A comparison of the frequency of familial suicide attempts across eating disorder diagnoses.

This study examined the prevalence of reported suicide attempts among family members of individuals with an eating disorder (ED). 1870 individuals presenting for ED treatment reported whether their family members ever made a suicide attempt using the Eating Disorders Questionnaire. A lifetime suicide attempt by any family member was reported by 10.8% (n = 202) of the sample and ranged from 7.0% of those with eating disorder not otherwise specified to 16.1% of those with purging disorder. Controlling for age and gender, individuals with bulimia nervosa had a higher prevalence of any familial suicide attempt and mother suicide attempt than individuals with EDNOS; no other differences were observed across ED diagnoses. There were no differences in prevalence of reported suicide attempts made by fathers, brothers, sisters, uncles, or aunts by ED diagnosis. Findings support a growing literature indicating a familial association between EDs and suicide risk.

Examining the utility of narrowing anorexia nervosa subtypes for adults.

OBJECTIVE: The purpose of this investigation was to examine whether narrowing the criteria of anorexia nervosa (AN) subtypes among adults based on further delineations of current binge eating and purging (i.e., binge eating only, purging only, binge eating and purging, and restricting only) improves the potential clinical utility of the current DSM-5 system that specifies two types (i.e., current binge eating and/or purging and restricting, specified as the absence of current binge eating and/or purging). METHOD: Self-reported eating disorder and psychiatric symptoms based on the Eating Disorder Questionnaire were examined in 347 adults from a multisite clinical sample who met DSM-IV criteria for AN. Classification based on binge eating and purging symptoms yielded the following subtypes: 118 restricting only (AN-R; no current binge eating or purging); 133 binge eating and purging (AN-B & P; current binge eating and purging); 43 binge eating only (AN-B; current binge eating and no current purging); and 53 purging only (AN-P; current purging and no current binge eating). RESULTS: The AN-R group had lower current body mass index compared to AN-B & P and AN-P with no group differences in highest, lowest, or desired body mass index. The probability of amenorrhea was higher for the AN-R and AN-B & P groups than the AN-P group. The probability of diet pill use was elevated for the AN-B & P and AN-P groups compared to the AN-R group. The AN-P group also had a higher probability of fasting than the AN-R group. The probability of substance use including tobacco was lower in the AN-R group than the other three groups. No group differences were found on measures of hospitalization, body image, physical symptoms, exercise, or dieting behaviors. CONCLUSIONS: These findings do not support the validity or clinical utility of classifying AN into narrower subtypes based on current binge eating, purging, and binge eating with purging given that few differences were found among groups who reported any combination of current binge eating and purging. Future research is needed to replicate these findings and to further examine the AN subtype classification schemes.

Effectiveness and clinical response rates of a residential eating disorders facility.

The purpose of this study was to determine the effectiveness of a residential treatment program for adults and adolescents with eating disorders across a wide spectrum of measures. Data on body mass, eating disorder severity, depression, anxiety, and two measures of quality of life were collected on 139 consecutively admitted adolescents and 111 adults at a residential treatment program (N = 250). The same measures were completed at post-treatment. Group level analyses showed that adults and adolescents improved on all measures analyzed. Only 1.7% of adolescents and 2.3% of adults were below a Body Mass Index of 18.5 at discharge. Positive results across diagnoses and ages are reported for three subscales of the Eating Disorder Inventory-3, with clinical response rates reported. Using clinical responder analyses, it was found that for all individuals struggling with secondary issues, 74.7% were responders on the Beck Depression Inventory-II, 41.0% on the Beck Anxiety Inventory, 63.5% on a measure of quality of life, and 95.8% were responders on the physical subscale and 72.6% on the mental subscale of the SF-36-v2. This study suggests that residential treatment for eating disorders is effective at the group level, and it was effective for the majority of individuals within the group.

Associations between weight suppression and dimensions of eating disorder psychopathology in a multisite sample.

