Review of Handbook of treatment for eating disorders.

Reviews the book, Handbook of treatment for eating disorders (2nd ed.) edited by David M. Garner and Paul E. Garfinkel (see record 1997-08478-000). In this book, the editors state that their primary goal is to present treatment approaches in sufficient detail that clinicians can conduct therapy of these disorders. A strong research base undergirds each chapter, filled with extensive case illustration and practical approaches, directed toward the practicing clinician. With new as well as revised chapters, this book consists of five major sections. The first, "The Context for Treatment," describes the history of eating disorders, focusing on Anorexia Nervosa and Bulimia Nervosa. The second, and most coherent, section focuses on cognitive-behavioral and educational approaches. A conglomeration of approaches based on other theoretical perspectives appears in the third section, entitled "Psychodynamic, Feminist, and Family Approaches." In the fourth section, issues around inpatient, partial hospitalization, and drug therapies are reviewed. A final, catch-all section covers special topics, including comorbid histories and conditions (sexual abuse, substance abuse, and medical issues), diagnostic concerns (personality disorders), alternative treatments (group, self-help), treatment dilemmas (treatment refusal in anorexia nervosa), age considerations (prepubertal eating disorders), and binge-eating disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Experiential therapies for eating disorders.

Reviews the book, Experiential therapies for eating disorders, edited by Lynne M. Hornyak and Ellen K. Baker (see record 1989-97569-000). In this book, Lynne Hornyak and Ellen Baker provide a collection of chapters describing "experiential" therapies for eating disorders. Hornyak and Baker define experiential therapy as '...treatment techniques, based on psychological principles that are developed and used with the specific intention of increasing clients' present awareness of feelings, perceptions, cognitions, and sensations; that is, their in-the-moment experience..." (p.3). The book is divided into two sections: The first part addresses the treatment of bulimia nervosa; the second deals with anorexia nervosa. Each author presents his or her treatment approach in sufficient detail to give the reader a clear picture of how the technique could be implemented in the clinical setting. This book may stimulate practitioners to consider the theoretical rationale of their clinical methods and to consider alternative therapies in their treatment of patients with eating disorders. However, the book fell short of the mark in several respects. First, although the authors of each chapter attempted to emphasize the interrelationship of theory and practice, they often glossed over the fact that there was little or no empirical support for either their conceptualiztion of the disorder or the efficacy of the intervention that they espoused. Second, the editors failed to provide the reader with an integrative summary. There was no attempt to provide the practicing clinician with a guide to decision making in the treatment of eating disorders. The editors did not address key questions such as how one assesses a patient with an eating disorder or how one decides which treatment is best suited for her. A related shortcoming is that the editors do not provide the reader with a summary of the state of the art with regard to the conceptualization and treatment of eating disorders. There is now sufficient empirical literature to support specific models of etiology and the efficacy of particular interventions (cf. Brownell & Foreyt, 1986). Without an overview, the reader is left with the impression that the current understanding and treatment of eating disorders is in a prescientific state and that personal preferences rather than empirical findings dictate which treatments are best suited for particular patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Puberty and the genetic diathesis of disordered eating attitudes and behaviors.

Twin studies from the Minnesota Twin Family Study (MTFS) suggest negligible genetic effects on eating pathology before puberty but increased genetic effects during puberty. However, an independent study found no pubertal differences in genetic and environmental effects (R. Rowe, A. Pickles, E. Simonoff, C. M. Bulik, & J. L. Silberg, 2002). Discrepant results may be due to methodological differences. The MTFS studies divided twins at mid-puberty, whereas R. Rowe et al. (2002) divided twins based on menarche alone. In the present study, the authors aimed to reconcile discrepant findings by examining differences in etiologic effects for disordered eating attitudes and behaviors (i.e., levels of weight preoccupation, body dissatisfaction, binge eating, compensatory behaviors) using both classification methods in a new sample of 656 female twins. Using the MTFS method (i.e., K. L. Klump, M. McGue, & W. G. Iacono, 2003), the authors observed nominal genetic effects in prepubertal twins but significant genetic effects in pubertal and young adult twins. Conversely, genetic effects were moderate and equal in all groups using the R. Rowe et al. (2002) method. Findings highlight the potentially important role of puberty in the genetic diathesis of disordered eating attitudes and behaviors and the need to use early indicators of pubertal status in studies of developmental effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Binge eating proneness emerges during puberty in female rats: A longitudinal study.

