Characterizing Loss of Control Associated With Binge Eating in College-Age Men.

BACKGROUND: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.) identifies key features of binge eating (BE) to include the consumption of a large amount of food and the perception of loss of control (LOC) over eating during a distinct episode. While earlier research has focused on food consumption, findings are now emerging on the role of LOC associated with the BE episodes, particularly in women. However, it is unclear that these findings are applicable to men without knowing how men experience LOC associated with BE. AIMS: This study examined how college-age men describe LOC associated with BE. METHOD: Previously collected qualitative data from a study examining BE in college age-students were used to examine responses from 53 men (mean age 19.9 ± 1.1 [SD] years). Respondents were asked about their individual experiences of LOC associated with BE episodes. Data were analyzed using content analysis. RESULTS: Four categories emerged from the data: (1) keep eating, (2) can't stop, (3) without thinking, and (4) food so good. CONCLUSIONS: Findings extend the current understanding of LOC associated with BE in men and point to potential gender differences, and/or weight influences, based on previous reports. Identified categories may be potentially targeted areas for tailored therapy to enhance awareness and self-regulation of BE behavior.

Factors associated with refeeding hypophosphatemia in adolescents and young adults hospitalized with anorexia nervosa.

BACKGROUND: Refeeding hypophosphatemia (RH) in individuals with anorexia nervosa (AN) is a potentially fatal complication of nutrition restoration; yet, little is known about risk. This retrospective cohort study examined factors found in hospitalized youth with AN that may contribute to RH. METHODS: We reviewed medical records of 300 individuals diagnosed with AN admitted between the years of 2010 and 2016. Logistic regression examined factors associated with RH. Multivariate regression examined factors associated with phosphorus nadir. RESULTS: For 300 participants, the mean (SD) age was 15.5 (2.5) years, 88.3% were White, and 88.3% were female. Participants lost an average of 11.3 (9.7) kg of body weight and were 82% (12.1) of median body mass index (BMI). Age (P = .022), nasogastric (NG) tube feeding (P = .054), weight gain (P = .003), potassium level (P = .001), and magnesium level (P = .024) were contributors to RH. Odds of RH were 13.7 times higher for each unit reduction in magnesium, 9.2 times higher for each unit reduction in potassium, three times higher in those who received NG feeding, 1.5 times higher for each kg of weight gain, and 1.2 times higher for each year of age. Regarding phosphorus nadir, serum magnesium level (P < .001) and admission BMI (P = .002) contributed significantly. CONCLUSION: The results indicate that age, NG feeding, weight gain, electrolyte abnormalities, and BMI on admission are potential indicators of the development of RH in youth. This study identifies clinical risk factors associated with RH and may guide further investigation.

Mindfulness in persons with anorexia nervosa and the relationships between eating disorder symptomology, anxiety and pain.

Mindfulness is useful for some psychiatric illnesses, but limited research exists among persons with anorexia nervosa (AN). This study aimed to determine the relationship between mindfulness, eating disorder symptomology and indicators of health in women with AN (n = 59) entering residential treatment. Participants completed a self-administered survey, including the Cognitive Affective Mindfulness Scale and other measures. Additional data from medical records were collected. Greater mindfulness was associated with less eating disorder symptoms (p = .049). This relationship was most profound in individuals with AN, including restrictive and binge-purge subtypes compared to individuals with atypical AN (interaction p-value = 0.044). Greater mindfulness was significantly associated with less shape (p = .023) and weight concern (p = .047). Expectedly, anxiety was inversely associated with eating disorder symptoms (p = .001). Greater pain was associated with less eating disorder symptoms (p = .024). Overall, mindfulness may be a protective factor against some eating disorder symptomology.

Binge Eating and Loss of Control in College-Age Women.

BACKGROUND: Loss of control (LOC) over eating is a cardinal feature of the DSM-5 definition of binge eating (BE). While this behavior is frequently reported in college-age women, there is limited research on descriptions of loss of control from first-person accounts from individuals reporting LOC associated with BE. OBJECTIVE: The objective of this study was to investigate descriptions of LOC associated with BE episodes in college-age women who reported recent BE behavior. STUDY DESIGN: A secondary analysis of previously collected qualitative data on BE behaviors in college students was conducted. Two hundred and twenty-one college-age women's (age = 19.77 ± 1.03) comments regarding the experiences of LOC associated with BE episodes were analyzed using conventional content analysis. Codes were inductively generated allowing categories to emerge from the data codes. RESULTS: Three major overarching descriptive categories were identified: (1) LOC over eating, (2) feelings associated with the LOC, and (3) cognitive dispositions (thoughts) associated with LOC during a BE episode. DISCUSSION: The findings of this study expand the current literature on LOC over eating and provide a number of potential targets for intervention with college-age women who report BE behaviors.