Evidence suggests that weight suppression, the difference between an individual's highest historical body weight and current body weight, may play a role in the etiology and/or maintenance of eating disorders (EDs), and may also impact ED treatment. However, there are limited findings regarding the association between weight suppression and dimensions of ED psychopathology, particularly in multi-diagnostic ED samples. Participants were 1748 adults (94% female) from five sites with a variety of DSM-IV ED diagnoses who completed the Eating Disorder Questionnaire, a self-report measure of various attitudinal, behavioral, and medical features of EDs. Four factor analytically derived dimensions of ED psychopathology were examined: (a) weight/shape concerns, (b) binge eating/vomiting, (c) exercise/restrictive eating behaviors, and (d) weight control medication use. Hierarchical regression analyses were conducted to examine the unique association of weight suppression with each dimension (controlling for ED diagnosis and BMI), as well as the independent unique associations of three interactions: (a) weight suppression×BMI, (b) weight suppression×ED diagnosis, and (c) BMI×ED diagnosis. Results revealed that weight suppression was uniquely associated with all of the ED psychopathology dimensions except binge eating/vomiting. The weight suppression × BMI interaction was significant only for weight/shape concerns, whereas the weight suppression×ED diagnosis was not significant for any of the dimensions. Significant BMI×ED diagnosis interactions were found for all dimensions except weight/shape concerns. Overall, the current results support the salience of weight suppression across multiple dimensions of ED psychopathology, with the exception of binge eating/vomiting.

Prevalence of Alcohol and Other Substance Use in Patients with Eating Disorders.

OBJECTIVE: The major aim of this study was to investigate any association between binge eating and purging and alcohol and substance use. METHOD: The Eating Disorder Questionnaire was completed by 2966 patients. Each patient was assigned to an approximate diagnostic group based on a DSM-5-based algorithm. RESULTS: Patients with bulimia nervosa (BN) used alcohol/other substances with higher frequencies compared to patients with anorexia nervosa-restricting type (AN-R), binge eating disorder (BED), and eating disorder not otherwise specified (EDNOS; p < 0.001). Patients with anorexia nervosa-binge eating/purging type (AN-BP) were more likely to use alcohol/substances than those with AN-R [odds ratio for alcohol use: 3.58 (p < 0.01); odds ratio for substance use: 30.14 (p < 0.01)]. Higher frequencies of binge eating and purging were associated with higher frequencies of substance use. DISCUSSION: Patients who manifest both binge eating and purging behaviour are at higher risk of substance use which may have important treatment implications.

Dietary Restriction Behaviors and Binge Eating in Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder: Trans-diagnostic Examination of the Restraint Model.

OBJECTIVE: To compare dietary restriction behaviors among adults with eating disorders involving binge eating, including anorexia nervosa-binge/purge subtype (AN-BE/P), bulimia nervosa (BN), and binge eating disorder (BED), and to examine whether dietary restriction behaviors impact binge eating frequency across diagnoses. METHOD: Participants included 845 treatment seeking adults (M=30.42+10.76years) who met criteria for DSM-5 AN-BE/P (7.3%;n=62), BN (59.7%;n=504), and BED (33.0%;n=279). All participants self-reported their past and current eating disorder symptoms on the Eating Disorder Questionnaire. RESULTS: Adults with AN-BE/P and BN reported significantly more dietary restriction behaviors (e.g. eating fewer meals per day, higher frequency of fasting, consuming small and low calorie meals) in comparison to adults with BED. Adults with AN-BE/P and BN who reported restricting food intake via eating fewer meals per day had more frequent binge eating episodes. However, adults with BN who reported restricting food intake via eating small meals and low calorie meals had less frequent binge eating episodes. DISCUSSION: This study provides mixed support for the restraint model by suggesting that not all dietary restriction behaviors are associated with higher levels of binge eating. It may be that adults with BN who report a higher frequency of eating small and low calorie meals display more control over their eating in general, and therefore also have lower frequency of binge eating. Clinicians should assess for dietary restriction behaviors at the start of treatment prior to assuming that all forms of strict dieting and weight control behaviors similarly impact binge eating.

A pilot study examining diagnostic differences among exercise and weight suppression in bulimia nervosa and binge eating disorder.

