1
|
Ozsvar J, Gissler M, Lavebratt C, Nilsson IAK. Exposures during pregnancy and at birth are associated with the risk of offspring eating disorders. Int J Eat Disord 2023; 56:2232-2249. [PMID: 37646613 DOI: 10.1002/eat.24053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Eating disorders (ED) are severe psychiatric disorders, commonly debuting early. Aberrances in the intrauterine environment and at birth have been associated with risk of ED. Here, we explore if, and at what effect size, a variety of such exposures associate with offspring ED, that is, anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). METHODS This population-based cohort study, conducted from September 2021 to August 2023, used Finnish national registries of all live births in 1996-2014 (N = 1,097,753). Cox proportional hazards modeling was used to compare ED risk in exposed versus unexposed offspring, adjusting for potential confounders and performing sex-stratified analyses. RESULTS A total of 6614 offspring were diagnosed with an ED; 3668 AN, 666 BN, and 4248 EDNOS. Lower risk of offspring AN was seen with young mothers, continued smoking, and instrumental delivery, while higher risk was seen with older mothers, inflammatory disorders, prematurity, small for gestational age, and low Apgar. Offspring risk of BN was higher with continued smoking and prematurity, while lower with postmature birth. Offspring risk of EDNOS was lower with instrumental delivery, higher for older mothers, polycystic ovary syndrome, insulin-treated pregestational diabetes, antibacterial treatment, prematurity, and small for gestational age. Sex-specific associations were found. CONCLUSIONS Several prenatal and at birth exposures are associated with offspring ED; however, we cannot exclude confounding by maternal BMI. Nevertheless, several exposures selectively associate with risk of either AN, BN, or EDNOS, and some are sex-specific, emphasizing the importance of subtype- and sex-stratified analyses of ED. PUBLIC SIGNIFICANCE We define environmental factors involved in the development of different ED, of importance as preventive measure, but also in order to aid in defining the molecular pathways involved and thus in the longer perspective contribute to the development of pharmacological treatment of ED.
Collapse
Affiliation(s)
- Judit Ozsvar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mika Gissler
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ida A K Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Centre for Eating Disorders Innovation, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Koch SV, Larsen JT, Plessen KJ, Thornton LM, Bulik CM, Petersen LV. Associations between parental socioeconomic-, family-, and sibling status and risk of eating disorders in offspring in a Danish national female cohort. Int J Eat Disord 2022; 55:1130-1142. [PMID: 35809040 PMCID: PMC9546370 DOI: 10.1002/eat.23771] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Studies on parental socioeconomic status (SES) and family risk factors for eating disorders (EDs) have yielded inconsistent results; however, several studies have identified high parental educational attainment as a risk factor. The aim was to evaluate associations of parental SES and family composition with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS) in the offspring, adjusting for parental age and parental mental health. METHODS The cohort included women born in Denmark between January 1, 1989 and December 31, 2010, derived from Danish national registers. Each person was followed from their sixth birthday until onset of the disorder of interest or to December 31, 2016. Exposure variables were: childhood SES, defined as individually evaluated parental level of income, occupation, and education; sibling status; and family composition. Outcomes were: AN, BN, EDNOS, and major depressive disorder (MDD), included as a psychiatric comparison disorder. Risks were estimated using Cox proportional hazards. RESULTS High parental SES was associated with increased risk of especially AN, and less so BN and EDNOS, in offspring. In comparison, low SES was associated with a higher risk of MDD. No differences between maternal or paternal socioeconomic risk factors were found. Family composition and sibling status showed limited influence on ED risk. DISCUSSION SES shows opposite associations with AN than MDD, whereas associations with BN and EDNOS are intermediate. The socioeconomic backdrop of AN differs markedly from that reported in other psychiatric disorders. Whether that is due to genetic and/or environmental factors remains unknown. PUBLIC SIGNIFICANCE STATEMENT Parental socioeconomic background (SES) may influence eating disorders risk in offspring somewhat differently than other psychiatric disorders. In Denmark, higher parental SES was associated with increased risk of, particularly, anorexia nervosa (AN). Importantly AN does strike across the SES spectrum. We must ensure that individuals of all backgrounds have equal access to care and are equally likely to be detected and treated appropriately for eating disorders.
Collapse
Affiliation(s)
- Susanne Vinkel Koch
- Department of Child and Adolescent PsychiatryCopenhagen University Hospital ‐ Psychiatry Region ZealandCopenhagenDenmark,Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Janne Tidselbak Larsen
- National Centre for Register‐based Research, Aarhus BSSAarhus UniversityAarhusDenmark,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)Aarhus UniversityAarhusDenmark,Centre for Integrated Register‐based Research (CIRRAU)Aarhus UniversityAarhusDenmark
| | - Kerstin J. Plessen
- Division of Child and Adolescent Psychiatry, Department of PsychiatryUniversity Hospital Lausanne, University of LausanneLausanneSwitzerland
| | - Laura M. Thornton
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Cynthia M. Bulik
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA,Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA,Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Liselotte Vogdrup Petersen
- National Centre for Register‐based Research, Aarhus BSSAarhus UniversityAarhusDenmark,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH)Aarhus UniversityAarhusDenmark,Centre for Integrated Register‐based Research (CIRRAU)Aarhus UniversityAarhusDenmark
| |
Collapse
|
3
|
Harrop EN, Mensinger JL, Moore M, Lindhorst T. Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. Int J Eat Disord 2021; 54:1328-1357. [PMID: 33864277 PMCID: PMC9035356 DOI: 10.1002/eat.23519] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Currently, there is debate in the eating disorders field regarding how to define atypical anorexia (AAN), how prevalent it is in community and clinical settings, and how AAN rates compare with low-weight AN. This systematic review assesses AAN literature from 2007 to 2020, to investigate: (a) the demographic characteristics of AAN studies, (b) the prevalence of AAN compared with AN, (c) the range of operational definitions of AAN and the implications of these definitions, and (d) the proportion of patients with AAN and AN represented in consecutive admission and referral samples. METHOD PsychINFO, CINAHL, PubMed, Greylit.org, and ProQuest databases were searched according to methods for Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic reviews, yielding 3,184 potential articles. Seventy-five eligible studies were coded for sixty-one variables. RESULTS Clinical samples predominantly included younger, female, white samples with limited diversity. In epidemiological designs, AAN was typically as common or more common than AN, and AAN rates varied significantly based on the population studied and operational definitions. In consecutive clinical samples, AAN was frequently less represented. DISCUSSION Although AAN appears to occur more frequently than AN in communities, fewer patients with AAN are being referred and admitted to eating disorder specific care, particularly in the United States. Given the significant medical and psychosocial consequences of AAN, and the importance of early intervention, this represents a crucial treatment gap. Additionally, results suggest the need for fine-tuning diagnostic definitions, greater diversity in AAN studies, and increased screening and referral for this vulnerable population.