Extreme Weight Loss Behaviors in Racially Diverse Urban Adolescents.

PURPOSE: Extreme weight loss behaviors (EWLBs) pose a serious health risk to adolescents. Studies suggest a link between EWLBs and other health-compromising behaviors. Extending these findings, this study examines correlates of EWLB in a predominantly minority adolescent population. METHODS: A secondary analysis of EWLB data from adolescents in an inner city pediatric emergency department was conducted. The sample (n = 3,876) included 60% African-American, 20% Hispanic, 16% Caucasian, and 4% Asian-Pacific Islander individuals. Comparative analyses and multivariate logistic regressions were applied. RESULTS: Fifteen percent of the sample endorsed use of EWLBs; endorsement did not differ between minority and Caucasian groups, or among minority subgroups. EWLB correlates included female gender, hopelessness, abuse history, current smoking, and alcohol use. CONCLUSIONS: Endorsement of EWLBs is not different between minority and Caucasian adolescents surveyed in an emergency department. Identified correlates are potential targets for prevention and early intervention.

Satiation deficits and binge eating: Probing differences between bulimia nervosa and purging disorder using an ad lib test meal.

Purging disorder (PD) has been included as a named condition within the DSM-5 category of Other Specified Feeding or Eating Disorder and differs from bulimia nervosa (BN) in the absence of binge-eating episodes. The current study evaluated satiation through behavioral and self-report measures to understand how this construct may explain distinct symptom presentations for bulimia nervosa (BN) and purging disorder (PD). Women (N = 119) were recruited from the community if they met DSM-5 criteria for BN (n = 57), PD (n = 31), or were free of eating pathology (n = 31 controls). Participants completed structured clinical interviews and questionnaires and an ad lib test meal during which they provided reports of subjective states. Significant group differences were found on self-reported symptoms, ad lib test meal intake, and subjective responses to food intake between individuals with eating disorders and controls and between BN and PD. Further, ad lib intake was associated with self-reported frequency and size of binge episodes. In a multivariable model, the amount of food consumed during binges as reported during clinical interviews predicted amount of food consumed during the ad lib test meal, controlling for other binge-related variables. Satiation deficits distinguish BN from PD and appear to be specifically linked to the size of binge episodes. Future work should expand exploration of physiological bases of these differences to contribute to novel interventions.

Plasma BDNF levels following weight recovery in anorexia nervosa.

OBJECTIVE: Preclinical studies have implicated brain-derived neurotrophic factor (BDNF) in the regulation of eating behavior and body weight. As reviewed in this report, prior studies of BDNF levels in anorexia nervosa have yielded variable results, perhaps reflecting effects of malnutrition and psychiatric comorbidity. The goal of the current report was to assess plasma BDNF as a biomarker in weight-recovered individuals with a history of anorexia nervosa (ANWR). METHODS: Study groups included women meeting criteria for ANWR and healthy female controls. Participants were in a normal weight range, free of current major psychiatric disorder, and free of medication. Self-ratings included eating disorder symptoms, depression and anxiety. Plasma BDNF levels were measured by enzyme linked immunoassay. RESULTS: Plasma BDNF levels were not significantly different for ANWR and control groups. Plasma BDNF levels were inversely correlated with anxiety ratings in controls (p<0.02) but not in the ANWR group. DISCUSSION: This report provides new evidence that circulating BDNF concentrations do not differ in healthy controls and ANWR free of psychiatric comorbidity. Additionally, the data provide new information on the relationship between plasma BDNF and anxiety in these two study groups.

Nursing Care Considerations for the Hospitalized Patient with an Eating Disorder.

Eating disorders are chronic psychiatric illnesses with significant medical complications, psychological distress, and psychiatric comorbidity. Although many patients are treated on an outpatient basis, inpatient care for the more severely ill hospitalized patient can be challenging given the severity of illness and concurrent issues requiring intervention. This article provides an overview of the clinical characteristics of eating disorders typically seen for inpatient care, focusing primarily on anorexia nervosa and bulimia nervosa, and the associated key areas for nursing assessment, diagnoses, and plan of care during hospitalization.

