International Journal of Eating Disorders

Fairburn, Christopher G.; Cowen, Phillip J.; Harrison, Paul J.

doi: 10.1002/(SICI)1098-108X(199912)26:4<349::AID-EAT1>3.0.CO;2-Bpmid: 10550776

Objective To evaluate the major twin studies of eating disorders in order to consider the empirical standing of the suggestion that these disorders, notably bulimia nervosa, are largely genetically determined. Method Examination of the relevant twin studies and the methods used. Results The findings of the twin studies are inconsistent and difficult to interpret, with estimates for the heritability of liability to bulimia nervosa ranging from 0% to 83%, and from 0% to 70% for anorexia nervosa. Methodological reasons for this variability include issues of definition of phenotype, diagnostic reliability, violation of the equal environments assumption, and small sample sizes. Many of these issues also apply to twin studies of other psychiatric disorders. Conclusions The heritability of eating disorders remains unknown. A broad view on the etiology of eating disorders should be maintained, with a focus on environmental mechanisms and gene‐environment interactions, as well as continuing genetic studies. © 1999 John Wiley & Sons, Inc. Int J Eat Disord 26: 349–358, 1999.

Fichter, Manfred M.; Quadflieg, Norbert

doi: 10.1002/(SICI)1098-108X(199912)26:4<359::AID-EAT2>3.0.CO;2-7pmid: 10550777

Objective Since there are discrepant findings in the literature, we studied the longer‐term course in a large sample of 103 DSM‐IV anorexia nervosa (AN) patients. Method Assessments were made at four points of time: beginning of therapy, end of therapy, 2‐year follow‐up, and 6‐year follow‐up. Self‐rating scales as well as expert‐rating interview data were used. Eating disorder‐specific and general psychopathology were assessed. These data were also compared with data on the 6‐year course of patients with bulimia nervosa and binge eating disorder, respectively, who were treated at the same institution at about the same time. Results The participation rate at the two follow‐ups was high (97.9% of those alive). The general pattern of results over time of those alive at 6‐year follow‐up was as follows: substantial improvement during therapy, moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 6 years posttreatment. At the time of the 6‐year follow‐up, 26.8% had AN, 9.9% had bulimia nervosa‐purging type (BN‐P), 2.0% were classified as eating disorder not otherwise specified (ED‐NOS), all diagnosed according to DSM‐IV criteria; more than one half (55.4%) showed no major DSM‐IV eating disorder. Based on an operationalized global outcome score at 6‐year follow‐up, 34.7% had a good outcome, 38.6% an intermediate outcome, 20.8% a poor outcome, and 6 of 101 persons (5.9%) were deceased. Body mass index was 17.9 ± 2.8 at the 6‐year follow‐up; amenorrhea was still found in 23.9%. Discussion In comparison to samples with bulimia nervosa or binge eating disorder, the 6‐year course of anorexia nervosa was less favorable. Mortality was rather high and symptomatic recovery protracted; predictors of unfavorable 6‐year course were the presence of binges during 4 weeks before index treatment, psychiatric comorbidity, and low body weight at discharge from index treatment. © 1999 John Wiley & Sons, Inc. Int J Eat Disord 26: 359–385, 1999.

North, Clive; Gowers, Simon

doi: 10.1002/(SICI)1098-108X(199912)26:4<386::AID-EAT3>3.0.CO;2-Apmid: 10550778

Objective To examine for specificity of Eating Disorders Inventory (EDI) ratings and differences in self‐reported cognitions and clinical outcome between adolescent cases of anorexia nervosa (AN) with and without comorbid depression. Method Thirty‐five subjects with AN and matched psychiatric and community controls received the EDI and a structured diagnostic interview. AN subjects were followed up at 1 and 2 years using the EDI and a semistructured interview to assess outcome. Results Subjects with AN and those with other psychiatric disorders scored similarly on the EDI. Differences between AN cases and community controls were marked for comorbid cases but rare for noncomorbid cases. Comorbid AN cases had an equally good outcome compared to those with AN alone. Discussion Abnormal cognitions reported in the EDI are much greater in those cases with comorbid depression, but neither the presence of depression nor high EDI scores appears to adversely affect prognosis. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 26: 386–391, 1999.