Collapse
Affiliation(s)
- Erin N. Harrop
- Graduate School of Social Work, University of Denver, Denver, Colorado,School of Social Work, University of Washington, Seattle, Washington
| | | | - Megan Moore
- School of Social Work, University of Washington, Seattle, Washington
| | - Taryn Lindhorst
- School of Social Work, University of Washington, Seattle, Washington
| |
Collapse
|
4
|
Abstract
BACKGROUND Among the most disabling and fatal psychiatric illnesses, eating disorders (EDs) often manifest early in life, which encourages investigations into in utero and perinatal environmental risk factors. The objective of this study was to determine whether complications during pregnancy and birth and perinatal conditions are associated with later eating disorder risk in offspring and whether these associations are unique to EDs. METHODS All individuals born in Denmark to Danish-born parents 1989-2010 were included in the study and followed from their 6th birthday until the end of 2016. Exposure to factors related to pregnancy, birth, and perinatal conditions was determined using national registers, as were hospital-based diagnoses of anorexia nervosa (AN), bulimia nervosa, and eating disorder not otherwise specified during follow-up. For comparison, diagnoses of depressive, anxiety, and obsessive-compulsive disorders were also included. Cox regression was used to compare hazards of psychiatric disorders in exposed and unexposed individuals. RESULTS 1 167 043 individuals were included in the analysis. We found that similar to the comparison disorders, prematurity was associated with increased eating disorder risk. Conversely, patterns of increasing risks of EDs, especially in AN, with increasing parental ages differed from the more U-shaped patterns observed for depressive and anxiety disorders. CONCLUSIONS Our results suggest that pregnancy and early life are vulnerable developmental periods when exposures may influence offspring mental health, including eating disorder risk, later in life. The results suggest that some events pose more global transdiagnostic risk whereas other patterns, such as increasing parental ages, appear more specific to EDs.
Collapse
Affiliation(s)
- Janne Tidselbak Larsen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susanne Vinkel Koch
- Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Petersen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| |
Collapse
|
5
|
Fleming C, Le Brocque R, Healy K. How are families included in the treatment of adults affected by eating disorders? A scoping review. Int J Eat Disord 2021; 54:244-279. [PMID: 33345319 DOI: 10.1002/eat.23441] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The involvement of families in the treatment of adults with eating disorders is recommended as a core component of comprehensive care, yet little is known about the optimal way to implement or routinely facilitate this. This article evaluates the recent evidence on the inclusion of families in treatment programs for adults with eating disorders. METHOD A systematic literature search was conducted to identify evidence of family inclusive treatment approaches for adults with eating disorders. A scoping review framework was applied to assess and synthesize findings. RESULTS Sixty-eight studies were identified. Substantial conceptual research contributing to the theoretical basis of current practice with families of adults with eating disorders and clinical applications in current use were identified. Most research used uncontrolled studies with few experimental designs, reflecting the standing of the extant literature. Common elements of existing approaches have been distinguished and shared core components of interventions identified. DISCUSSION Results confirmed that family members of adults were willing to be involved with eating disorder treatment services and appeared to respond to interventions of varying intensity and duration. The impact on individual patients, and effect on treatment outcomes, are yet to be established. The localized settings of existing studies, the homogenous nature of interventions used, and the limited diversity in research subjects, make it difficult to generalize from the results to the wide range of adult eating disorder presentations seen in practice. Suggestions for future research and further clinical developments are discussed.
Collapse
Affiliation(s)
- Carmel Fleming
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Health Metro North Hospital and Health Service, Queensland Eating Disorder Service, Brisbane, Australia
| | - Robyne Le Brocque
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Karen Healy
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
6
|
Williams H, Moxley K, Macharia M, Kidd M, Jordaan GP. Eating disorders and substance use at a South African tertiary hospital over a 21-year period. S Afr J Psychiatr 2020; 26:1421. [PMID: 32670633 PMCID: PMC7343936 DOI: 10.4102/sajpsychiatry.v26i0.1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 03/05/2020] [Indexed: 11/24/2022] Open
Abstract
Background Eating disorders (EDs) and substance-related disorders pose a challenge when they co-occur and have implications for patient management. Clinical information on EDs and substance-related disorders as independent disorders is fairly well established in South Africa, but our understanding of the coexistence of these disorders is limited. Aim To determine the prevalence, the concurrent nature and the possible trends of substance use among patients diagnosed with EDs at a South African tertiary hospital over a 21-year period. Setting The ED unit at Tygerberg Hospital, Cape Town, South Africa. Methods We performed a retrospective chart review of 162 patients who were treated for EDs between January 1993 and December 2014. Results The prevalence of ED subtypes was 40.1% bulimia nervosa (BN), 33.3% EDs not otherwise specified (EDNOS) and 26.5% anorexia nervosa. Most participants (71.0%) used at least one substance. Alcohol was the most prevalent substance of choice (54.8%). Most patients had an additional psychiatric disorder (62.3%), of which major depressive disorder was the most prevalent (46.3%). Apart from the use of alcohol and cannabis, which remained consistent, the use of most other substances as well as the prevalence of BN declined during the study period. Conclusion Understanding the prevalence and trends of EDs and the corresponding patterns of substance misuse is essential to improve service provision. This study emphasises the need to better understand the ongoing and changing behavioural trends in EDs to improve patient management.
Collapse
Affiliation(s)
- Hannelie Williams
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karis Moxley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Muiruri Macharia
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Department of Statistics and Actuarial Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gerhard P Jordaan
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
7
|
Górski M, Całyniuk B, Garbicz J, Żukowska-Bąk M, Kapcińska A, Paciorek K, Polaniak R. [Eating disorders - diagnosis and characteristics]. Pol Merkur Lekarski 2020; 48:133-138. [PMID: 32352948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Eating disorders are characterized by eating and appetite disorders, which develop on a mental basis. Currently, there is a rapid increase in the frequency of these disorders, especially among children and adolescents. Eating disorders include anorexia nervosa, bulimia nervosa and EDNOS, which include a dozen or so disorders, but this group is still expanding. Eating disorders are characterized by the highest mortality rate among all mental illnesses. They mainly affect adolescents and young adults as well as the female sex, however, there are more and more cases among men and people from other age groups. Anorexia nervosa is the conscious reduction of food intake in order to reduce body weight. In this disorder there is abnormal body image, underweight and fear of weight gain. According to the American Psychiatric Association, there are two types of anorexia nervosa - restrictive (limiting) and bulimic (laxative). Bulimia nervosa is characterized by abnormal food intake (overeating) and co-occurrence of compensatory methods aimed at limiting the absorption of consumed food. These methods include: provoking vomiting, excessive physical effort, taking diuretics and laxatives. Among the eating disorders we also distinguish eating disorders not defined otherwise (EDNOS). This is a group of diseases in which pathological eating behaviour occurs, but they do not meet the diagnostic criteria of anorexia or bulimia. The diagnosis of eating disorders is difficult not only because of the lack of specialists dealing with this subject, but also because of the lack of public awareness of these diseases. That is why it is so important to educate both medical staff and the general public about eating disorders.
