCUSSION

Data emphasize that the same psychological factors underlie initiation and persistence of recurrent BSEDs and should shape the focus of future interventions for college men. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:581-590).

Loss of control eating in adolescents from the community

OBJECTIVE

Loss of control (LOC) eating is a salient indicator of eating disorder psychopathology in adolescents and is associated with marked distress. While research has focused on the relevance of episode size, clinical significance of LOC eating frequency has rarely been explored. Therefore, this study aimed at identifying LOC eating prevalence with respect to its recurrence and associated variables in a community-based sample.

METHOD

Participants were 1,643 adolescents, aged 12-20 years (62.4% female). Based on EDE-Q self-report, participants were categorized as those reporting recurrent (N = 156; 9.5%), nonrecurrent (N = 226; 13.8%), and no LOC eating (N = 1261; 76.7%).

RESULTS

Adolescents with recurrent LOC eating reported clinically relevant and significantly greater eating disorder psychopathology, functional impairment, and distress because of LOC eating, and a significantly higher body mass index (BMI, kg/m(2) ) than adolescents with nonrecurrent and those without LOC eating.

DISCUSSION

These results underline that LOC eating is a common eating behavior among adolescents in the community associated with clinical characteristics of eating disorders, and could therefore be a risk factor for developing full- or partial-syndrome eating disorders. Further research on the classification of eating disorders in adolescents with LOC eating and severity indicators is warranted.

Incidence and weight trajectories of binge eating disorder among young women in the community

OBJECTIVE

To assess the population prevalence and incidence of binge eating disorder (BED) among young women.

METHOD

In a nationwide longitudinal study of Finnish twins born 1975-1979, the women participated in five surveys from age 16 until their mid-thirties. At Wave 4 (mean age 24 years), the women (N = 2,825) underwent a 2-stage screening for eating disorders. We assessed the lifetime prevalence, incidence, and clinical characteristics of DSM-5 BED.

RESULTS

We detected 16 women who met DSM-5 criteria for BED, yielding a lifetime prevalence of 0.7% (95% confidence interval [CI] 0.4-1.2%). The incidence of BED among women between 10 and 24 years of age was 35 (95% CI 20-60) per 100,000 person-years. The mean age of onset of BED was 19 years (range 13-27 years). Of the cases, 13/16 (81%) were currently ill. Duration of illness at the time of assessment ranged from less than a year to 13 years (median 6 years). Of women with BED, only two had a history of other eating disorders, but six had lifetime major depressive disorder. Two-thirds of the women with BED belonged to the highest weight quartile at age 16, and their mean BMI at age 22-27 year was 26.2 kg/m(2) (range 22.1-32.5 kg/m(2)).

DISCUSSION

Incident BED as defined by DSM-5 was relatively rare among younger women and was often preceded by relative overweight. BED often occurred without a history of other eating disorders, but comorbidity with major depressive disorder was common.

Bulimic symptom onset in young girls: A longitudinal trajectory analysis

To investigate whether there are different patterns of development for binge eating and purging behavior among preadolescent and early adolescent girls, we conducted trajectory analyses of those behaviors in 938 girls across 8 waves of data from the spring of 5th grade (the last year of elementary school) through the spring of 9th grade (the first year of high school). Analyses revealed 4 separate developmental trajectories for binge eating behavior (labeled none, increasing, decreasing, and high steady) and 3 separate developmental trajectories for purging behavior (labeled none, dabble, and increasing). Fifth grade scores on risk factors that were both transdiagnostic (negative affect and negative urgency) and eating disorder specific (expectancies for reinforcement from eating and from thinness) differentiated among the trajectory groups, in some cases before the groups differed in the target behaviors. These findings are the first, to our knowledge, to examine developmental trajectories for bulimic symptom onset in youth as young as elementary school. Clinical implications are discussed.

