Social resources and social function in comorbid eating and substance disorder: a matched-pairs study.

OBJECTIVE: To assess social resources and function among patients with comorbid Eating Disorder (ED) and substance abuse/dependence, referred to here as Substance Related Disorder (SRD). DESIGN: Descriptive, cross-sectional, comparative. SETTINGS: A university medical center with an Alcohol-Drug Program located within a Department of Psychiatry. SUBJECTS: 70 patients with Substance Related Disorder and Eating Disorder (SRD-ED), matched for gender, age, and race-ethnicity with 70 SRD-only patients. METHODS: A research associate assessed current social resources and social function based on data obtained from patients and collateral sources while blind to the ED status of the patient. Addiction psychiatrists made the diagnoses of SRD and ED and conducted assessments for axis 4 psychosocial stressors and axis 5 psychosocial function. RESULTS: SRD-ED patients had more advantageous social resources than SRD-only patients, including residence with family or friends, more education, higher socioeconomic status, and larger social networks. However, SRD-ED patients manifested martial status, employment, stressors, and coping levels similar to SRD-only patients. CONCLUSIONS: Several alternative explanations exist for these expected though unusual findings. Further analyses will be required to understand this lack of articulation between social resources and social function across two diagnostic groups.

The health professionals services program. An alternative for physicians with psychiatric disorders.

By removing the obstacles of social stigma and board sanction, HPSP offers physicians a way to fulfill their reporting obligations and get confidential help for a psychiatric disorder, chemical abuse, or a medical condition. Physicians who are willing to document how they manage their illness can enroll in HPSP for monitoring without board involvement. Physicians are encouraged to learn more about HPSP--for themselves, colleagues, or any health professional licensed in Minnesota--by calling 651/643-2120 or visiting our Web site at www.hpsp.state.mn.us.

Effects of dynorphin A(1-13) on opiate withdrawal in humans.

The objectives of the current study were to determine 1) the effects of various doses of dynorphin A (1-13) on opiate withdrawal in humans and 2) the safety of dynorphin at these doses. Opiate dependent subjects who had been stabilized on morphine received a single IV dose of placebo, 150, 500 or 1000 microg/kg dynorphin after exhibiting spontaneous withdrawal using a randomized, double-blinded, between-subjects study design. Observer Withdrawal Scores were lower in the 150 and 1000 microg/kg groups as compared to placebo (P < 0.05) but no significant differences were observed on the observer-rated Wang or Sickness Scales. Significant decreases were also found for self-reported symptoms of nervousness, runny nose, sneezing, and painful joints in the 500 microg/kg group. Significant increases in serum prolactin levels were seen after all dynorphin doses; however, these were not dose-related. Dynorphin A (1-13) was well tolerated and safe, with no changes in physiologic parameters. We conclude that dynorphin A (1-13) has a modest effect in reducing mild opiate withdrawal in humans and is well tolerated at doses up to 1000 microg/kg.

Psychopathology in pathological gamblers seeking treatment.

High rates of psychiatric symptoms have been reported in pathological gamblers. This study of psychiatric comorbidity in pathological gamblers is the first to use structured psychiatric interviews assessing DSM-III-R Axis I and II disorders. The Structured Clinical Interview for DSM III-R (SCID-P, SCID-II) was administered to 40 (25 male, 15 male) pathological gamblers seeking outpatient treatment in Minnesota for gambling, and 64 (41 male, 23 female) controls. High lifetime rates of Axis I (92%) but not Axis II (25%) psychopathology were found in pathological gamblers as compared to controls. No differences between male and female gamblers were found in rates of affective, substance use or personality disorders. Females had higher rates of anxiety disorders and histories of physical/sexual abuse. Possible associations between psychiatric disorders and pathological gambling are discussed along with gambler typologies and implications for future research.

Impulse control disorders and attention deficit disorder in pathological gamblers.

Little systematic research has been done on psychiatric comorbidity of pathological gambling, an impulse control disorder. This report describes the occurrence of attention deficit disorder and impulse control disorders in 40 pathological gamblers in treatment for gambling problems and 64 controls. Diagnoses were made by structured interviews which utilized operationalized diagnostic criteria. An impulse control disorder other than pathological gambling was noted in 35% of the pathological gamblers, compared to 3% of the controls (p < .001). Compulsive buying (p < .001) and compulsive sexual behavior (p < .05) were significantly higher in pathological gamblers than controls. A strong association was seen among pathological gambling, attention deficit, and other impulse control disorders. Attention deficit disorder was seen in 20% of the pathological gamblers. Rates of impulse control disorders did not differ by gender. Implications of these high rates of comorbidity are discussed.

Alexithymia, obesity, and binge eating disorder.