Collapse
Affiliation(s)
- Michał Górski
- Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Poland: Doctoral School
| | - Beata Całyniuk
- Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Poland: Department of Human Nutrition
| | - Jagoda Garbicz
- Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Poland: Doctoral School
| | - Magdalena Żukowska-Bąk
- Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Poland: Doctoral School
| | - Anna Kapcińska
- Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Poland: Second Scientific Group of the Department of Toxicology and Health Protection
| | - Kamila Paciorek
- Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Poland: Second Scientific Group of the Department of Toxicology and Health Protection
| | - Renata Polaniak
- Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Poland: Department of Human Nutrition
| |
Collapse
|
8
|
Vrabel K, Bratland-Sanda S. Exercise Obsession and Compulsion in Adults With Longstanding Eating Disorders: Validation of the Norwegian Version of the Compulsive Exercise Test. Front Psychol 2019; 10:2370. [PMID: 31695652 PMCID: PMC6817603 DOI: 10.3389/fpsyg.2019.02370] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/04/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives The objectives of this study were to (1) validate the Norwegian version of the Compulsive Exercise Test (CET) in adults with longstanding eating disorders, and (2) explore predictors of high CET-score. Methods: Adult inpatients (n = 166) with longstanding DSM-IV Anorexia Nervosa, Bulimia Nervosa (BN) or Eating Disorder not Otherwise Specified (EDNOS) completed the CET instrument, Eating Disorder examination questionnaire (EDE-Q), Beck Depression Inventory-II (BDI-II) and Symptom checklist-90 (SCL-90). A total CET score of 15 or above was defined as high CET-score. ANOVA, Confirmatory factor analysis, Pearson’s correlation, and logistic regression were used to analyze the data. Results Cronbach’s alpha varied from 0.68 to 0.96 for the CET and its subscales. The confirmatory factor analysis showed adequate fit. Convergent validity of the CET demonstrated correlation between EDE-Q global and subscale scores and CET total score. The same pattern was found for correlation between CET subscales and EDE-Q subscales. EDE-Q global score and frequency of exercise episodes predicted high CET-score, yet 21% of the patients with high CET score had less than one episode of exercise per week. Conclusion The Norwegian version of CET is valid and useful for assessing compulsive exercise in a sample with longstanding ED. The understanding of compulsive exercise must to a greater extent differ between obsessions and compulsions, as a significant number of patients with high CET score showed no or little exercise behavior.
Collapse
Affiliation(s)
- Karianne Vrabel
- Research Institute, Modum Bad Psychiatric Center, Vikersund, Norway
| | - Solfrid Bratland-Sanda
- Department of Sports, Physical Education and Outdoor Life, University of South-Eastern Norway, Kongsberg, Norway
| |
Collapse
|
9
|
Larsen JT, Munk-Olsen T, Bulik CM, Thornton LM, Koch SV, Mortensen PB, Petersen L. Early childhood adversities and risk of eating disorders in women: A Danish register-based cohort study. Int J Eat Disord 2017; 50:1404-1412. [PMID: 29105808 DOI: 10.1002/eat.22798] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Previous studies evaluating the association between early childhood adversities and eating disorders have yielded conflicting results. The aim of this study is to examine the association between a range of adversities and risk of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS) in 495,244 women. METHOD In this nationwide, register-based cohort study, nine types of early childhood adversity (family disruption, residential instability, placement in out-of-home care, familial death, parental somatic illness, parental psychiatric illness, parental disability, severe parental criminality, and parental substance use disorder) were defined and exposure during the first 6 years of life was determined. Hazard ratios for eating disorders were calculated using Cox regression. RESULTS Few adversities were significantly associated with AN, and for each, the presence of the adversity was associated with lower risk for AN. BN, and EDNOS were positively associated with several types of adversities. AN rates were unchanged or reduced by up to 54% by adversities, whereas rates of BN and EDNOS were unchanged or increased by adversities by up to 49 and 89%, respectively. DISCUSSION Our findings indicate that childhood adversities appear to be associated with an increased risk of BN and in particular EDNOS, whereas they seem to be either unassociated or associated with a decreased risk of AN.
Collapse
Affiliation(s)
- Janne Tidselbak Larsen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Trine Munk-Olsen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susanne Vinkel Koch
- Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Preben Bo Mortensen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Liselotte Petersen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| |
Collapse
|
10
|
Goh KHR, Lee EL. Prevalence of abnormal liver function tests and comorbid psychiatric disorders among patients with anorexia nervosa and eating disorders not otherwise specified in the anorexia nervosa DSM-IV criteria. Singapore Med J 2016; 56:488-92. [PMID: 26451050 DOI: 10.11622/smedj.2015132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Anorexia nervosa (AN) and eating disorders not otherwise specified (EDNOS) are on the rise in Singapore. Abnormal liver function tests have been reported for up to 12.2% of patients with AN. These patients are also known to present with comorbid psychiatric disorders. This study aims to investigate the correlation between body mass index (BMI) and the severity of abnormal liver function tests, and between BMI and the presence of comorbid psychiatric disorders. METHODS A retrospective cohort analysis of 373 patients diagnosed with AN or EDNOS at a tertiary hospital was performed. The clinical course of transaminitis and comorbid psychiatric disorders was correlated with the patient's BMI. RESULTS Patients with a BMI of ≥ 16.6 kg/m(2) at their first consult had a significantly lower risk of having comorbid psychiatric disorders (χ(2) = 32.08, p < 0.001). These patients were five times less likely to have comorbid psychiatric disorders as compared to patients from the other BMI groups (odds ratio [OR] 0.21). On the other hand, patients with a BMI of < 14.6 kg/m(2) had a significantly higher risk of having transaminitis (χ(2) = 72.5, p < 0.001). They were 11.1 times more likely to develop transaminitis as compared to patients with a BMI of ≥ 14.6 kg/m(2) (OR 11.05). CONCLUSION Severity of BMI can be used by clinicians as an indicator to assess for secondary psychiatric comorbidities and/or transaminitis during the first consultation. This could help reduce the morbidity and mortality rates in patients with AN or EDNOS.