Puberty is a critical risk period for binge eating and eating disorders characterized by binge eating. Previous research focused almost entirely on psychosocial risk factors during puberty to the relative exclusion of biological influences. The current study addressed this gap by examining the emergence of binge eating during puberty in a rat model. We predicted that there would be minimal differences in binge eating proneness during pre-early puberty, but significant differences would emerge during puberty. Two independent samples of female Sprague–Dawley rats (n = 30 and n = 36) were followed longitudinally across pre-early puberty, mid-late puberty, and adulthood. Binge eating proneness was defined using the binge eating resistant (BER)/binge eating prone (BEP) model of binge eating that identifies BER and BEP rats in adulthood. Across two samples of rats, binge eating proneness emerged during puberty. Mixed linear models showed little difference in palatable food intake between BER and BEP rats during pre-early puberty, but significant group differences emerged during mid-late puberty and adulthood. Group differences could not be accounted for by changes in nonpalatable food intake or body weight. Similar to patterns in humans, individual differences in binge eating emerge during puberty in female rats. These findings provide strong confirming evidence for the importance of biological risk factors in developmental trajectories of binge eating risk across adolescence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology.

The authors explore the extent to which eating disorders, specifically anorexia nervosa (AN) and bulimia nervosa (BN), represent culture-bound syndromes and discuss implications for conceptualizing the role genes play in their etiology. The examination is divided into 3 sections: a quantitative meta-analysis of changes in incidence rates since the formal recognition of AN and BN, a qualitative summary of historical evidence of eating disorders before their formal recognition, and an evaluation of the presence of these disorders in non-Western cultures. Findings suggest that BN is a culture-bound syndrome and AN is not. Thus, heritability estimates for BN may show greater variability cross-culturally than heritability estimates for AN, and the genetic bases of these disorders may be associated with differential pathoplasticity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic risk factors for disordered eating in adolescent males and females.

The etiologic role of genetic and environmental factors on disordered eating was examined in a sample of 15- to 17-year-old female–female, male–male, and opposite-sex twin pairs. Also assessed was whether a single factor is underlying 3 facets (body dissatisfaction, drive for thinness, bulimia) of disordered eating, including the possible importance of sex differences. Univariate model-fitting analyses indicated that genetic factors are more important for girls and environment more important for boys for body dissatisfaction and drive for thinness. A multivariate common factor analysis indicated that a single factor accounted for the association among these 3 facets of disordered eating in both sexes. However, only 50% of the genetic risk for this factor is shared between the sexes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Critique sur l'état actuel de la recherche sur l'anorexie mental.

Critiques the current state of research on anorexia. The principal approaches that have guided research on the disorder stress the importance of the theoretical analysis of the problem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic and environmental influences on antisocial behavior: A meta-analysis of twin and adoption studies.

A meta-analysis of 51 twin and adoption studies was conducted to estimate the magnitude of genetic and environmental influences on antisocial behavior. The best fitting model included moderate proportions of variance due to additive genetic influences (.32), nonadditive genetic influences (.09), shared environmental influences (.16), and nonshared environmental influences (.43). The magnitude of familial influences (i.e., both genetic and shared environmental influences) was lower in parent-offspring adoption studies than in both twin studies and sibling adoption studies. Operationalization, assessment method, zygosity determination method, and age were significant moderators of the magnitude of genetic and environmental influences on antisocial behavior, but there were no significant differences in the magnitude of genetic and environmental influences for males and females. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Handbook of psychotherapy for anorexia nervosa and bulimia.