Prevalence of and familial influences on purging disorder in a community sample of female twins

OBJECTIVE

Purging disorder (PD) was recently included as an otherwise specified feeding or eating disorder (OSFED) in the DSM-5; however, limited information is available on its prevalence, and its etiology is unknown.

METHOD

Data from 1,790 monozygotic and 1,440 dizygotic European American female twins (age range = 18-29 years) from the Missouri Adolescent Female Twin Study were used to investigate prevalence and familial influences for PD. A structured clinical interview assessed lifetime DSM-IV criteria for eating disorders and PD. After adjustment for age, twin correlations and biometrical twin models were used to estimate familial (i.e., genetic plus shared environmental) influences on PD.

RESULTS

One hundred and twenty one (3.77%; 95% CI: 3.14, 4.49) women met criteria for lifetime PD. Twin correlations suggested that genetic, shared environmental, and nonshared environmental factors influenced liability to PD. Nonshared environmental factors accounted for 56% [35%, 79%] of the variance in PD. Although familial effects accounted for a significant proportion of variance (44% [21%, 65%]), it was not possible to disentangle the independent contributions of additive genetic effects (20% [0%, 65%]) and shared environmental effects (24% [0%, 57%]).

DISCUSSION

PD is a prevalent form of eating pathology. Familial factors are relevant to the development of PD but do not demonstrate the magnitude of heritable factors found for other eating disorders.

Recent Advances in Developmental and Risk Factor Research on Eating Disorders

The Diagnostic and Statistical Manual of Mental Disorders (i.e., DSM-5) currently recognizes three primary eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder. The origins of eating disorders are complex and remain poorly understood. However, emerging research highlights a dimensional approach to understanding the multifactorial etiology of eating disorders as a means to inform assessment, prevention, and treatment efforts. Guided by research published since 2011, this review summarizes recent findings elucidating risk factors for the development of eating disorders across the lifespan in three primary domains: (1) genetic/biological, (2) psychological, and (3) socio-environmental. Prospective empirical research in clinical samples with full-syndrome eating disorders is emphasized with added support from cross-sectional studies, where relevant. The developmental stages of puberty and the transition from adolescence to young adulthood are discussed as crucial periods for the identification and prevention of eating disorders. The importance of continuing to elucidate the mechanisms underlying gene by environmental interactions in eating disorder risk is also discussed. Finally, controversial topics in the field of eating disorder research and the clinical implications of this research are summarized.

Problematic Internet use, excessive alcohol consumption, their comorbidity and cardiovascular and cortisol reactions to acute psychological stress in a student population

BACKGROUND AND AIMS

Problematic Internet use and excessive alcohol consumption have been associated with a host of maladaptive outcomes. Further, low (blunted) cardiovascular and stress hormone (e.g. cortisol) reactions to acute psychological stress are a feature of individuals with a range of adverse health and behavioural characteristics, including dependencies such as tobacco and alcohol addiction. The present study extended this research by examining whether behavioural dependencies, namely problematic Internet use, excessive alcohol consumption, and their comorbidity would also be associated with blunted stress reactivity.

METHODS

A large sample of university students (N = 2313) were screened using Internet and alcohol dependency questionnaires to select four groups for laboratory testing: comorbid Internet and alcohol dependence (N = 17), Internet dependence (N = 17), alcohol dependence (N = 28), and non-dependent controls (N = 26). Cardiovascular activity and salivary cortisol were measured at rest and in response to a psychological stress protocol comprising of mental arithmetic and public speaking tasks.

RESULTS

Neither problematic Internet behaviour nor excessive alcohol consumption, either individually or in combination, were associated with blunted cardiovascular or cortisol stress reactions. Discussion It is possible that problematic Internet behaviour and excessive alcohol consumption in a student population were not related to physiological reactivity as they may not reflect ingrained addictions but rather an impulse control disorder and binging tendency.