Collapse
Affiliation(s)
| | - Ee Lian Lee
- Department of Psychiatry, Singapore General Hospital, Singapore
| |
Collapse
|
11
|
Bellows BK, DuVall SL, Kamauu AWC, Supina D, Babcock T, LaFleur J. Healthcare costs and resource utilization of patients with binge-eating disorder and eating disorder not otherwise specified in the Department of Veterans Affairs. Int J Eat Disord 2015; 48:1082-91. [PMID: 25959636 DOI: 10.1002/eat.22427] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 04/13/2015] [Accepted: 04/19/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this study was to compare the one-year healthcare costs and utilization of patients with binge-eating disorder (BED) to patients with eating disorder not otherwise specified without BED (EDNOS-only) and to matched patients without an eating disorder (NED). METHODS A natural language processing (NLP) algorithm identified adults with BED from clinical notes in the Department of Veterans Affairs (VA) electronic health record database from 2000 to 2011. Patients with EDNOS-only were identified using ICD-9 code (307.50) and those with NLP-identified BED were excluded. First diagnosis date defined the index date for both groups. Patients with NED were randomly matched 4:1, as available, to patients with BED on age, sex, BMI, depression diagnosis, and index month. Patients with cost data (2005-2011) were included. Total healthcare, inpatient, outpatient, and pharmacy costs were examined. Generalized linear models were used to compare total one-year healthcare costs while adjusting for baseline patient characteristics. RESULTS There were 257 BED, 743 EDNOS-only, and 823 matched NED patients identified. The mean (SD) total unadjusted one-year costs, in 2011 US dollars, were $33,716 ($38,928) for BED, $37,052 ($40,719) for EDNOS-only, and $19,548 ($35,780) for NED patients. When adjusting for patient characteristics, BED patients had one-year total healthcare costs $5,589 higher than EDNOS-only (p = 0.06) and $18,152 higher than matched NED patients (p < 0.001). DISCUSSION This study is the first to use NLP to identify BED patients and quantify their healthcare costs and utilization. Patients with BED had similar one-year total healthcare costs to EDNOS-only patients, but significantly higher costs than patients with NED.
Collapse
Affiliation(s)
- Brandon K Bellows
- VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah
| | - Scott L DuVall
- VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah.,Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
| | | | | | | | - Joanne LaFleur
- VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah
| |
Collapse
|
12
|
Bould H, Sovio U, Koupil I, Dalman C, Micali N, Lewis G, Magnusson C. Do eating disorders in parents predict eating disorders in children? Evidence from a Swedish cohort. Acta Psychiatr Scand 2015; 132:51-9. [PMID: 25572654 DOI: 10.1111/acps.12389] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We investigated whether parental eating disorders (ED) predict ED in children, using a large multigeneration register-based sample. METHOD We used a subset of the Stockholm Youth Cohort born 1984-1995 and resident in Stockholm County in 2001-2007 (N = 286,232), The exposure was a diagnosed eating disorder in a parent; the outcome was any eating disorder diagnosis in their offspring, given by a specialist clinician, or inferred from an appointment at a specialist eating disorder clinic. A final study sample of 158,697 (55.4%) had data on these variables and confounding factors and contributed a total of 886,241 person years to the analysis. RESULTS We found good evidence in support of the hypothesis that ED in either parent are independently associated with ED in their female children (HR 1.97 (95% CI: 1.17-3.33), P = 0.01) and that ED in mothers are independently associated with ED in their female children (HR 2.35 (95% CI: 1.39-3.97) P = 0.001). Numbers were too low to permit separate analysis of ED in parents and their male children. CONCLUSION Eating disorders in parents were associated with ED in children. This study adds to our knowledge about the intergenerational transmission of ED, which will help identify high-risk groups and brings about the possibility of targeted prevention.
Collapse
Affiliation(s)
- H Bould
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - U Sovio
- Department of Obstetrics & Gynaecology, The Rosie Hospital, Cambridge, UK
| | - I Koupil
- Centre for Health Equity Studies, Stockholm University/Karolinska Institute, Stockholm, Sweden
| | - C Dalman
- Division of Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - N Micali
- Behavioural and Brain Sciences Unit, UCL Institute of Child Health, London, UK
| | - G Lewis
- Mental Health Sciences Unit, Faculty of Brain Sciences, UCL, London, UK
| | - C Magnusson
- Division of Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
13
|
Ackard DM, Richter S, Egan A, Cronemeyer C. Poor outcome and death among youth, young adults, and midlife adults with eating disorders: an investigation of risk factors by age at assessment. Int J Eat Disord 2014; 47:825-35. [PMID: 25111891 DOI: 10.1002/eat.22346] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/23/2014] [Accepted: 07/23/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Eating disorders (EDs) present across a broad age range, yet little is known about the characteristics and outcome of midlife patients compared to younger patients. Among patients seeking ED treatment who were stratified by age at initial assessment (IA), this study aimed to (1) discern sociodemographic and clinical differences, (2) determine outcome rates, and (3) identify predictors of poor outcome including death. METHOD Participants [219 females (12 years or older, 94.1% Caucasian) who completed outcome assessment and 31 known decedents] were stratified by age at IA (<18 as youth, 18-39 as young adult, and ≥40 years as midlife adult). Analyses of variance and chi-square tests identified group differences; ordered logistic regression with stepwise selection identified factors predicting outcome. RESULTS Midlife adults were more significantly compromised at follow-up compared to youths and young adults, including psychological and physical quality of life, ineffectiveness, interpersonal concerns, and general psychological maladjustment. Midlife adults had the highest rates of poor outcome or death; good outcome was achieved by only 5.9% of midlife adult compared to 14.0% of young adult and 27.5% of youth patients. Older age at IA, alcohol and/or drug misuse, endocrine concerns, and absence of family ED history predicted poor outcome or death. DISCUSSION Midlife adults seeking ED treatment have more complex medical and psychological concerns and poorer outcomes than youths and young adults; further exploration is needed to improve treatment outcome. Specialized treatment focusing on quality of life, comorbid medical concerns, interpersonal connection, and emotion regulation is encouraged.