Eighty-three obese subjects with binge eating disorder (BED) were compared with 99 obese subjects not meeting criteria for BED on the Toronto Alexithymia Scale (TAS). Overall, the subjects in our sample were not significantly alexithymic, the mean global TAS score being 62.8 (SD = 10.2) which is comparable with the values found in non-patient control samples. Furthermore, the mean TAS scores did not differ between obese subjects with and without BED. However, we found a slightly higher prevalence of alexithymia (TAS total score 74 and above) in BED subjects compared with non-BED subjects (24.1% and 11.1%, respectively). A series of stepwise multiple regression analyses were run, exhibiting a significant relationship between the TAS and educational level and the Eating Disorder Inventory (EDI) subscales Interpersonal Distrust and Ineffectiveness. Age, body mass index, measures of depression, and eating pathology did not predict TAS scores.

Food deprivation history and cocaine self-administration: an animal model of binge eating.

In this two-part study, an animal model of binge eating was first produced, then the rate of acquisition of cocaine self-administration was assessed. Initially, 16 female weanling rats were food deprived (DEPR) at 25, 95, and 143 days of age. Another group of 16 age-matched controls was allowed ad lib access to food. Each time the DEPR group was food deprived, they were allowed to recover to normal weight. They were then injected with butorphanol tartrate (BUTR), an opioid that stimulates feeding, and food intake was measured for 4 h. All rats given BUTR consumed significantly more food than those given saline. Animals with DEPR history consumed food over a longer period of time, and at h 4 after BUTR injection, they consumed significantly more food than controls. In the second part of the experiment, an autoshaping procedure was used to quantitatively evaluate the rate of acquisition of cocaine self-administration. By day 30, 86% of the DEPR and 69% of the control groups had acquired cocaine self-administration.

Psychopathology in subgroups of obese women with and without binge eating disorder.

The examination of psychopathology in subgroups of obese patients is a new area of research in psychiatry. This project studied rates and types of psychopathology among obese subjects meeting the proposed DSM-IV criteria of binge eating disorder (BED) and obese subjects without BED. One hundred obese women with a mean age of 39.2 years and a mean body mass index (BMI) of 35.9 kg/m2 were evaluated using the Structured Clinical Interview for DSM-III-R (SCID-Modified Version) and a self-rating personality inventory, Personality Diagnostic Questionnaire-Revised (PDQ-R), before entering a treatment study for weight reduction. Those subjects meeting proposed DSM-IV criteria for BED had significantly higher lifetime rates for an axis I diagnosis compared with those that did not meet criteria for BED. Subjects with BED showed higher rates of lifetime affective disorder and bulimia nervosa, but did not differ on any other axis I diagnoses. Axis II cluster B and cluster C diagnoses were found more frequently among BED subjects. The specific diagnoses of histrionic, borderline, and avoidant personality disorders were found significantly more often among BED subjects. The results support the idea that binge eating may identify a distinct subgroup among the obese population who have significantly higher rates of certain forms of psychopathology on both Axis I and Axis II. The findings of increased rates of depression are consistent with other studies and suggest that our treatment modalities need to address this problem.

Substance abuse and associated psychiatric disorder among 100 adolescents.

One hundred adolescents aged 14 to 20 were studied in treatment programs located in two states (Minnesota and Oklahoma). The purpose of the study was to assess the course of substance use, number and type of substance disorder diagnoses, severity of substance disorder, treatment history for substance disorder, and psychiatric comorbidity. Duration of course, frequency of substance use, abuse vs. dependence, types of substances used, and associated problems are described as a function of age. Areas of psychiatric and social assessment included: (1) psychiatric self rating scales in those 17 years and older (BDI and SCL-90); (2) psychiatrist rated scales (Hamiltons for anxiety and depression, BPRS, GAS); (3) psychosocial status (Hollingshead and Redlich SES, DSM-III Axes 3 and 4); (4) associated Axis 1 psychiatric diagnoses; (5) family history of mood and other psychiatric disorder; (6) childhood history; and (7) history of previous psychiatric treatment. These data confirm the severity of substance use among younger adolescents presenting to clinical facilities with substance disorder, but further reveal progressive substance disorder severity as these adolescents age. Both self rated and psychiatrist rated scales showed increased depressive symptoms with increasing age. Eating Disorders occurred more often among older adolescents. Loss of either parent in childhood was associated with younger current age.

Compulsive buying: descriptive characteristics and psychiatric comorbidity.

BACKGROUND: Compulsive buying is infrequently described in the psychiatric literature despite suggestions that it may be prevalent. The authors investigated the demographics and phenomenology of this syndrome and assessed psychiatric comorbidity via interviews of both compulsive buyers and normal buyers. METHOD: Twenty-four compulsive buyers were compared with 24 age- and sex-matched normal buyers using (1) a semistructured interview for compulsive buying and impulse control disorders, (2) a modified version of the Structured Clinical Interview for DSM-III-R, and (3) scales measuring compulsiveness, depression, and anxiety. RESULTS: The typical compulsive buyer was a 36-year-old female who had developed compulsive buying at age 17 1/2 and whose buying had resulted in adverse psychosocial consequences. Purchases were usually of clothes, shoes, jewelry, or makeup, which frequently went unused. Compared with normal buyers, compulsive buyers had a higher lifetime prevalence of anxiety disorders, substance use disorders, and eating disorders and were more depressed, anxious, and compulsive. Among compulsive buyers, 16 (66.7%) described buying that resembled obsessive compulsive disorder, whereas 23 (95.8%) described buying that resembled an impulse control disorder. CONCLUSION: Compulsive buying is a definable clinical syndrome that can result in significant psychosocial impairment and which displays features of both obsessive compulsive disorder and the impulse control disorders.