OBJECTIVE: The objective of this study was to investigate diagnostic differences in weight suppression (e.g., the difference between one's current body weight and highest non-pregnancy adult body weight) and exercise among Bulimia Nervosa (BN) and Binge Eating Disorder (BED). Because exercise may be a key contributor to weight suppression in BN, we were interested in examining the potential moderating effect of exercise on weight suppression in BN or BED. METHOD: Participants with BN (n = 774) and BED (n = 285) completed self-report surveys of weight history, exercise and eating disorder symptoms. Generalised linear model analyses were used to examine the associations among diagnosis, exercise frequency and their interaction on weight suppression. RESULTS: Exercise frequency and BN/BED diagnosis were both associated with weight suppression. Additionally, exercise frequency moderated the relationship between diagnosis and weight suppression. Specifically, weight suppression was higher in BN than in BED among those with low exercise frequency but comparable in BN and BED among those with high exercise frequency. DISCUSSION: Our results suggest that exercise frequency may contribute to different weight suppression outcomes among BN and BED. This may inform clinical implications of exercise in these disorders. Specifically, much understanding of the differences among exercise frequency and the compensatory use of exercise in BN and BED is needed.

Health-related quality of life among adolescents with eating disorders.

OBJECTIVE: Health-related quality of life (HRQoL) is an emerging area of research in eating disorders (EDs) that has not been examined in adolescents in detail. The aim of the current study is to investigate HRQoL in an adolescent ED sample, examining the impact of ED symptoms on HRQoL. METHODS: Sixty-seven treatment-seeking adolescents (57 females) with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) completed self-report measures of HRQoL and ED symptoms. RESULTS: Participants reported poorer HRQoL in mental health domains than in physical health domains. Disordered attitudes, binge eating, and compensatory behaviors were associated with poorer mental health HRQoL, and body dissatisfaction was associated with poorer physical health HRQoL. CONCLUSION: The current study assessed HRQoL among adolescents with EDs, finding several consistencies with the literature on adults with EDs. Future research should compare adolescents and adults with EDs on HRQoL.

Failure to feed patients with anorexia nervosa and other perils and perplexities in the medical care of eating disorder patients.

A 28 year old woman with anorexia nervosa was sent to an emergency room by her gastroenterologist for weakness and nausea following placement of a percutaneous endoscopic gastrostomy (PEG) tube, with a plan for admission to the hospital. She spent 2 days in the emergency room without receiving any nutrition, and was discharged home after being told that her laboratory tests and x-rays were normal. The following day, her gastroenterologist reviewed the x-rays and determined that she had a bowel obstruction, at which point she was admitted to the hospital, weighing 2 kg less than on her initial visit. A 26 year old woman with anorexia nervosa was prematurely discharged from a residential facility with a Dobhoff feeding tube in her small intestine. She developed dizziness and weakness and was admitted to the hospital, but did not receive any feeding during the 6 days she was there, despite documented blood sugars in the 30s. Apparently an early order for tube feeding was cancelled, for unclear reasons. Two days after discharge, she again developed weakness and returned to the emergency room with a letter from her physician stating that she required medical supervision for the initiation of feeding. However, she was discharged from the emergency room within hours, only to be re-admitted to the hospital the next day.

Psychopharmacologic treatment of obesity and eating disorders in children and adolescents.

This review discusses the evidence base for medications that are currently used for obesity and eating disorders, including their Food and Drug Administration approval status by disorder and age group, contraindications, and major adverse effects. Investigational agents currently being considered, issues related to psychiatric and medical comorbidity, limitations of pharmacologic strategies, and recommendations for treatment are also addressed.

Double-blind placebo-controlled trial of quetiapine in anorexia nervosa.

OBJECTIVE: Our objective is to determine whether quetiapine was superior to placebo in increasing weight or reducing core symptoms of anorexia nervosa as assessed by the Yale-Brown-Cornell Eating Disorder Scale and the Eating Disorder Inventory-2. METHOD: Participants were randomised to 8 weeks of quetiapine or placebo. RESULTS: There are 21 participants who signed informed consent, 15 were randomised, 14 returned for at least one visit after receiving drug and 10 completed the study. There were no differences between drug and placebo in questionnaire scores, weight or measures of anxiety or depression. DISCUSSION: There was no difference between quetiapine and placebo on weight gain or core symptoms. Small effect sizes suggest that a higher number of participants would not increase significant differences between groups.

Eating disorder symptomatology in normal-weight vs. obese individuals with binge eating disorder.