Collapse
Affiliation(s)
- Diann M Ackard
- Park Nicollet Melrose Center, St. Louis Park, Minnesota; Offices of Diann M Ackard, PhD, LP, LLC, Golden Valley, Minnesota
| | | | | | | |
Collapse
|
14
|
Swanson SA, Horton NJ, Crosby RD, Micali N, Sonneville KR, Eddy K, Field AE. A latent class analysis to empirically describe eating disorders through developmental stages. Int J Eat Disord 2014; 47:762-72. [PMID: 24909947 PMCID: PMC4211958 DOI: 10.1002/eat.22308] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/18/2014] [Accepted: 05/20/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The current standards for classifying eating disorders were primarily informed by adult, clinical study populations, while it is unknown whether an empirically based classification system can be supported across preadolescence through young adulthood. Using latent class analyses, we sought to empirically classify disordered eating in females from preadolescence to young adulthood, and assess the association between classes and adverse outcomes. METHOD Latent class models were fit using observations from the 9,039 girls participating in the growing up today study, an on-going cohort following participants annually or biennially since 1996 when they were ages 9-14 years. Associations between classes and drug use, binge drinking, and depressive symptoms were assessed using generalized estimating equations. RESULTS Across age groups, there was evidence of six classes: a large asymptomatic class, a class characterized by shape/weight concerns, a class characterized by overeating without loss of control, and three resembling full and subthreshold binge eating disorder, purging disorder, and bulimia nervosa. Relative prevalences of classes varied across developmental stages, with symptomatic classes increasing in prevalence with increasing age. Symptomatic classes were associated with concurrent and incident drug use, binge drinking, and high depressive symptoms. DISCUSSION A classification system resembling broader definitions of DSM-5 diagnoses along with two further subclinical symptomatic classes may be a useful framework for studying disordered eating among adolescent and young adult females.
Collapse
Affiliation(s)
- Sonja A. Swanson
- Department of Epidemiology, Harvard School of Public Health, Boston MA
| | | | - Ross D. Crosby
- Neuropsychiatric Research Institute and Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Nadia Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK
| | - Kendrin R. Sonneville
- Division of Adolescent Medicine, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - Kamryn Eddy
- Harris Center for Education and Advocacy in Eating Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Alison E. Field
- Department of Epidemiology, Harvard School of Public Health, Boston MA,Division of Adolescent Medicine, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
15
|
Abstract
BACKGROUND AND OBJECTIVES Clinicians are increasingly observing adolescents who have lost large amounts of weight, experience typical cognitions and acute medical complications of anorexia nervosa (AN), yet do not meet diagnostic criteria for AN owing to weight. We refer to this category of Eating Disorder Not Otherwise Specified as EDNOS-Wt. We set out to describe the changing incidence of EDNOS-Wt compared with AN, and to compare the characteristics of these 2 groups in a cohort that required hospitalization after weight loss. METHODS A 6-year retrospective cohort study (2005 to 2010) was undertaken of first admissions of 12- to 19-year-old patients to a tertiary children's hospital using Diagnostic Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) AN or EDNOS-Wt. Clinical, biochemical, and nutritional data were collected up to day 28 of admission. RESULTS Ninety-nine adolescents were admitted; 73 had AN and 26 had EDNOS-Wt. Mean (SD) age at admission was 15.2 years (1.3) and 87% were female. In 2005, EDNOS-Wt represented 8% of admissions; by 2009 this proportion had increased to 47%. Hypophosphatemia developed in 41% of AN and in 39% of EDNOS-Wt patients. The lowest mean pulse rate in AN was 45.1 bpm compared with 47.1 bpm in EDNOS-Wt patients. CONCLUSIONS We have experienced more than a fivefold increase in the proportion of adolescents who have EDNOS-Wt admitted over this 6-year period. Despite not being underweight, EDNOS-Wt patients experienced a similar profile of life-threatening complications of weight loss as patients who have AN. Higher-weight adolescents who have extensively lost weight require careful medical assessment.
Collapse
Affiliation(s)
- Melissa Whitelaw
- Department of Nutrition and Food Services, and Centre for Adolescent Health, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; and Murdoch Children's Research Institute, Melbourne, Australia
| | - Heather Gilbertson
- Department of Nutrition and Food Services, and Department of Paediatrics, The University of Melbourne, Melbourne, Australia; and Murdoch Children's Research Institute, Melbourne, Australia
| | - Katherine J Lee
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; and Murdoch Children's Research Institute, Melbourne, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; and Murdoch Children's Research Institute, Melbourne, Australia
| |
Collapse
|
16
|
Ackard DM, Richter S, Egan A, Engel S, Cronemeyer CL. The meaning of (quality of) life in patients with eating disorders: a comparison of generic and disease-specific measures across diagnosis and outcome. Int J Eat Disord 2014; 47:259-67. [PMID: 24123164 DOI: 10.1002/eat.22193] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 08/23/2013] [Accepted: 08/27/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Compare general and disease-specific health-related quality of life (HRQoL) among female patients with an eating disorder (ED). METHOD Female patients (n = 221; 95.3% Caucasian; 94.0% never married) completed the Medical Outcome Short Form Health Survey (SF-36) and Eating Disorders Quality of Life (EDQoL) as part of a study of treatment outcomes. Multivariate regression models were used to compare HRQoL differences across initial ED diagnosis (85 AN-R, 19 AN-B/P, 27 BN, 90 EDNOS) and ED diagnostic classification at time of outcome assessment (140 no ED, 38 subthreshold ED, 43 full threshold ED). RESULTS There were no significant differences across ED diagnosis at initial assessment on either of the SF-36 Component Summary scores. However, patients with AN-B/P scored poorer on the work/school EDQoL subscales than other ED diagnoses, and on the psychological EDQoL subscale compared to AN-R and EDNOS. At outcome assessment, comparisons across full threshold, subthreshold and no ED classification indicated that those with no ED reported better HRQoL than those with full threshold ED on the SF-36 Mental Components Summary and three of four EDQoL subscales. Furthermore, those with no ED reported better psychological HRQoL than those with subthreshold ED. DISCUSSION Disease-specific HRQOL measures are important to use when comparing HRQoL in ED patients across treatment and outcome, and may have the sensitivity to detect meaningful differences by diagnosis more so than generic instruments. EDQoL scores from patients remitted from symptoms approach but do not reach scores for unaffected college females; thus, treatment should continue until quality of life is restored.