Lowinger, Kitty; Griffiths, Rosalyn A.; Beumont, Pierre J.V.; Scicluna, Helen; Touyz, Stephen W.

doi: 10.1002/(SICI)1098-108X(199912)26:4<392::AID-EAT4>3.0.CO;2-Ipmid: 10550779

Objective The deliberate restriction of fluids to control weight is even more dangerous than food restriction since it results in several serious medical complications. However, there has been scant attention given to the anorexia nervosa patient's manipulation of fluids. It is our clinical impression that fluid restriction in this illness is more common than previously thought. Method We summarize the demographic and clinical features of six cases of anorexia nervosa and one case of eating disorder not otherwise specified (ED‐NOS) (subthreshold anorexia nervosa), where fluid restriction was a major behavioral problem. We then decribe two of the anorexia nervosa cases in more detail. All were treated at a dieting disorders unit affiliated with the University of Sydney. Their preadmission history, psychological and physical status on admission, results of physical investigations, the beginning of the fluid restriction, fluid and food intake throughout treatment, and the resolution of the fluid restriction were assessed. Results Patterns emerged in the relationship between eating and drinking. In all cases, food restriction was severe prior to the onset of fluid restriction but, notably, fluid intake recommenced prior to food intake. The reasons given by patients for restricting fluid were that it contained calories and that it made them feel full. Most anorexic patients equate feeling full with “feeling fat.” Furthermore, they feel fully in control when they restrict fluid as well as food and this produces a strong motivation to maintain the behavior. Discussion The cases illustrate the insidious nature and serious consequences of fluid restriction and the difficulties managing dieting‐disordered patients who undertake it. Careful attention must be given to assessment and clinicians should be aware of fluid restriction as an important aspect of anorexic behavior. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 26: 392–396, 1999.

Lucas, Alexander R.; Crowson, Cynthia S.; O'Fallon, W. Michael; Melton, L. Joseph

doi: 10.1002/(SICI)1098-108X(199912)26:4<397::AID-EAT5>3.0.CO;2-0pmid: 10550780

Objective We updated our incidence study by identifying Rochester, Minnesota, residents diagnosed with anorexia nervosa during 1985 through 1989. Method From a community‐based epidemiologic resource, 2,806 medical records with diagnoses including anorexia nervosa, eating disorder, bulimia, amenorrhea and other conditions were screened to identify new cases of anorexia nervosa. Results Two hundred eight (193 females and 15 males) residents fulfilled standard diagnostic criteria for anorexia nervosa. The overall age‐sex‐adjusted incidence rate was 8.3 per 100,000 person‐years. The age‐adjusted incidence among females was 15.0 per 100,000 person‐years compared to 1.5 per 100,000 among males. The long‐term linear increase for 15 to 24‐year‐old females noted during the first 50 years of the study continued. The disorder remained less frequent among older females. Discussion Anorexia nervosa remains a relatively common disorder among young females. While there are short‐term fluctuations in incidence, the long‐term increasing trend for 15 to 24‐year‐old females has continued. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 26: 397–405, 1999.

Rizvi, Shireen L.; Stice, Eric; Agras, W. Stewart

doi: 10.1002/(SICI)1098-108X(199912)26:4<406::AID-EAT6>3.0.CO;2-6pmid: 10550781

Objective This study investigated the course of eating attitudes and eating‐disordered behaviors in a community sample of adult women. Method Participants (N = 166; mean age = 32.8 years) completed the Eating Disorder Inventory (EDI), the Three‐Factor Eating Questionnaire (TFEQ), and a questionnaire assessing bulimic behaviors at two time points, 6 years apart. Results Correlations for rank ordering of scores on these measures were all significant, indicating high rank stability over time. Although rates of specific bulimic behaviors decreased over time, mean scores on eating disorder attitude scales tended to increase. Discussion Findings challenge the commonly held belief that disturbed eating attitudes decline with age. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 26: 406–413, 1999.