Although normal-weight individuals comprise a substantial minority of the binge eating disorder (BED) population, little is known about their clinical presentation. This study sought to investigate the nature and severity of eating disturbances in normal-weight adults with BED. We compared 281 normal-weight (n = 86) and obese (n = 195) treatment-seeking adults with BED (mean age = 31.0; s.d. = 10.8) on a range of current and past eating disorder symptoms using ANOVA and χ(2) analyses. After controlling for age and sex, normal-weight participants reported more frequent use of a range of healthy and unhealthy weight control behaviors compared to their obese peers, including eating fewer meals and snacks per day; exercising and skipping meals more frequently in the past month; and avoiding certain foods for weight control. They also endorsed more frequent attempts at dieting in the past year, and feeling more frequently distressed about their binge eating, at a trend level. There were no group differences in binge eating frequency in the past month, age at onset of binge eating, overvaluation of shape/weight, or likelihood of having used certain weight control behaviors (e.g., vomiting, laxative use) or having sought treatment for an eating disorder in the past. Based on our findings, normal-weight individuals appear to be a behaviorally distinct subset of the BED population with significantly greater usage of both healthy and unhealthy weight control behaviors compared to their obese peers. These results refute the notion that distress and impairment in BED are simply a result of comorbid obesity.

Empirical identification and validation of eating disorder phenotypes in a multisite clinical sample.

Identified problems with the classification system of eating disorders (EDs), including its imperfect application to clinical samples, challenge its validity and limit its utility. The present study aimed to empirically identify and validate ED phenotypes in a multisite clinical sample using latent profile analysis (LPA). ED symptom data collected from 687 individuals were included in LPA. Identified latent profiles (LPs) were compared on clinical validators. Five LPs were identified: LP1 (n = 178), objective bingeing and multiple purging methods; LP2 (n = 172), objective bingeing without purging; LP3 (n = 130), objective bingeing and vomiting; LP4 (n = 108), low/normal weight and excessive exercise; LP5 (n = 99), low/normal weight and absence of ED symptoms. Validation analyses demonstrated the most extreme psychopathology/medical morbidity in LP1 and the least in LP5. LP1 and LP3 were most likely to report medication treatment for EDs. Identified LPs imperfectly resembled diagnostic and statistical manual of mental disorders-IV-TR EDs. Multiple purging methods and the absence of ED cognitions marked differences in severity across groups, whereas low weight did not. Clinical differences in psychopathology, medical morbidity, and treatment utilization validated groups. Future research should examine longitudinal stability of empirically-derived phenotypes and incremental validity of alternative classification schema to inform DSM-V.

Pharmacotherapy for eating disorders and obesity.

Anorexia nervosa and bulimia nervosa are significant mental health problems in the adolescent population; however, there are no medications approved by the FDA for the treatment of adolescents with either of these disorders. Many medications are used off label for both the symptoms of eating disorders and their co-morbid conditions, particularly SSRIs and atypical anti-psychotics. The dosing, side effect profile, and long term effects of these medications in children and adolescents is unclear. Binge eating disorder, night eating syndrome, and sleep-related eating disorder often are associated with over-weight in adolescents. There are various pharmacological approaches to the treatment of obesity in the adolescent population some of which have FDA approval. In the article the authors discuss pharmacological approaches to guide the treatment of eating disorders and obesity in the pediatric population, including risks of treatment, monitoring of potential side effects, and recent outcomes in the literature.

Latent profile analysis of a cohort of patients with eating disorders not otherwise specified.

OBJECTIVE: This article examined possible ways of classifying eating disorders not otherwise specified (EDNOS) using latent profile analysis (LPA). METHOD: Of 687 patients being seen for an evaluation for an eating disorder, 284 were classified as having anorexia nervosa (AN) or bulimia nervosa (BN). LPA was performed on the remaining 403 cases (EDNOS). RESULTS: Five clusters were identified that characterized individuals who appeared to be: (1) subsyndromal restrictor AN patients that denied a great deal of eating disorder (ED) psychopathology; (2) subsyndromal ED patients, some but not all of whom were low weight; (3) subsyndromal BN with higher rates of vomiting than binge-eating; (4) primarily overweight individuals with low levels of ED pathology; or (5) overweight patients who most resembled binge eating disorder (BED). CONCLUSION: Most EDNOS cases resembled AN, BN, or BED cases and can be conceptualized several ways, one of which is to see them as existing on a continuum with the DSM-IV ED.