CONCLUSIONS

The present results serve to indicate some of the limits of the developing hypothesis that blunted stress reactivity is a peripheral marker of the central motivational dysregulation in the brain underpinning a wide range of health and behavioural problems.

Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence

AIM

To examine the evidence to support using a staging heuristic for eating disorders, suggesting that the diagnosis of an eating disorder follows a trajectory across the life course. Specifically, to examine whether high-risk markers and prodromal features presenting in childhood and adolescence can later transition to the full manifestation of the illness in early adulthood, and whether over time, the illness can be described as becoming severe and enduring, often resistant to treatment.

METHODS

We conducted a comprehensive literature search on the MEDLINE, PubMed, PsycINFO, EMBASE and Cochrane databases from using the following terms: staging, duration of illness, early intervention, developmental epidemiology, neurobiological marker, phenotype, partial syndrome, severe enduring, chronic, prospective, longitudinal, cohort, epidemiology, adolescent, adult with anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder. The evidence was organized according to the staging heuristic defined by McGorry.

RESULTS

Evidence from epidemiological studies, neuropsychological findings, treatment responsivity and prognosis, support a specific staging trajectory for anorexia nervosa in that there is a longitudinal trajectory with evidence of neurobiological progression and evidence that interventions matched to stage of illness may optimize the benefit. There is less data at the moment to support such a model for bulimia nervosa and binge eating disorder.

CONCLUSION

The staging heuristic is a useful model for anorexia nervosa in terms of providing prognostic information and stage matched interventions. Although the evidence is encouraging, further research is needed before a similar model could be applied for bulimia nervosa and binge eating disorder.

Eating disorder symptoms do not just disappear: the implications of adolescent eating-disordered behaviour for body weight and mental health in young adulthood

This study reports the outcomes of childhood and adolescent eating-disordered behaviour on the development of body mass index (BMI) and psychological functioning in young adulthood in a population-based sample in Germany (the BELLA study). Information at baseline and follow-up was obtained through a telephone interview and mailed self-report questionnaires. At both measurement points, BMI, eating disorder symptoms (SCOFF questionnaire), and symptoms of depression and anxiety were assessed in the same cohort of 771 participants (n = 420 females, n = 351 males). The age range at baseline was 11-17 years, and the age range at follow-up was 17-23 years. High scores for eating-disordered behaviour in childhood or adolescence significantly predicted eating-disordered behaviour in young adulthood (multiplicative effect estimate: 1.31; 95 % CI: 1.2-1.42, p < 0.0001), although there was a decline in prevalence (from 19.3 to 13.8 %, p = 0.002) and severity (mean decrease in SCOFF 0.07, 95 % CI: -0.01-0.14, p = 0.06). After accounting for potentially confounding variables at baseline (SES, probands' BMI, parental BMI, depressive symptoms), participants with more eating disorder symptoms at baseline had a higher risk of developing overweight (odds ratio (OR): 1.58; 95 % CI: 1.19-2.09, p = 0.001), obesity (OR = 1.67; 95 % CI: 1.03-2.66, p = 0.03), and depressive symptoms at follow-up (additive effect estimate: 0.45; 95 %CI: 0.19-0.7, p = 0.0006). Early symptoms of depression showed a significant relationship with extreme underweight in young adulthood (OR = 1.13; 95 %CI: 1.01-1.25, p = 0.02). The high stability of eating disorder symptoms and the significant association with overweight and worse mental health in adulthood underscore the need for early detection and intervention during childhood and adolescence. Youth with depression should be monitored for the development of restrictive eating disorders.

Prevalence of purging at age 16 and associations with negative outcomes among girls in three community-based cohorts

BACKGROUND

The comorbidity of purging behaviours, such as vomiting, inappropriate use of laxatives, diuretics or slimming medications, has been examined in literature. However, most studies do not include adolescents, individuals who purge in the absence of binge eating, or those purging at subclinical frequency. This study examines the prevalence of purging among 16-year-old girls across three countries and their association with substance use and psychological comorbidity.