Eckern, Michael; Stevens, Wendy; Mitchell, James

doi: 10.1002/(SICI)1098-108X(199912)26:4<414::AID-EAT7>3.0.CO;2-8pmid: 10550782

Objective Rumination has been described as a symptom in association with eating disorders, but also as a separate disorder. Method A series of 8 female volunteers who reported rumination were systematically screened for the presence of eating disorders and other psychopathology. Results Seven met current or prior criteria for an Axis I disorder and five had a current or prior eating disorder. Discussion The importance of screening for eating disorders among women who ruminate, and for screening for rumination among eating disorder patients, is stressed. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 26: 414–419, 1999.

Huon, Gail; Hayne, Angela; Gunewardene, Anoushka; Strong, Kathryn; Lunn, Natasha; Piira, Tiina; Lim, Jacqueline

doi: 10.1002/(SICI)1098-108X(199912)26:4<420::AID-EAT8>3.0.CO;2-Gpmid: 10550783

Objective The overriding objective of this paper is to outline the steps involved in refining a structural model to explain differences in dieting status. Methods Cross‐sectional data (representing the responses of 1,644 teenage girls) derive from the preliminary testing in a 3‐year longitudinal study. A battery of measures assessed social influence, vulnerability (to conformity) disposition, protective (social coping) skills, and aspects of positive familial context as core components in a model proposed to account for the initiation of dieting. Path analyses were used to establish the predictive ability of those separate components and their interrelationships in accounting for differences in dieting status. Results Several components of the model were found to be important predictors of dieting status. The model incorporates significant direct, indirect (or mediated), and moderating relationships. Taking all variables into account, the strongest prediction of dieting status was from peer competitiveness, using a new scale developed specifically for this study. Conclusion Systematic analyses are crucial for the refinement of models to be used in large‐scale multivariate studies. In the short term, the model investigated in this study has been shown to be useful in accounting for cross‐sectional differences in dieting status. The refined model will be most powerfully employed in large‐scale time‐extended studies of the initiation of dieting to lose weight. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 26: 420–433, 1999.

Polivy, Janet; Herman, C. Peter

doi: 10.1002/(SICI)1098-108X(199912)26:4<434::AID-EAT9>3.0.CO;2-0pmid: 10550784

Objective The persistence of dieters' weight loss efforts, despite repeated failures, suggests that there must be some interim reinforcement for dieting that sustains the behavior. We propose that self‐change efforts capitalize on a “false hope syndrome,” in which the initial commitment to change brings immediate rewards (largely improvements in self‐image), regardless of the eventual outcome. Method Eighty female students chose whether they would attempt either to reduce their weight or to increase their study time over a 2‐week period. A control group did not attempt self‐change. Results The effects of making a resolution to change differed for novice and veteran self‐changers (nondieters and chronic dieters). Nondieters showed an immediate improvement in their mood and self‐image after making a resolution, but this subjective improvement dissipated over the course of the study. Veteran dieters showed a mixed response, initially feeling both more depressed, yet more hopeful of success. Discussion These results are discussed in terms of variations on the false hope syndrome for different kinds of individuals (novices and veterans). © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 26: 434–447, 1999.

Turton, Penelope; Hughes, Patricia; Bolton, Helen; Sedgwick, Philip

doi: 10.1002/(SICI)1098-108X(199912)26:4<448::AID-EAT10>3.0.CO;2-3pmid: 10550785

Objective To obtain a picture of eating disorder symptoms in a population of pregnant women. Method Five hundred thirty women attending antenatal follow‐up clinics at a large London district general hospital during a 4‐week period were surveyed. The Eating Attitudes Test (EAT), the Edinburgh Postnatal Depression Scale (EPDS), and a demographic questionnaire were administered. Unadjusted relative risks and their 95% confidence intervals were calculated for a series of prognostic factors. Results 4.9% of women scored above the recommended threshold on the EAT in pregnancy. Eating disorder symptomatology was found to be associated with younger age, previous symptomatology, lower educational attainment, poorer housing, employment status, and previous miscarriage. Discussion The meaning and potential implications of high levels of eating disorder symptomatology in a pregnant population are discussed in the light of the physiological and psychological effects of eating disorders on both pregnancy outcome and infant development. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 26: 448–452, 1999.