Collapse
Affiliation(s)
- Diann M Ackard
- Park Nicollet Melrose Center, 3525 Monterey Drive, St. Louis Park, Minnesota, 55416; Private Practice, 5101 Olson Memorial Highway Suite 4001, Golden Valley, Minnesota, 55422
| | | | | | | | | |
Collapse
|
17
|
Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Pope HG, Kinzl J. Prevalence of eating disorders in middle-aged women. Int J Eat Disord 2014; 47:320-4. [PMID: 24293379 DOI: 10.1002/eat.22232] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Little is known about the prevalence and correlates of eating disorders (ED) in middle-aged women. METHOD We mailed anonymous questionnaires to 1,500 Austrian women aged 40-60 years, assessing ED (defined by DSM-IV), subthreshold ED, body image, and quality of life. We broadly defined "subthreshold ED" by the presence of either (1) binge eating with loss of control or (2) purging behavior, without requiring any of the other usual DSM-IV criteria for frequency or severity of these symptoms. RESULTS Of the 715 (48%) responders, 33 [4.6%; 95% confidence interval (CI): 3.3-6.4%] reported symptoms meeting full DSM-IV criteria for an ED [bulimia nervosa = 10; binge eating disorder = 11; eating disorder not otherwise specified (EDNOS) = 12]. None displayed anorexia nervosa. Another 34 women (4.8%; CI: 3.4-6.6%) displayed subthreshold ED. These women showed levels of associated psychopathology virtually equal to the women with full-syndrome diagnoses. DISCUSSION ED appear common in middle-aged women, with a preponderance of binge eating disorder and EDNOS diagnoses as compared to the "classical" diagnoses of anorexia and bulimia nervosa. Interestingly, middle-aged women with even very broadly defined subthreshold ED showed distress and impairment comparable to women with full-scale ED.
Collapse
Affiliation(s)
- Barbara Mangweth-Matzek
- University Clinic of Psychosomatic Medicine, Innsbruck Medical University, Innsbruck, Austria
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Ackard DM, Richter SA, Egan AM, Cronemeyer CL. What does remission tell us about women with eating disorders? Investigating applications of various remission definitions and their associations with quality of life. J Psychosom Res 2014; 76:12-8. [PMID: 24360135 DOI: 10.1016/j.jpsychores.2013.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare remission rates, determine level of agreement and identify quality of life (QoL) distinctions across a broad spectrum of remission definitions among patients with eating disorders (ED). METHODS Women (N=195; 94 AN, 24 BN, and 77 EDNOS) from inpatient and partial hospital ED programs participated in a study of treatment outcomes. Remission rates were evaluated with percentages, kappa coefficients identified level of agreement and Mann-Whitney-Wilcoxon tests with Bonferroni corrections determined differences in quality of life between remitted and not remitted patients by remission definition. RESULTS Depending on remission definition used, the percent of remitted patients varied from 13.2% to 40.5% for AN, 15.0% to 47.6% for BN and 24.2% to 53.1% for EDNOS. Several definitions demonstrated "very good" agreement across diagnoses. Remission was associated with higher quality of life in psychological, physical/cognitive, financial and work/school domains on a disease-specific measure, and in mental but not physical functioning on a generic measure. CONCLUSIONS Remission rates vary widely depending on the definition used; several definitions show strong agreement. Remission is associated with quality of life, and often approximates scores for women who do not have an eating disorder. The ED field would benefit from adopting uniform criteria, which would allow for more accurate comparison of remission rates across therapeutic interventions, treatment modalities and facilities. We recommend using the Bardone-Cone criteria because it includes assessment of psychological functioning, was found to be applicable across diagnoses, demonstrated good agreement, and was able to distinguish quality of life differences between remitted and not remitted patients.
Collapse
Affiliation(s)
- Diann M Ackard
- Park Nicollet Melrose Center, 3525 Monterey Drive, Minneapolis, MN 55416, USA; Private Practice, 5101 Olson Memorial Highway, Golden Valley, MN 55422, USA.
| | - Sara A Richter
- Park Nicollet Institute, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416, USA
| | - Amber M Egan
- Park Nicollet Melrose Center, 3525 Monterey Drive, Minneapolis, MN 55416, USA
| | | |
Collapse
|
19
|
Mariano P, Watson HJ, Leach DJ, McCormack J, Forbes DA. Parent-child concordance in reporting of child eating disorder pathology as assessed by the eating disorder examination. Int J Eat Disord 2013; 46:617-25. [PMID: 23847149 DOI: 10.1002/eat.22158] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to examine parent-youth concordance in reporting of eating disorder pathology, as assessed by the Eating Disorder Examination (EDE) in a clinical pediatric sample. METHOD The sample comprised 619 parent-youth dyads of youth (8-18 years) presenting for treatment at a specialist eating disorder clinic. A cross-sectional correlational design was used to examine the association between parent and youth symptom reports. RESULTS On the whole, parent-youth inter-rater agreement was poor to moderate. Agreement was acceptable for the presence of behavioral symptoms, with the exception of excessive exercise (PAK = 0.48-0.98). There was poor inter-rater agreement on frequency of behavioral symptoms, with parents providing lower estimates than youth (ICC = 0.07-0.52). Although we predicted that inter-rater agreement on cognitive symptoms would by higher with adolescents than children, both groups were discordant with parent reports. Younger children identified less severe eating disorder cognitions than parents and the opposite occurred for adolescents. An anorexia nervosa presentation and lower malnutrition were not associated with lower inter-rater agreement, as might have been expected through ego syntonicity. Youth with bulimia nervosa presentations reported significantly higher severity of cognitive symptoms and more frequent disordered eating behaviors compared with their parents. DISCUSSION Results support the utility of parent-youth assessment via the EDE to obtain a wider clinical picture of eating disorder psychopathology in children and adolescents, particularly for younger children. Clinical implications pertinent to administration of the EDE and parent literacy regarding eating disorder symptoms are discussed.
Collapse
Affiliation(s)
- Paige Mariano
- School of Psychology, Murdoch University, Perth, Australia
| | | | | | | | | |
Collapse
|
20
|
Schmidt U, Renwick B, Lose A, Kenyon M, DeJong H, Broadbent H, Loomes R, Watson C, Ghelani S, Serpell L, Richards L, Johnson-Sabine E, Boughton N, Whitehead L, Beecham J, Treasure J, Landau S. The MOSAIC study - comparison of the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) with Specialist Supportive Clinical Management (SSCM) in outpatients with anorexia nervosa or eating disorder not otherwise specified, anorexia nervosa type: study protocol for a randomized controlled trial. Trials 2013; 14:160. [PMID: 23721562 PMCID: PMC3679869 DOI: 10.1186/1745-6215-14-160] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/14/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a biologically based serious mental disorder with high levels of mortality and disability, physical and psychological morbidity and impaired quality of life. AN is one of the leading causes of disease burden in terms of years of life lost through death or disability in young women. Psychotherapeutic interventions are the treatment of choice for AN, but the results of psychotherapy depend critically on the stage of the illness. The treatment response in adults with a chronic form of the illness is poor and drop-out from treatment is high. Despite the seriousness of the disorder the evidence-base for psychological treatment of adults with AN is extremely limited and there is no leading treatment. There is therefore an urgent need to develop more effective treatments for adults with AN. The aim of the Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related Conditions (MOSAIC) is to evaluate the efficacy and cost effectiveness of two outpatient treatments for adults with AN, Specialist Supportive Clinical Management (SSCM) and the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA). METHODS/DESIGN 138 patients meeting the inclusion criteria are randomly assigned to one of the two treatment groups (MANTRA or SSCM). All participants receive 20 once-weekly individual therapy sessions (with 10 extra weekly sessions for those who are severely ill) and four follow-up sessions with monthly spacing thereafter. There is also optional access to a dietician and extra sessions involving a family member or a close other. Body weight, eating disorder- related symptoms, neurocognitive and psychosocial measures, and service use data are measured during the course of treatment and across a one year follow up period. The primary outcome measure is body mass index (BMI) taken at twelve months after randomization. DISCUSSION This multi-center study provides a large sample size, broad inclusion criteria and a follow-up period. However, the study has to contend with difficulties directly related to running a large multi-center randomized controlled trial and the psychopathology of AN. These issues are discussed.