Eating related and general psychopathology in obese females with binge eating disorder.

One hundred obese women with a mean age of 39.2 years, and a mean body mass index (BMI) of 35.9 kg/m2 were evaluated before entering a treatment study for weight reduction. According to the results of a structured interview, subjects were divided into four groups: (1) no overeating episodes, (2) episodic overeating episodes without the feeling of loss of control, (3) overeating plus the sense of loss of control (binge eating), and (4) full diagnostic criteria for binge eating disorder (BED). One-way analyses of variance (ANOVAs) revealed significant positive associations between binge eating and eating/weight-related characteristics such as a history of frequent weight fluctuations, the amount of time spent dieting, drive for thinness, and a tendency for disinhibition of eating. Furthermore, subjects exhibited more feelings of ineffectiveness, stronger perfectionistic attitudes, more impulsivity, less self-esteem, and less interoceptive awareness the more problems with binge eating they reported. The results support the idea that binge eaters might be a distinct subgroup among the obese population, and corroborate the utility of a diagnosis of BED in identifying the most disturbed obese subjects with regard to the variables tested.

A review of the controlled trials of pharmacotherapy and psychotherapy in the treatment of bulimia nervosa.

The treatment literature on bulimia nervosa includes several double-blind placebo controlled studies, the majority of which examine the use of antidepressants in bulimia nervosa. The psychotherapy literature has focused heavily on the use of cognitive behavioral therapy (CBT) in the treatment of this eating disorder. Some studies have compared CBT to other types of therapy or waiting list controls. The following review will examine the methodology and outcome of the pharmacotherapy and psychotherapy treatment studies of bulimia nervosa. The authors conclude that while the studies indicate treatment is somewhat effective, there remains uncertainty regarding the long-term effectiveness of most of the reported treatments.

Diagnosing binge eating disorder: level of agreement between self-report and expert-rating.

We assessed the correlation between a self-report questionnaire and an expert-rating including an initial interview and a longitudinal evaluation on the diagnosis of binge eating disorder (BED) in a sample of 100 obese women participating in a treatment program for weight reduction. The level of diagnostic agreement between patient-rating and expert-rating with regard to the presence or absence of BED was modest, with a kappa value of .57. According to Shrout, Spitzer, and Fleiss (Archives of General Psychiatry, 44, 172-177, 1987) this represents fair to good agreement beyond chance. The self-report instrument did not produce higher estimates of the frequency of BED in this selected sample of treatment seekers than the expert-rating, as observed in studies on the epidemiology of bulimia nervosa in community samples. The questionnaire identified 40 cases of BED, the expert-rating 43 cases. The results indicate that the disagreement between self-report and interview was mainly due to discordances in three of the diagnostic criteria of BED--namely loss of control, marked distress regarding binge eating, and the frequency requirement of two binge eating episodes per week for a 6-month period. Inconsistencies between subjects and clinicians with regard to the definition of an overeating episode and with regard to the behavioral indicators of loss of control did not lead to differences between self-report and observer-rating in the final diagnosis of BED.

Survival analysis of response to group psychotherapy in bulimia nervosa.

A reanalysis of treatment response and relapse was performed using survival analysis in a 12-week clinical trial of cognitive behavioral group psychotherapy for the treatment of bulimia nervosa. One hundred forty-three (143) bulimic women with high incidence of binge eating, self-induced vomiting, and/or laxative abuse were randomly assigned to one of four possible treatment conditions that consisted of a combination of two factors: (1) emphasis on abstinence (high and low), and (2) treatment intensity (high and low). "Initial" and "maintained" response to treatment based on "total" and "near" abstinence criteria were determined using self-reported binge eating, vomiting, and laxative use data. Results suggest that an emphasis on abstinence appears important in achieving initial abstinence, whereas intensity of treatment may be important in maintaining abstinence.

Comorbidity and medical complications of bulimia nervosa.

The syndrome of bulimia nervosa has been associated with a high rate of comorbidity with other psychiatric disorders. In particular, high rates of affective disorders, chemical dependency problems, anxiety disorders, and personality disorders have been described among these patients and, in some studies, among their relatives. The reasons for this elevated comorbidity remain unclear. It is frequently difficult to tell which condition develops first. Bulimia nervosa has also been associated with significant medical complications. Most patients with bulimia evidence metabolic and endocrine changes suggestive of a state of semistarvation. Fluid and electrolyte abnormalities are common, as are dental complications. Gastrointestinal complications are rare, but can be quite serious. A careful physical assessment is indicated for each bulimic patient.