Objective
To compare individuals who have experienced binge‐eating disorder (BED) and anorexia nervosa (AN) (BED AN+) to those who have experienced BED and not AN (BED AN–).
Method
Participants ...(N = 898) met criteria for lifetime BED and reported current binge eating. Approximately 14% had a lifetime diagnosis of AN. Analyses compared BED AN+ and BED AN– on sociodemographic variables and clinical history.
Results
The presence of lifetime AN was associated with more severe eating disorder symptoms, including earlier onset, more frequent, more chronic, and more types of eating disorder behaviors over the lifetime, as well as a higher lifetime prevalence of bulimia nervosa (BN). Participants with lifetime AN reported being more likely to have received treatments for BED or BN, had significantly lower minimum, current, and maximum BMIs, had more severe general anxiety, and were significantly more likely to be younger and female. In the full sample, the lifetime prevalence of unhealthy weight control behaviors was high and treatment utilization was low, despite an average 15‐year history since symptom onset. Gastrointestinal disorders and comorbid anxiety, depression, and attention‐deficit/hyperactivity disorder symptoms were prevalent.
Discussion
Individuals fared poorly on a wide array of domains, yet those with lifetime AN fared considerably more poorly. All patients with BED should be screened for mental health and gastrointestinal comorbidities and offered referral and treatment options.
Public Significance
Individuals experiencing binge‐eating disorder have severe symptomology, but those who have experienced binge‐eating disorder and anorexia nervosa fare even more poorly. Our study emphasizes that patients with binge‐eating disorder would benefit from being screened for mental health and gastrointestinal comorbidities, and clinicians should consider history of unhealthy weight control behaviors to inform treatment and relapse prevention.
Objective
The aim of the study was to compare the DSM‐IV, DSM‐5, and ICD‐10 eating disorders (ED) nomenclatures to assess their value in the classification of pediatric eating disorders. We ...investigated the prevalence of the disorders in accordance with each system's diagnostic criteria, diagnostic concordance between the systems, and interrater reliability.
Method
Participants were 1062 children and adolescents assessed at intake to a specialist Eating Disorders Program (91.6% female, mean age 14.5 years, SD = 1.75). Measures were collected from routine intake assessments.
Results
DSM‐5 categorization led to a lower prevalence of unspecified EDs when compared with DSM‐IV. There was almost complete overlap for specified EDs. Kappa values indicated almost excellent agreement between the two coders on all three diagnostic systems, although there was higher interrater reliability for DSM‐5 and ICD‐10 when compared with DSM‐IV.
Discussion
DSM‐5 nomenclature is useful in classifying eating disorders in pediatric clinical samples.
Genetic factors contribute to anorexia nervosa (AN); and the first genome-wide significant locus has been identified. We describe methods and procedures for the Anorexia Nervosa Genetics Initiative ...(ANGI), an international collaboration designed to rapidly recruit 13,000 individuals with AN and ancestrally matched controls. We present sample characteristics and the utility of an online eating disorder diagnostic questionnaire suitable for large-scale genetic and population research.
ANGI recruited from the United States (US), Australia/New Zealand (ANZ), Sweden (SE), and Denmark (DK). Recruitment was via national registers (SE, DK); treatment centers (US, ANZ, SE, DK); and social and traditional media (US, ANZ, SE). All cases had a lifetime AN diagnosis based on DSM-IV or ICD-10 criteria (excluding amenorrhea). Recruited controls had no lifetime history of disordered eating behaviors. To assess the positive and negative predictive validity of the online eating disorder questionnaire (ED100K-v1), 109 women also completed the Structured Clinical Interview for DSM-IV (SCID), Module H.
Blood samples and clinical information were collected from 13,363 individuals with lifetime AN and from controls. Online diagnostic phenotyping was effective and efficient; the validity of the questionnaire was acceptable.