Collapse
Affiliation(s)
- Ulrike Schmidt
- PO59, Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Beth Renwick
- PO59, Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Anna Lose
- PO59, Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Martha Kenyon
- PO59, Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Hannah DeJong
- PO59, Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Hannah Broadbent
- PO59, Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Rachel Loomes
- Oxford Adult Eating Disorder Service, Cotswold House, Warneford Hospital, Oxford, UK
| | | | | | - Lucy Serpell
- Hope Wing, Porters Avenue Health Centre, Dagenham, Essex, UK
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Lorna Richards
- The Phoenix Wing, St Ann’s Hospital, Tottenham, London, UK
| | | | - Nicky Boughton
- Oxford Adult Eating Disorder Service, Cotswold House, Warneford Hospital, Oxford, UK
| | - Linette Whitehead
- Oxford Adult Eating Disorder Service, Cotswold House, Warneford Hospital, Oxford, UK
| | - Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Janet Treasure
- PO59, Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Sabine Landau
- Department of Biostatistics, Institute of Psychiatry, Kings College London, London, UK
| |
Collapse
|
21
|
Keel PK, Crosby RD, Hildebrandt TB, Haedt-Matt AA, Gravener JA. Evaluating new severity dimensions in the DSM-5 for bulimic syndromes using mixture modeling. Int J Eat Disord 2013; 46:108-18. [PMID: 22887026 PMCID: PMC3509271 DOI: 10.1002/eat.22050] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Proposed DSM-5 severity dimensions reveal ambiguity regarding the extent to which certain features define boundaries between similar diagnoses or represent underlying dimensions within a broader category of bulimic syndromes. The current study utilized a novel mixed modeling approach that can simultaneously model latent dimensions and latent categories to address this ambiguity. METHOD Data from structured clinical interviews in 528 adult participants were analyzed. RESULTS A three-class solution with one severity dimension that was invariant across groups provided the best-fitting model. Both latent Classes 1 and 2 included bulimic syndromes but were distinguished by greater purging and weight phobia in latent Class 1. Latent Class 3 resembled a noneating disorder class. External validation analyses supported significant differences among empirically derived groups. DISCUSSION Weight phobia contributes to categorical distinctiveness among bulimic syndromes whereas other features (purging, binge eating, and weight) may do so only in specific combinations. Uniform severity criteria may be appropriate across bulimic syndromes.
Collapse
Affiliation(s)
- Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, Florida,Corresponding Author: Pamela K. Keel, Ph.D., Professor, Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306.
| | - Ross D. Crosby
- Neuropsychiatric Research Institute and Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Thomas B. Hildebrandt
- Eating and Weight Disorders Program, Mount Sinai School of Medicine, New York, New York
| | | | - Julie A. Gravener
- Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, New York
| |
Collapse
|
22
|
Grilo CM, Pagano ME, Stout RL, Markowitz JC, Ansell EB, Pinto A, Zanarini MC, Yen S, Skodol AE. Stressful life events predict eating disorder relapse following remission: six-year prospective outcomes. Int J Eat Disord 2012; 45:185-92. [PMID: 21448971 PMCID: PMC3275672 DOI: 10.1002/eat.20909] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not-otherwise-specified (EDNOS) and test for the effects of stressful life events (SLE) on relapse after remission from these eating disorders. METHOD 117 female patients with BN (N = 35) or EDNOS (N = 82) were prospectively followed for 72 months using structured interviews performed at baseline, 6- and 12-months, and then yearly thereafter. ED were assessed with the structured clinical interview for DSM-IV, and monitored over time with the longitudinal interval follow-up evaluation. Personality disorders were assessed with the diagnostic interview for DSM-IV-personality-disorders, and monitored over time with the follow-along-version. The occurrence and specific timing of SLE were assessed with the life events assessment interview. Cox proportional-hazard-regression-analyses tested associations between time-varying levels of SLE and ED relapse, controlling for comorbid psychiatric disorders, ED duration, and time-varying personality-disorder status. RESULTS ED relapse probability was 43%; BN and EDNOS did not differ in time to relapse. Negative SLE significantly predicted ED relapse; elevated work and social stressors were significant predictors. Psychiatric comorbidity, ED duration, and time-varying personality-disorder status were not significant predictors. DISCUSSION Higher work and social stress represent significant warning signs for triggering relapse for women with remitted BN and EDNOS.
Collapse
Affiliation(s)
- Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut,Correspondence to: Dr. Carlos M. Grilo, Yale University School of Medicine, P.O. Box 208098, New Haven, CT, 06520.
| | - Maria E. Pagano
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio
| | | | | | - Emily B. Ansell
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Anthony Pinto
- New York State Psychiatric Institute, Columbia University, New York
| | | | - Shirley Yen
- Department of Psychiatry, Brown University, Providence, Rhode Island
| | - Andrew E. Skodol
- Department of Psychiatry, University of Arizona, Tucson, Arizona
| |
Collapse
|
23
|
Abstract
Eating disorders are relatively rare among the general population. This review discusses the literature on the incidence, prevalence and mortality rates of eating disorders. We searched online Medline/Pubmed, Embase and PsycINFO databases for articles published in English using several keyterms relating to eating disorders and epidemiology. Anorexia nervosa is relatively common among young women. While the overall incidence rate remained stable over the past decades, there has been an increase in the high risk-group of 15-19 year old girls. It is unclear whether this reflects earlier detection of anorexia nervosa cases or an earlier age at onset. The occurrence of bulimia nervosa might have decreased since the early nineties of the last century. All eating disorders have an elevated mortality risk; anorexia nervosa the most striking. Compared with the other eating disorders, binge eating disorder is more common among males and older individuals.
