Repeated binge/purge cycles in bulimia nervosa: role of glucose and insulin.

The available data indicate that over half of patients with bulimia nervosa binge and purge daily with repetitions of the binge/purge cycle being common. An understanding of the biobehavioral mechanisms associated with frequent binge/purge cycles may aid the general conceptualization of bulimia nervosa including its development and maintenance. Binging and purging have demonstrable physiological effects that may be partially responsible for the repetition of binge/purge episodes. In the present study, the cephalic phase oversecretion of insulin and high insulin levels subsequent to purging were investigated as possible mediators of repeated binging and purging. Insulin and glucose levels of bulimic and nonbulimic women were measured in response to: thinking about food, the presence of food, while eating, and for the bulimic group, after purging. Bulimic subjects displayed a dramatic reduction in both insulin and glucose after purging the test meal. When these same subjects ate a subsequent meal that was not purged, they displayed elevations in insulin and glucose similar to those of the normal controls. The hypoglycemia resulting from purging appears to be partially responsible for the continuation of repeated binge/purge episodes.

Psychiatric comorbidity in patients with generalized anxiety disorder.

OBJECTIVE: The goal of this study was to test the validity of generalized anxiety disorder as an independent diagnostic entity and to evaluate the prevalence and type of other psychiatric disorders coexisting with generalized anxiety disorder. Although a few published studies have addressed the subject, this study presents data from a larger group of subjects and excludes concurrent major depression as a potential confound. METHOD: The authors studied patients with a primary diagnosis of generalized anxiety disorder assigned after evaluation with the Structured Clinical Interview for DSM-III-R. Patients with a concurrent major depressive episode were excluded. All diagnoses for which the patient met criteria were determined, including lifetime occurrence of major depressive episode and substance use. RESULTS: One hundred nine patients with generalized anxiety disorder were included in the analysis. Twenty-eight (26%) of these patients were not given any other lifetime psychiatric diagnosis. The most prevalent comorbid diagnoses were social phobia (25 [23%] of the patients) and simple phobia (23 [21%] of the patients). Forty-six (42%) of the patients with generalized anxiety disorder had experienced at least one major depressive episode during their lifetime. CONCLUSIONS: These results support previous findings of high rates of psychiatric comorbidity in generalized anxiety disorder and validate the usefulness of generalized anxiety disorder as a separate diagnostic entity.

The Kids' Eating Disorders Survey (KEDS): a study of middle school students.

OBJECTIVE: Anorexia nervosa and bulimia nervosa are known to occur in children although prevalence studies are lacking. METHOD: Using a newly developed self-report instrument, the Kids' Eating Disorders Survey (KEDS), 3,175 students (1,610 females, 1,565 males) enrolled in grades 5 to 8 were surveyed. RESULTS: More than 40% of respondents reported feeling fat and/or the wish to lose weight. These frequencies of weight control behaviors were reported, many of which were significantly greater in girls than boys (*p < 0.05, chi-square): dieting (31.4%*), fasting (8.7%*), diet pill use (2.4%*), vomiting (4.8%), diuretic use (1.5%). The effects of age, grade, weight, and race on responses are reviewed. CONCLUSIONS: Findings demonstrate that development of prevention programs aimed at recognizing problem eating behavior in children is indicated.

Psychological aspects of obesity and very-low-calorie diets.

This paper selectively reviews available evidence concerning psychological characteristics associated with obesity, psychological changes accompanying very-low-calorie diets (VLCDs), and the influence of certain psychological factors on response to VLCD treatment. The obese population as a whole does not show an elevated incidence of psychopathology. Treatment-seeking obese do show more psychiatric disturbance, at a level comparable to other medical/surgical patients. There appear to be no global personality traits or profiles that are associated with obesity. However, obese people differ from non-obese groups on psychological and behavioral variables related to weight and eating and more frequently display perceptual and emotional body image anomalies. Binge eating appears rather common among obese groups. VLCDs have generally neutral to positive effects on hunger, depression, and anxiety. New data on body image suggest that VLCDs are associated with post-treatment underestimation of body size. Finally, recent data on possible psychological and behavioral correlates of VLCDs outcome are presented.

Behavioral assessment and treatment of postprandial regurgitation.

The behavioral assessment and treatment of five patients with postprandial symptoms of regurgitation and "rumination" illustrate the contribution of behavior therapy to alleviating postprandial distress. They also suggest that psychological/behavioral factors may influence the development and course of some gastrointestinal disorders.

Differential effects of feedback sensitivity upon learned control of skin temperature.

Ninety subjects participated in a skin temperature biofeedback study concerning the effects of feedback sensitivity. Subjects were randomly assigned to a high sensitivity, low sensitivity, or a no-feedback condition. Based upon previous research, it was predicted that the low sensitivity condition would produce superior skin temperature warming and greater reduction of autonomic arousal. Also, it was predicted that both feedback conditions would be superior to the no-feedback condition for skin temperature control and reduction of autonomic arousal. The results indicated that low sensitivity feedback was not superior to high sensitivity feedback for skin temperature control, but did produce greater reduction of autonomic variables. The prediction that feedback was superior to no-feedback was also confirmed.

Comparisons of high, medium, and low feedback sensitivity for the control of heart-rate acceleration.

Thirty-four student volunteers were randomly assigned to one of three feedback sensitivity conditions: high sensitivity, medium sensitivity, or low sensitivity. Each subject received four sessions of biofeedback training with instructions to accelerate heart rate. In each condition, analogue feedback was provided during heart-rate acceleration trials. In addition to heart rate, frontal EMG and digital skin temperature were also recorded. Results replicated and extended the findings of a previous study in that medium and low sensitivity feedback was found to be superior to high sensitivity feedback during the final training session. These results confirm previous findings that a high sensitivity feedback produces very poor control of heart-rate acceleration. These data were discussed in terms of motor skills theory and in terms of possible effects of feedback sensitivity upon the motivation of subjects.