A randomized controlled two-stage trial in the treatment of bulimia nervosa, comparing CBT versus motivational enhancement in Phase 1 followed by group versus individual CBT in Phase 2.

OBJECTIVE: To conduct a randomized, controlled, two-stage trial in the treatment of bulimia nervosa, comparing cognitive-behavioral therapy (CBT) versus motivational enhancement in Phase 1 followed by group versus individual CBT in Phase 2. METHODS: A total of 225 patients with bulimia nervosa or eating disorder not otherwise specified (EDNOS) were recruited into a randomized controlled trial lasting 12 weeks with follow-ups at 1 year and 2.5 years. RESULTS: Patients improved significantly across all of the interventions with no differences in outcome or treatment adherence. Including motivational enhancement therapy rather than a CBT first phase of treatment did not affect outcome. CONCLUSIONS: Outcome differences between individual and group CBT were minor, suggesting that group treatment prefaced by a short individual intervention may be a cost-effective alternative to purely individual treatment.

Validation of the eating disorder diagnostic scale for use with Hong Kong adolescents.

OBJECTIVE: We examined the psychometric properties of the Eating Disorder Diagnostic Scale (EDDS) in a community sample of Hong Kong school children. METHOD: Participants (359 boys and 387 girls), aged 12 to 19 years, were assessed on the EDDS on two occasions, one month apart. Factor structure, internal consistency, test-retest reliability, and validity against the Eating Disorders Examination-Questionnaire (EDE-Q) and Center for Epidemiological Studies-Depression (CES-D) were investigated. RESULTS: Four groupings emerged on exploratory factor analysis: body dissatisfaction, bingeing behaviors, bingeing frequency, and frequency of compensatory behaviors. Items loaded on the same factors for boys and girls. Internal consistency for these factors was acceptable. Test-retest reliability was high for body dissatisfaction factor but weak to moderate for other factors and for diagnoses. High concurrent validity with the EDE-Q, and correlation with the CES-D was shown. CONCLUSION: We offer preliminary reliability and validity evidence to support the further development of the EDDS as a screening instrument to assess eating disturbances in Hong Kong youth.

The incidence of anorexia nervosa on Curaçao.

OBJECTIVE: Although anorexia nervosa was once thought to occur only in affluent societies, cases have now been documented across the globe. To examine whether anorexia nervosa emerges in societies undergoing socioeconomic transition, the authors studied the incidence of anorexia nervosa on the Caribbean island of Curaçao. METHOD: The authors contacted the full range of community health and service providers on Curaçao, including dietitians, school counselors, and all 82 general practitioners. They also studied inpatient records for 84,420 admissions to Curaçao General Hospital and two private hospitals in 1995-1998. Probable-incident subjects were interviewed. RESULTS: The incidence rates in 1995-1998 per 100,000 person-years for anorexia nervosa on Curaçao were 1.82 (95% confidence interval [CI]=0.74-2.89) for the total population and 17.48 (95% CI=4.13-30.43) for the high-risk group of 15-24-year-old females. No cases were found among the majority black population. For the Curaçao mixed and white population, the incidence rate per 100,000 person-years for anorexia nervosa was 9.08 (95% CI=3.71-14.45). CONCLUSIONS: The overall incidence of anorexia nervosa on Curaçao is much lower than in the affluent societies of the United States and Western Europe. Within Curaçao, sociocultural factors appear to be associated with differential incidence rates of anorexia nervosa. The incidence of anorexia nervosa among the majority black population is nil, while the incidence among the minority mixed and white population on Curaçao is similar to that of the United States and the Netherlands.

The meaning of 'self-starvation' in impoverished black adolescents in South Africa.

Recent surveys in South Africa have demonstrated that disordered eating is equally common among black and white female students. Self-report measures have been used in these surveys to establish levels of disordered eating. One study in Tanzania, where a two-stage design was implemented, showed that upon interview the majority of participants did not present with disordered eating. The absence of two-stage studies in South Africa brings into question some of the findings from these surveys. In the present study, we surveyed a sample of black and white high school students in South Africa to establish the prevalence of disordered eating. In the second phase of this study, we attempted to interview those black students from one particular school who scored high on the eating disorder measures. This process proved both challenging and elucidating. While a significant number of young black females endorsed eating disorder symptoms on self-report, interviews with some participants showed that self-starvation and related symptoms had a different meaning from what we would typically expect from someone with an eating disorder. Consequently, this study highlights the need to revisit the methods typically employed in cross-cultural research in eating disorders. Careful consideration of a variety of cultural factors that may alter the meaning of standard measures is called for.

Not your "typical island woman": anorexia nervosa is reported only in subcultures in Curaçao.

Anorexia nervosa (AN), once thought to be a problem of wealthier, Western countries has now been documented in survey studies and case reports across geographic and economic groups; however, few epidemiological studies including interview have been done on these populations. We report on a comprehensive study on Curaçao, a Caribbean island in economic transition, where the majority of the population is of predominantly black African origin. As part of an epidemiological study on the island of Curaçao indigenous cases of AN were identified. Participants were interviewed and asked to complete standardized measures of eating behaviors and cultural attitudes. In addition, matched controls completed the same measures and were seen in a focus group to assess their knowledge of eating disorders and perceived current and future challenges to young Curaçao women. Six of the nine indigenous cases of AN were successfully traced; all were of mixed race. No cases of anorexia were found among the majority black population. The women with AN were from the high-education and high-income sectors of the society and the majority had spent time overseas. The women with a history of anorexia reported higher levels of perfectionism and anxiety than the matched controls. All of the women reported challenges to maintaining an active professional and personal life and viewed themselves as different from the norm. Women who presented with AN evidenced vulnerability to a triple threat to identity formation: (1) they were of mixed race, aspiring to fit into the mobile elite (and mostly white) subgroup while distancing themselves from the black majority; (2) they had the means for education and travel that left them caught between modern and traditional constructs of femininity; and (3) they had lived overseas, and therefore struggled upon reentry with the frustrations of what was possible within the island culture. The race, class and overseas exposures of the women with anorexia were anything but typical on the island. Cases of anorexia in other developing countries may similarly be limited to specific subgroups, which require specialized treatment and planning efforts.