Collapse
Affiliation(s)
- Frédérique R. E. Smink
- Parnassia Bavo Psychiatric Institute, Kiwistraat 43, NL-2552 DH The Hague, The Netherlands
| | - Daphne van Hoeken
- Parnassia Bavo Psychiatric Institute, Kiwistraat 43, NL-2552 DH The Hague, The Netherlands
| | - Hans W. Hoek
- Parnassia Bavo Psychiatric Institute, Kiwistraat 43, NL-2552 DH The Hague, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, United States
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands
| |
Collapse
|
24
|
Dellava JE, Von Holle A, Torgersen L, Reichborn-Kjennerud T, Haugen M, Meltzer HM, Bulik CM. Dietary supplement use immediately before and during pregnancy in Norwegian women with eating disorders. Int J Eat Disord 2011; 44:325-32. [PMID: 21472751 PMCID: PMC3072566 DOI: 10.1002/eat.20831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Many pregnant women use dietary supplements. Little is known about dietary supplement use during pregnancy in women with eating disorders. METHOD We examined dietary supplement use in 37,307 pregnant women, from the Norwegian Mother and Child Cohort Study. RESULTS Dietary supplement use during pregnancy was as follows: 91.2% of women with anorexia nervosa, 92.2% of women with bulimia nervosa, 93.2% of women with eating disorder not otherwise specified-purging subtype (EDNOS-P), 90.6% of women with binge eating disorder, and 93.5% of the women without eating disorders. Between group differences were not statistically significant. After adjusting for covariates, women with EDNOS-P were more likely to take iron containing supplements (p ≤ .04). DISCUSSION Overall dietary supplement use in this sample is similar in women with and without eating disorders.
Collapse
Affiliation(s)
- Jocilyn E. Dellava
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC, USA 27599-7160
| | - Ann Von Holle
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC, USA 27599-7160
| | - Leila Torgersen
- Division of Mental Health, Norwegian Institute of Public Health ,PO Box 4404 Nydalen, N-0403 Oslo, Norway
| | - Ted Reichborn-Kjennerud
- Division of Mental Health, Norwegian Institute of Public Health ,PO Box 4404 Nydalen, N-0403 Oslo, Norway
,Department of Psychiatry, University of Oslo, PO Box 1130 Blindern, N-0318 Oslo, Norway
,Department of Epidemiology, Columbia University, New York, NY, USA
| | - Margaretha Haugen
- Division of Environmental Medicine, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
| | - Helle M. Meltzer
- Division of Environmental Medicine, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC, USA 27599-7160
,Department of Nutrition, University of North Carolina at Chapel Hill, NC, USA
,Correspondence to: Dr Bulik, Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160, Voice: (919) 843 1689 Fax: (919) 966-5628,
| |
Collapse
|
25
|
Abstract
OBJECTIVE This study aimed to compare bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) on clinically significant variables and examine the utility of once versus twice-weekly diagnostic thresholds for disturbed eating behaviors. METHOD 234 women with BN, BED, or PD were identified through self-report measures via an online survey and categorized based on either once-weekly or twice-weekly disturbed eating behaviors. RESULTS BN emerged as a more severe disorder than BED and PD. The three groups differed significantly in self-reported restraint and disinhibition and the BN and BED groups reported higher levels of depression than PD. For BN, those engaging in behaviors twice-weekly versus once-weekly were more symptomatic. DISCUSSION The BN, BED, and PD groups differed in clinically meaningful ways. Future research need to clarify the relationship between mood disturbances and eating behaviors. Reducing the twice-weekly behavior threshold for BN would capture individuals with clinically significant eating disorders, though the twice-weekly threshold may provide important information about disorder severity for both BN and BED.
Collapse
Affiliation(s)
- Christina A. Roberto
- Department of Psychology, Yale University, New Haven, Connecticut
,
Department of Epidemiology and Public Health, Yale University, New Haven, Connecticut
| | - Carlos M. Grilo
- Department of Psychology, Yale University, New Haven, Connecticut
,
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Robin M. Masheb
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Marney A. White
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
,Correspondence to: Eating Disorders Research Program, Yale Psychiatric Research at Congress Place, 301 Cedar Street, 2nd Floor, PO Box 208098, New Haven, Connecticut 06520.
| |
Collapse
|
26
|
Eddy KT, Swanson SA, Crosby RD, Franko DL, Engel S, Herzog DB. How should DSM-V classify eating disorder not otherwise specified (EDNOS) presentations in women with lifetime anorexia or bulimia nervosa? Psychol Med 2010; 40:1735-1744. [PMID: 20047706 PMCID: PMC3740170 DOI: 10.1017/s0033291709992200] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) and bulimia nervosa (BN) are marked by longitudinal symptom fluctuations. DSM-IV-TR does not address how to classify eating disorder (ED) presentations in individuals who no longer meet full criteria for these disorders. To consider this issue, we examined subthreshold presentations in women with initial diagnoses of AN and BN. METHOD A total of 246 women with AN or BN were followed for a median of 9 years; weekly symptom data were collected at frequent intervals using the Longitudinal Interval Follow-up Evaluation of Eating Disorders (LIFE-EAT-II). Outcomes were ED presentations that were subthreshold for 3 months, including those narrowly missing full criteria for AN or BN, along with binge eating disorder (BED) and purging disorder. RESULTS During follow-up, most women (77.6%) experienced a subthreshold presentation. Subthreshold presentation was related to intake diagnosis (Wald chi2=8.065, df=2, p=0.018). Individuals with AN most often developed subthreshold presentations resembling AN; those with BN were more likely to develop subthreshold BN. Purging disorder was experienced by half of those with BN and one-quarter of those with AN binge/purge type (ANBP); BED occurred in 20% with BN. Transition from AN or BN to most subthreshold types was associated with improved psychosocial functioning (p<0.001). CONCLUSIONS Subthreshold presentations in women with lifetime AN and BN were common, resembled the initial diagnosis, and were associated with modest improvements in psychosocial functioning. For most with lifetime AN and BN, subthreshold presentations seem to represent part of the course of illness and to fit within the original AN or BN diagnosis.
Collapse
Affiliation(s)
- K. T. Eddy
- Harris Center, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - S. A. Swanson
- National Institute of Mental Health, Section on Developmental Genetic Epidemiology, Bethesda, MD, USA
| | - R. D. Crosby
- Neuropsychiatric Research Institute, Fargo, ND, USA
- Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - D. L. Franko
- Harris Center, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Counseling and Applied Educational Psychology, Northwestern University, Boston, MA, USA
| | - S. Engel
- Neuropsychiatric Research Institute, Fargo, ND, USA
- Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - D. B. Herzog
- Harris Center, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|