METHODS

Data were obtained by questionnaire in 3 population-based cohorts (Avon Longitudinal Study of Parents and Children (ALSPAC), United Kingdom, n = 1,608; Growing Up Today Study (GUTS), USA, n = 3,504; North Finland Birth Cohort (NFBC85/86), Finland, n = 2,306). Multivariate logistic regressions were employed to estimate associations between purging and outcomes. Four models were fit adjusting for binge eating and potential confounders of these associations.

RESULTS

In ALSPAC, 9.7% of girls reported purging in the 12-months prior to assessment, 7.3% in GUTS, and 3.5% in NFBC. In all 3 cohorts, purging was associated with adverse outcomes such as binge drinking (ALSPAC: odds ratio (OR) = 2.0, 95% confidence interval (CI) = 1.4-2.9; GUTS: OR = 2.5, 95% CI = 1.5-4.0; NFBC: OR = 1.7, 95% CI = 1.0-2.8), drug use (ALSPAC: OR = 2.9, 95% CI = 1.8-4.7; GUTS: OR = 4.5, 95% CI = 2.8-7.3; NFBC: OR = 4.1, 95% CI = 2.6-6.6), depressive symptoms in ALSPAC (OR = 2.2, 95% CI = 1.5-3.1) and GUTS(OR = 3.7, 95% CI = 2.2-6.3), and several psychopathology measures including clinical anxiety/depression in NFBC (OR = 11.2, 95% CI = 3.9, 31.7).

CONCLUSIONS

Results show a higher prevalence of purging behaviours among girls in the United Kingdom compared to those in the United States and Finland. Our findings support evidence highlighting that purging in adolescence is associated with negative outcomes, independent of its frequency and binge eating.

Adolescent eating disorders: update on definitions, symptomatology, epidemiology, and comorbidity

The prevalence of eating disorders among adolescents continues to increase. The starvation process itself is often associated with severe alterations of central and peripheral metabolism, affecting overall health during this vulnerable period. This article aims to convey basic knowledge on these frequent and disabling disorders, and to review new developments in classification issues resulting from the transition to DSM-5. A detailed description is given of the symptomatology of each eating disorder that typically manifests during adolescence. New data on epidemiology, and expanding knowledge on associated medical and psychiatric comorbidities and their often long-lasting sequelae in later life, are provided.

Risk factors for binge eating and purging eating disorders: differences based on age of onset

OBJECTIVE

To (1) determine whether childhood risk factors for early onset binge eating and purging eating disorders also predict risk for later-onset binge eating and purging disorders, and (2) compare the utility of childhood and early adolescent variables in predicting later-onset disorders.

METHOD

Participants (N = 1,383) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to age 20. Eating disorders were assessed when participants were aged 14, 17, and 20. Risk factors for early onset eating disorders have been reported previously (Allen et al., J Am Acad Child Psychiat, 48, 800-809, 2009). This study used logistic regression to determine whether childhood risk factors for early onset disorders, as previously identified, would also predict risk for later-onset disorders (n = 145). Early adolescent predictors of later-onset disorders were also examined.

RESULTS

Consistent with early onset cases, female sex and parent-perceived child overweight at age 10 were significant multivariate predictors of binge eating and purging disorders with onset in later adolescence. Eating, weight, and shape concerns at age 14 were also significant in predicting later-onset disorders. In the final stepwise multivariate model, female sex and eating, weight, and shape concerns at age 14 were significant in predicting later-onset eating disorders, while parent-perceived child overweight at age 10 was not.

DISCUSSION

There is overlap between risk factors for binge eating and purging disorders with early and later onset. However, childhood exposures may be more important for early than later onset cases.