Binge eating among racial minority groups in the United States: an integrative review.

BACKGROUND: Binge eating (BE) is a disordered eating behavior that has been linked to the development of eating disorders and obesity, with the latter being a condition with higher prevalence rates among some racial minority groups. Although researchers have begun to examine characteristics of BE among racial minority groups, it is unclear how these differ from White populations. OBJECTIVE: This article provides an integrative review of published literature within the past decade reporting on the characteristics of BE in minority compared with White racial groups. METHOD: Health care computerized databases were searched using key terms. RESULTS: Eighteen research studies met the inclusion criteria. More than half of the studies reviewed reported racial differences in some aspect of BE; however, heterogeneity in the definition and measurement of BE limits the ability to compare findings across studies. CONCLUSIONS: BE is reported across racial groups. To determine whether meaningful differences in BE exist by race, further studies using the same conceptual and operational definitions of BE are needed.

Self-report of eating disorder symptoms among women with and without infertility.

OBJECTIVE: To compare eating disorder (ED) symptoms in women seeking treatment for infertility to women receiving routine primary care. DESIGN: A cross-sectional comparative design. SETTING: Women were recruited from two infertility centers and a general hospital primary care setting. PARTICIPANTS: Participants included 51 women seeking treatment for ovulatory and unexplained infertility and 34 women attending routine primary care. MEASURES: Participants completed a battery of standardized rating scales measuring self-reported ED symptoms, drive for thinness, bulimic symptoms, body dissatisfaction, and related clinical characteristics. RESULTS: Multivariate analysis of covariance confirmed that women seeking treatment for infertility had significantly greater scores on measures of drive for thinness (p = .001) and bulimic symptoms (p = .002) than those receiving routine primary care. However, the comparison group had significantly greater scores on measures of body dissatisfaction (p < .001) and dietary restraint (p = .001) than the infertility group. Both groups had elevated rates of lifetime ED diagnoses compared to national prevalence rates. CONCLUSIONS: Results demonstrated that women seeking treatment for ovulatory and unexplained infertility have greater drive for thinness and bulimic symptoms but not body dissatisfaction or dietary restraint compared to women seeking primary care. The results suggest that infertility and routine health care visits may provide opportunities for early identification and treatment of women with ED symptomatology. Future studies may benefit from further elucidation of the potential role of ED symptoms in the etiology and maintenance of infertility in, particularly, normal-weight women.

Peripheral brain derived neurotrophic factor (BDNF) in bulimia nervosa: a systematic review.

INTRODUCTION: Currently, there is limited understanding of the etiology of BN. While multifaceted etiology is likely, several neurobiological factors may play a role. Brain derived neurotrophic factor (BDNF), a potential biomarker linked to eating and weight disorders, is one factor of recent investigation. This paper examined studies comparing BDNF blood levels in BN to healthy control (HC) subjects. METHODS: A systematic review of the literature was conducted utilizing five databases (PubMed, CINAHL, EMBASE, PsycINFO, and Medline). Key terms included eating disorders, BDNF, and bulimia nervosa. CONCLUSIONS: BDNF blood levels appear lower in BN than in HC subjects; however, studies are needed to examine the influence of possible correlates including symptom severity, mood, medications, exercise, and substance use.

CCK response in bulimia nervosa and following remission.

The core defining features of bulimia nervosa (BN) are repeated binge eating episodes and inappropriate compensatory (e.g., purging) behavior. Previous studies suggest an abnormal post-prandial response in the satiety-signaling peptide cholecystokinin (CCK) in persons with BN. It is unknown whether this altered response persists following remission or if it may be a potential target for the development of clinical treatment strategies. To examine the nature of this altered response, this study assessed whether CCK normalizes following remission from BN (RBN). This study prospectively evaluated the plasma CCK response and corresponding eating behavior-related ratings (e.g., satiety, fullness, hunger, urge to binge and vomit) in individuals with BN-purging subtype (n=10), RBN-purging subtype (n=14), and healthy controls (CON, n=13) at baseline, +15, +30, and +60 min following the ingestion of a standardized liquid test meal. Subject groups did not significantly differ in CCK response to the test meal. A significant relationship between CCK response and satiety ratings was observed in the RBN group (r=.59, p<.05 two-tailed). A new and unanticipated finding in the BN group was a significant relationship between CCK response and ratings of "urge to vomit" (r=.86, p<.01, two-tailed). Unlike previous investigations, CCK response did not differ in BN and CON groups. Thus the role of symptom severity remains an area of further investigation. Additionally, findings suggest that in this sample, CCK functioning following remission from BN-purging subtype is not different from controls. It remains unknown whether or not CCK functioning may be a protective or liability factor in the stabilization and recovery process. Replication studies utilizing a larger sample size are needed to further elucidate the role of CCK in recovery from BN and its potential target of related novel treatment strategies.