Quetiapine in anorexia nervosa patients: an open label outpatient pilot study.

OBJECTIVES: The main objective of the study was to determine whether quetiapine was effective in reducing scores on the positive and negative syndrome scale (PANSS) in anorexia nervosa (AN) patients. Secondary objectives included determining whether quetiapine was effective in reducing symptoms of anxiety and depression. In addition, the effect on weight was determined. METHOD: In an open label design, 19 patients with AN but without schizophrenia or schizoaffective disorder were given 150-300 mg quetiapine daily over a 10 week period. Results were analyzed using last observation carried forward (LOCF). RESULTS: Fourteen patients completed the study and all but one of the 5 patients who dropped out returned for an early termination visit. Scores on the total, general psychopathology, and depression scales of the PANSS declined significantly (p = .024, .010, .0005, respectively) at LOCF. There were improvements in several measures of anxiety, depression, and obsessive compulsive symptoms. Mean weight gain was modest at 1.6 lbs (0.73 kg). Adverse events were generally mild and no patients discontinued due to adverse events CONCLUSION: Quetiapine was well-tolerated and patients had significant improvements in several subscales of the PANSS as well as decreases in measures of anxiety and depression.

Available pharmacological treatments for anorexia nervosa.

Currently, no medications are approved by the FDA for the treatment of anorexia nervosa (AN). However, there are several promising pharmacological targets. Treatment includes a weight restoration and a weight maintenance phase and different pharmacological treatments may be useful in one phase, but not the other. Although cyproheptadine has some modest benefit during the weight restoration phase, it is not widely used. Fluoxetine administered during the weight maintenance phase decreases relapse rate. The medications currently being most widely studied are the atypical antipsychotics, particularly olanzapine. Emerging evidence suggests that some AN patients have psychotic symptoms that may respond to antipsychotic agents. There are promising case reports and open-label studies of the atypical antipsychotics, but as yet, no randomised, placebo-controlled, double-blind studies have been reported. Additional novel treatment approaches are urgently needed for this group of severely ill patients who have a high premature mortality rate.

Gender, ethnicity, self-esteem and disordered eating among college athletes.

OBJECTIVE: This study was undertaken to compare ethnic and gender differences regarding self-esteem and various disordered eating attitudes and behaviors among elite college athletes. METHOD: A total of 1445 student athletes from 11 Division I schools were surveyed using a 133-item questionnaire. RESULTS: White female athletes reported significantly lower self-esteem than Black female, Black male and White male athletes. Black female athletes' self-esteem was equal to both Black and White male athletes. White female athletes reported significantly higher drive for thinness, body dissatisfaction, and more disturbed eating behaviors than Black female and both groups of male athletes. DISCUSSION: The current study demonstrates that White female athletes appear to be most at risk for having difficulty with eating disorders. Their reporting of significantly lower self-esteem indicates that this may be a risk factor that is more characteristic of this ethnic group. Questions are raised about what factors exist in the Black female culture that protect them from low self-esteem and disordered eating attitudes and behaviors.

Predictors of disordered eating in a sample of elite Division I college athletes.

OBJECTIVE: The present study sought to investigate the relationship between a number of areas of elite student-athletes' lives and disordered eating. METHOD: We surveyed 1445 elite Division I athletes at 11 different institutions and in 11 different sports. Hierarchical regression was used to indicate specific areas of the participants' collegiate experience that may be associated with disordered eating attitudes and symptomatology. RESULTS: Results demonstrate that the variables entered into each model predicted between 40.5% and 46.4% of the variance for the restriction of food, body dissatisfaction, and drive for thinness. Categories of variables that generally predicted the most variance for each dependent measure were demographics, athletic involvement, and personality. Of the 11 sports included in the analysis, wrestling and gymnastics demonstrated elevated levels of drive for thinness, food restriction, and purging behavior compared to other athletes. DISCUSSION: Findings suggest that in elite athletes gender, ethnicity, sport, and self-esteem are associated with several behaviors and attitudes indicative of disordered eating.