Distinguishing Between Risk Factors for Bulimia Nervosa, Binge Eating Disorder, and Purging Disorder

Binge eating disorder and purging disorder have gained recognition as distinct eating disorder diagnoses, but risk factors for these conditions have not yet been established. This study aimed to evaluate a prospective, mediational model of risk for the full range of binge eating and purging eating disorders, with attention to possible diagnostic differences. Specific aims were to determine, first, whether eating, weight and shape concerns at age 14 would mediate the relationship between parent-perceived childhood overweight at age 10 and a binge eating or purging eating disorder between age 15 and 20, and, second, whether this mediational model would differ across bulimia nervosa, binge eating disorder, and purging disorder. Participants (N = 1,160; 51 % female) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to age 20. Eating disorders were assessed via self-report questionnaires when participants were aged 14, 17 and 20. There were 146 participants (82 % female) with a binge eating or purging eating disorder with onset between age 15 and 20 [bulimia nervosa = 81 (86 % female), binge eating disorder = 43 (74 % female), purging disorder = 22 (77 % female)]. Simple mediation analysis with bootstrapping was used to test the hypothesized model of risk, with early adolescent eating, weight and shape concerns positioned as a mediator between parent-perceived childhood overweight and later onset of a binge eating or purging eating disorder. Subsequently, a conditional process model (a moderated mediation model) was specified to determine if model pathways differed significantly by eating disorder diagnosis. In the simple mediation model, there was a significant indirect effect of parent-perceived childhood overweight on risk for a binge eating or purging eating disorder in late adolescence, mediated by eating, weight and shape concerns in early adolescence. In the conditional process model, this significant indirect effect was not moderated by eating disorder group. The results support a prospective model of risk that applies to bulimia nervosa, binge eating disorder and purging disorder. Common prevention approaches may be possible for bulimia nervosa, binge eating disorder and purging disorder.

Two pathways toward impulsive action: an integrative risk model for bulimic behavior in youth

BACKGROUND

This study provides an integrative review of existing risk factors and models for bulimia nervosa (BN) in young girls. We offer a new model for BN that describes two pathways of risk that may lead to the initial impulsive act of binge eating and purging in children and adolescents.

SCOPE

We conducted a selective literature review, focusing on existing and new risk processes for BN in this select population.

FINDINGS

We identify two ways in which girls increase their risk to begin engaging in the impulsive behavior of binge eating and purging. The first is state-based: the experience of negative mood, in girls attempting to restrain eating, leads to the depletion of self-control and thus increased risk for loss of control eating. The second is personality-based: elevations on the trait of negative urgency, or the tendency to act rashly when distressed, increase risk, particularly in conjunction with high-risk psychosocial learning. We then briefly discuss how these behaviors are reinforced, putting girls at further risk for developing BN.

CONCLUSIONS

We highlight several areas in which further inquiry is necessary, and we discuss the clinical implications of the new risk model we described.

[The role of the family in childhood and adolescent binge eating - a systematic review]

OBJECTIVE

While family factors in childhood and adolescent anorexia nervosa and bulimia nervosa are well documented and have often been reviewed in the past, less is known about these influences on binge eating without compensatory behavior. This systematic review describes family factors in the development and maintenance of binge eating.

METHOD

A systematic literature search was conducted for studies on associations between binge eating, loss of control eating, and family outcomes.

RESULTS

Consistent evidence was found for cross-sectional associations between binge eating and insecure attachment of the child, lower family functioning, and lower parental involvement; for parental unemployment and parental depression as retrospective correlates; and for fewer family meals and more critical comments about weight or shape by parents as variable risk factors. In contrast, rather inconsistent findings referred to the influence of family structures, parental eating disorders, dieting, and their knowledge about child's eating behavior. Gender differences were identified in association with family relationships and weight stigmatization.

CONCLUSIONS

As with other eating disorders in youth, the results suggest the importance of familial factors in binge eating. Consequently, family assessment and family-based interventions might be helpful in the treatment of childhood and adolescent binge eating. More research should clarify inconsistent findings using prospective designs.