Our multi-pronged recruitment approach was highly effective for rapid recruitment and can be used as a model for efforts by other groups. High online presence of individuals with AN rendered the Internet/social media a remarkably effective recruitment tool in some countries. ANGI has substantially augmented Psychiatric Genomics Consortium AN sample collection. ANGI is a registered clinical trial: clinicaltrials.govNCT01916538; https://clinicaltrials.gov/ct2/show/NCT01916538?cond=Anorexia+Nervosa&draw=1&rank=3.
Objective
The fetal programming model hypothesizes that developmental programming in utero and in early life induces adaptations that predetermine the adult phenotype. This study investigated whether ...prenatal/perinatal complications are associated with lifetime eating disorders in women.
Method
Participants included 46,373 adult women enrolled in the Norwegian Mother and Child Cohort Study (den norske Mor & barn‐undersøkelsen MoBa). MoBa mothers and their mothers (MoBa grandmothers) were the focus of the current study. MoBa mothers with lifetime eating disorders were compared to a referent group.
Results
MoBa mothers who weighed more at birth (birth weight, adjusted odds ratio OR = 1.14; 95% confidence interval CI: 1.10–1.19) or were born large‐for‐gestational‐age (adjusted OR = 1.39; 95% CI: 1.27–1.52) were more likely to develop binge‐eating disorder in later life. MoBa mothers who weighed less at birth were more likely to develop anorexia nervosa (birth weight, adjusted OR = 0.88; 95% CI: 0.81–0.95). Bulimia nervosa and purging disorder (PD) were not significantly predicted by the prenatal and perinatal factors examined.
Discussion
Results of this study, which include the first known investigation of prenatal and perinatal factors in binge‐eating disorder and PD, suggest that fetal programming may be relevant to the development of anorexia nervosa and binge‐eating disorder. Future genetically informative research is needed to help disentangle whether these associations are a function of genetic influences or a true environmental fetal programming effect.
Objective
Clinical perfectionism has been found to be a risk and maintaining factor in eating disorders (EDs), compulsive exercise, and athlete burnout. This study investigated whether an unguided ...internet cognitive–behavioral treatment (ICBT) for perfectionism would reduce ED pathology, compulsive exercise, and burnout in individuals who engage in regular exercise.
Method
Participants were randomly allocated to intervention (n = 38) or waitlist control (n =29). A generalized linear mixed model (GLMM) analysis was conducted pre and post treatment. A follow‐up analysis was conducted with the intervention group at 3 and 6 months.
Results
The intervention group experienced a significant reduction in perfectionism (FMPS‐CM: F1,117 = 17.53, p = < .001, Cohen's d = .82), ED symptomology (EDE‐Q: F1,55 = 7.27, p = .009,Cohen's d = .53) and compulsive exercise (CET: F1,116 = 10.33, p < .001,Cohen's d = .63). The changes attained post‐treatment were maintained within the intervention group at 3‐month (FMPS‐CM (t1,100 = 3.67, p < . 001, Cohen's d = .85) (EDE‐Q (t1,50 = 2.20, p = .03, Cohen's d = 1.26) and 6‐month follow‐up (FMPS (t1,100 = 2.74, p = 007, Cohen's d = .70) (EDE‐Q (t1,50 = 2.18, p = .03, Cohen's d = 1.26).
Discussion
The results indicate unguided ICBT for perfectionism can have a significant impact on perfectionism, compulsive exercise, and ED symptomatology.