Accuracy of self-reported body weight and height in remitted anorexia nervosa.

BACKGROUND: The literature reflects contradictory evidence on the ability of persons with anorexia nervosa (AN) to accurately report body weight and height. Furthermore, it is currently unknown if individuals are able to correctly report their weight and height following weight recovery from AN. OBJECTIVE: This study examined the accuracy of self-reported body weight and height following remission from anorexia nervosa (RAN). DESIGN: Individuals included women with RAN (n = 45), anorexia nervosa (AN; n = 23), and controls (CON; n = 71). Subjective body mass index (BMI; kg/m(2)) was calculated from self-reported weight and height; objective BMI was calculated using values obtained with standard measures. RESULTS: Subjective weights were significantly less than objective weights for the RAN and CON groups (p < .005). These groups reported being taller resulting in lower subjective BMIs (p < .001). The AN group did not significantly differ on subjective and objective weight, height, or BMI. CONCLUSIONS: Results highlight the importance of objective measures for early identification/relapse prevention.

Serum amylase in bulimia nervosa and purging disorder: differentiating the association with binge eating versus purging behavior.

OBJECTIVE: Elevated serum amylase levels in bulimia nervosa (BN), associated with increased salivary gland size and self-induced vomiting in some patients, provide a possible marker of symptom severity. The goal of this study was to assess whether serum hyperamylasemia in BN is more closely associated with binge eating episodes involving consumption of large amounts of food or with purging behavior. METHOD: Participants included women with BN (n=26); women with "purging disorder" (PD), a subtype of EDNOS characterized by recurrent purging in the absence of objectively large binge eating episodes (n=14); and healthy non-eating disorder female controls (n=32). There were no significant differences in age or body mass index (BMI) across groups. The clinical groups reported similar frequency of self-induced vomiting behavior and were free of psychotropic medications. Serum samples were obtained after overnight fast and were assayed for alpha-amylase by enzymatic method. RESULTS: Serum amylase levels were significantly elevated in BN (60.7±25.4 international units [IU]/liter, mean±sd) in comparison to PD (44.7±17.1 IU/L, p<.02) and to Controls (49.3±15.8, p<.05). CONCLUSION: These findings provide evidence to suggest that it is recurrent binge eating involving large amounts of food, rather than self-induced vomiting, which contributes to elevated serum amylase values in BN.

Quality of eating disorders websites: what adolescents and their families need to know.

OBJECTIVE: The purpose of this study was to examine the accessibility and content quality of eating disorder websites. METHODS: A descriptive, exploratory study using four search engines and seven search terms was conducted to identify and evaluate the accuracy of eating disorder information available on consumer oriented websites. FINDINGS: One hundred fifteen (82.1%) websites were accessed. Few sites fully described the DSM diagnostic criteria for anorexia nervosa (13.2%), bulimia nervosa (15.8%), eating disorder not otherwise specified (6.9%), and binge eating disorder (8%), as well as associated treatment options. CONCLUSIONS: Results suggest that eating disorder websites do not adequately address diagnostic criteria or treatment options.

Psychobiology of purging disorder: reduction in circulating leptin levels in purging disorder in comparison with controls.

OBJECTIVE: Purging disorder (PD), a recently recognized eating disorder syndrome, is differentiated from bulimia nervosa (BN) based on the absence of objectively large binge episodes. BN has been associated with low serum leptin levels. This study examined whether PD is also characterized by low serum leptin. METHOD: Participants included women with PD (n = 20) or BN (n = 37), and non-eating disorder controls (n = 33). Blood samples for measurement of leptin and total ghrelin were obtained after overnight fast. RESULTS: In comparison with control values, leptin levels were significantly decreased in PD (p < .01), as well as in BN (p < .02). Plasma ghrelin levels did not differ significantly across groups. DISCUSSION: These results provide the first evidence that PD is associated with alteration in a neurobiological pathway influencing eating patterns and body weight. Further research is needed to assess whether low leptin levels in PD and BN are associated with restrained eating and weight suppression.