Determining empirical thresholds for "definitely large" amounts of food for defining binge-eating episodes.

Binge episodes involve "definitely large" amounts of food, yet limited data exist regarding the upper limits of food consumption in non-binge eating episodes. Study 1 examined the concurrent validity of a self-report measure developed to measure "usual" food consumption. Results support good concurrent validity for most items across response versions. Study 2 identified the upper limits of normal food consumption (i.e., 85(th) percentile of participants' largest reported usual servings). Thresholds differed across types of foods, and men reported higher thresholds than women for several foods. Type of food and gender should be considered when assessing for "definitely large" amounts of food.

Defining Features of Unhealthy Exercise Associated with Disordered Eating and Eating Disorder Diagnoses.

OBJECTIVES: The current study sought to compare different features of unhealthy exercise on associations with disordered eating and their ability to identify individuals with eating disorders. A secondary aim of the study was to compare prevalence and overlap of different aspects of unhealthy exercise and potential differences in their gender distribution. DESIGN: Cross-sectional epidemiological study. METHODS: A community-based sample of men (n=592) and women (n=1468) completed surveys of health and eating patterns, including questions regarding exercise habits and eating disorder symptoms. RESULTS: Compulsive and compensatory features of exercise were the best predictors of disordered eating and eating disorder diagnoses compared to exercise that was excessive in quantity. Further, compulsive and compensatory aspects of unhealthy exercise represented overlapping, yet distinct qualities in both men and women. CONCLUSIONS: Including the compulsive quality among the defining features of unhealthy exercise may improve identification of eating disorders, particularly in men. Results suggest that the compensatory aspect of unhealthy exercise is not adequately captured by the compulsive aspect of unhealthy exercise. Thus, interventions that target unhealthy exercise behaviors among high-risk individuals, such as athletes, may benefit from addressing both the compulsive and compensatory aspects of unhealthy exercise. Future prospective longitudinal studies will aid in determining the direction of the association between these features of unhealthy exercise and the onset of eating pathology.

A preliminary examination of a nonpurging compensatory eating disorder.

OBJECTIVE: To evaluate correlates of a compensatory eating disorder (CED) characterized by recurrent nonpurging compensatory behaviors in the absence of objectively large binge episodes among normal weight individuals who endorse undue influence of weight/shape on self-evaluation as possible indicators of clinical significance and distinctiveness. METHOD: Women with CED (n = 20), women with bulimia nervosa (BN) (n = 20), and controls (n = 20) completed an interview and questionnaires assessing eating disorder and general psychopathology and weight history. RESULTS: Compared with controls, women with CED reported significantly greater body image disturbance and disordered eating, higher anxiety proneness, increased perfectionism, and greater weight suppression. Compared with BN, CED was associated with significantly less body image disturbance, disordered eating, weight suppression, and lower likelihood of being overweight in childhood. However, CED and BN did not differ on anxiety proneness or perfectionism. DISCUSSION: CED merits further examination to determine whether it is a clinically significant and distinct eating disorder.

Comparing operational definitions of DSM-5 anorexia nervosa for research contexts.

OBJECTIVE: DSM-5 anorexia nervosa (AN) criteria include several changes that increase reliance on clinical judgment. However, research contexts require operational definitions that can be applied reliably and that demonstrate validity. The present study evaluated different operational definitions for DSM-5 AN. METHOD: DSM-5 AN criteria were applied to diagnostic interview data from 364 women varying two features: threshold for determining low weight for Criterion A (body mass index [BMI] <17.0 kg/m(2) vs. <18.5 kg/m(2)) and explicit endorsement of weight phobia (Criterion B explicit vs. inferred). Resulting groups of individuals with DSM-5 AN were compared on estimated frequency. In addition, AN groups were compared to non-eating disorder controls and individuals with an other specified feeding or eating disorder (OSFED) on external validators. RESULTS: All operational DSM-5 definitions produced higher lifetime frequency estimates than reported for DSM-IV AN, with a particularly large increase associated with the broadest definition. All definitions produced significant differences in comparison to controls on external validators that were associated with medium to large effect sizes. Only definitions that required a lower weight threshold or explicit endorsement of weight phobia demonstrated significant differences compared to OSFED on external validators, and these were of small effect size. The specific combination of BMI <18.5 kg/m(2) with inferred weight phobia exhibited few meaningful distinctions from the OSFED group. DISCUSSION: To balance inclusivity, syndromal reliability, and validity, an operational definition for DSM-5 AN in research contexts should define low weight as BMI <18.5 kg/m(2) and require measurable rather than inferred weight phobia.

Psychological factors predict eating disorder onset and maintenance at 10-year follow-up.

The present study sought to identify psychological factors that predict onset and maintenance of eating disorders. Secondary analyses were conducted using data from an epidemiological study of health and eating behaviours in men and women (N = 1320; 72% female) to examine the prospective and independent influence of the Eating Disorder Inventory Perfectionism, Interpersonal Distrust, and Maturity Fears subscales in predicting the onset and maintenance of eating disorders at 10-year follow-up. Multivariate models indicated higher Perfectionism (p = .025), lower Interpersonal Distrust (p < .001), and higher Maturity Fears (p = .037) predicted increased risk for eating disorder onset at 10-year follow-up, but only Perfectionism (p = .004) predicted eating disorder maintenance. Differential prediction of eating disorder onset versus maintenance highlights potentially different psychological foci for prevention versus treatment efforts.

Influence of peer context on the relationship between body dissatisfaction and eating pathology in women and men.

OBJECTIVE: This study examined the influence of peer context on the relationship between body dissatisfaction and eating pathology in women and men. METHOD: Secondary analyses were conducted using survey data from a large community sample of women and men (N = 2,060). RESULTS: The frequency of friend comments on weight and diet moderated the relationship between body dissatisfaction and eating pathology such that more frequent comments strengthened the relationship between body dissatisfaction and eating pathology in women. This effect was not significant in analyses of men. Instead, friend comments were directly related to eating pathology in men. DISCUSSION: Both women and men may benefit from peer-led interventions, with the greatest potential benefits for women with high body dissatisfaction, consistent with results from selective peer-led prevention programs in sororities.

Empirical classification of eating disorders.

Current diagnostic criteria for anorexia nervosa (AN) and bulimia nervosa (BN) account for a minority of individuals with clinically significant disorders of eating, raising concerns about the clinical utility of current definitions. This review examines evidence for the validity of current and alternative approaches to defining eating disorders and implications for draft criteria for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Although this review largely supports the predictive validity of distinctions among AN, BN, and the newly proposed binge eating disorder (BED), it also highlights that our tendency to "study what we define" has created a gap between the problems that people have and what we know about those problems. Future research on the causes and consequences of eating disorders should include more heterogeneous groups to enable identification of meaningful boundaries that distinguish between disorders based on etiological and predictive validity.