Abstract Objectives To compare quality of life (QoL) in mental health outpatients to non-clinical norms, and examine the associations between QoL and principal diagnosis, number of comorbid Axis I ...diagnoses, and type of comorbidity. Methods Consecutively referred and assessed patients (n = 2024) formed the study sample pool. Of these, 1486 individuals who had completed a QoL instrument at intake and had a principal diagnosis amenable to comparison by group analysis were included in the study. Principal diagnoses were unipolar mood disorder (n = 687), eating disorder (n = 226), bipolar disorder (n = 165), social anxiety disorder (n = 165), generalized anxiety disorder (n = 125), and panic disorder (n = 118). QoL for psychiatric groups was compared to non-clinical norms using a valid and reliable measure. Results QoL was significantly impaired in all psychiatric groups compared to nonclinical norms. There was a significant interaction between principal diagnosis and number of comorbid Axis I disorders, controlling for age, sex, marital status, employment, and years of school. The addition of one comorbidity significantly attenuated QoL in social anxiety disorder, panic disorder, and bipolar disorder. For all other conditions, a significant loss in QoL occurred with two or more comorbidities. Axis I depressive and anxiety comorbidity significantly attenuated QoL across all diagnostic groups. Conclusions QoL is significantly impaired in psychiatric outpatients and diagnostic groups vary in the extent to which they experience additional QoL burden with increasing comorbidities.
The aim of this study was to examine whether compulsive exercise mediates the relationship between clinical perfectionism and eating pathology, based on the cognitive behavioral model of compulsive ...exercise. Participants were 368 adults who participated regularly in sport/exercise and completed online measures of perfectionism, compulsive exercise and eating disorders. In support of the well-established link between perfectionism and eating disorders, clinical perfectionism predicted eating pathology both directly and indirectly mediated by compulsive exercise. In addition, there were also direct effects of clinical perfectionism on the avoidance/rule-driven behavior, weight control, and mood improvement subscales of the Compulsive Exercise Test (CET). There was a direct effect of the CET weight control subscale on eating pathology and a negative direct effect of the CET subscale mood improvement on eating pathology. Findings lend support to the cognitive behavioral model of compulsive exercise in which clinical perfectionism is conceptualized as related to eating disorders directly and indirectly through the mediation of compulsive exercise. Compulsive exercise was also found to have a direct effect on eating disorders. Compulsive exercise may be a symptom of eating pathology, rather than an antecedent, however causal inferences could not be established given the correlational design. Longitudinal research using cross-lagged panel designs to examine a bidirectional relationship between compulsive exercise and eating disorders is needed.
•Structural equation modelling was used to examine a model of compulsive exercise.•Clinical perfectionism predicted eating pathology and was mediated by compulsive exercise.•Compulsive exercise had direct effects on eating pathology.•The results support the cognitive-behavioral model of compulsive exercise.•Research should investigate treatments for perfectionism and compulsive exercise.
This study examined perfectionism and self-concept constructs across eating disorder recovery stages in men, using a conceptualization of recovery that encompasses physical, behavioral, and cognitive ...recovery.
Participants were 35 men with an eating disorder history (Mage = 26.60 years, SD = 10.81), categorized as in full recovery, in partial recovery, or with a current eating disorder diagnosis/pathology, and 27 men with no eating disorder history (controls; Mage = 26.44 years, SD = 10.08). Data for determining recovery status were collected from surveys, interviews, and measured weight and height; perfectionism and self-concept were assessed via surveys.
Among the perfectionism constructs, the greatest magnitude of effect sizes involving the fully recovered group was for socially prescribed perfectionism where this group had lower levels of perfectionism than the eating disorder diagnosis/pathology group (Hedge's g = −1.72) or the partially recovered group (Hedge's g = −1.56). For the self-concept constructs, effect sizes involving the fully recovered group and the other recovery status groups were all large (absolute values: 0.76–1.58) and reflected a large magnitude of difference with fully recovered men having higher self-esteem and self-efficacy and lower social comparison than men with a current eating disorder diagnosis or pathology or those partially recovered.
Full recovery in men was associated with healthy self-concept constructs and with low socially prescribed perfectionism. Future research with larger samples should seek to replicate these findings and, using a longitudinal design, examine these constructs as potential predictors or maintenance factors of comprehensive eating disorder recovery in men.
•Research on eating disorders (ED) in men lags behind research on women.•Full ED recovery in men was associated with low socially prescribed perfectionism.•Full ED recovery in men was associated with healthy self-concept constructs.•Given small samples, effect sizes provide directions for future ED research in men.
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