Reviews the book, Handbook of psychotherapy for anorexia nervosa and bulimia edited by David M. Garner and Paul E. Garfinkel (1985). In the Introduction, the editors indicate that the text, intended for an audience of practising and academically oriented clinicians, has two major purposes: (1) to delineate the various types of therapy advocated for the treatment of anorexia and bulimia, and (2) to identify the factors that predispose or precipitate these eating disorders. The book is immensely successful in fulfilling the first intent. However, the ability of the various chapter authors to isolate the risk factors for anorexia and bulimia is less satisfying. In fairness, however, this does not represent a shortcoming on the part of the authors but rather provides an accurate reflection of the degree of our current understanding of these eating disorders. Several features of the book make it an invaluable reference text on anorexia and bulimia--a large range of treatment options is presented ranging from feminist psychoanalytic approaches to behavioural management techniques; the authors attempt to articulate the theoretical bases that underlie or justify the particular treatment they advocate; and the inclusion of case studies, sample therapist-patient dialogue, and the overall detailed manner with which the therapies are described provide the reader with a clear flavour of the treatment modality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A 20-year longitudinal study of body weight, dieting, and eating disorder symptoms.

The article describes a 20-year longitudinal study of body weight, dieting, and disordered eating in women and men. Body weight increased significantly over time in both women and men. However, women's weight perception and dieting frequency decreased over time, whereas men's weight perception and dieting frequency increased, and disordered eating declined more in women than in men from late adolescence to midlife. In both women and men, changes in weight perception and dieting frequency were associated with changes in disordered eating. In addition, adult roles such as marriage and parenthood were associated with significant decreases in disordered eating from late adolescence to midlife in women, whereas few associations were observed in men. Despite different developmental trajectories, women demonstrated more weight dissatisfaction, dieting, and disordered eating compared with men across the period of observation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fasting increases risk for onset of binge eating and bulimic pathology: A 5-year prospective study.

Although adolescent girls with elevated dietary restraint scores are at increased risk for future binge eating and bulimic pathology, they do not eat less than those with lower restraint scores. The fact that only a small proportion of individuals with elevated dietary restraint scores develop bulimic pathology suggests that some extreme but rare form of dietary restriction may increase risk for this disturbance. The authors tested the hypothesis that fasting (going without eating for 24 hr for weight control) would be a more potent predictor of binge eating and bulimic pathology onset than dietary restraint scores using data from 496 adolescent girls followed over 5 years. Results confirmed that only 23% of participants with elevated dietary restraint scores reported fasting. Furthermore, fasting generally showed stronger and more consistent predictive relations to future onset of recurrent binge eating and threshold/subthreshold bulimia nervosa over 1- to 5-year follow-up relative to dietary restraint, though the former effects were only significantly stronger than the latter for some comparisons. Results provide preliminary support for the hypothesis that fasting is a stronger risk factor for bulimic pathology than is self-reported dieting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological treatment of eating disorders.

Significant progress has been achieved in the development and evaluation of evidence-based psychological treatments for eating disorders over the past 25 years. Cognitive behavioral therapy is currently the treatment of choice for bulimia nervosa and binge-eating disorder, and existing evidence supports the use of a specific form of family therapy for adolescents with anorexia nervosa. Important challenges remain. Even the most effective interventions for bulimia nervosa and binge-eating disorder fail to help a substantial number of patients. A priority must be the extension and adaptation of these treatments to a broader range of eating disorders (eating disorder not otherwise specified), to adolescents, who have been largely overlooked in clinical research, and to chronic, treatment-resistant cases of anorexia nervosa. The article highlights current conceptual and clinical innovations designed to improve on existing therapeutic efficacy. The problems of increasing the dissemination of evidence-based treatments that are unavailable in most clinical service settings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic relationships between personality and eating attitudes and behaviors.

Genetic and environmental factors underlying relationships between personality traits and disordered eating were examined in 256 female adolescent twin pairs (166 monozygotic, 90 dizygotic). Eating behaviors were assessed with the Total Score, Body Dissatisfaction, Weight Preoccupation, Binge Eating, and Compensatory Behavior subscales from the Minnesota Eating Disorders Inventory (M-EDI; K. L. Klump, M. McGue, & W. G. Iacono, 2000). Personality characteristics were assessed with the Negative Emotionality, Positive Emotionality, and Constraint scales from the Multidimensional Personality Questionnaire: (MPQ; A. Tellegen, 1982). Model-fitting analyses indicated that although genetic factors were more likely to contribute to MPQ and M-EDI phenotypic associations than environmental factors, shared genetic variance between the 2 phenotypes was limited. MPQ personality characteristics may represent only some of several genetic risk factors for eating pathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dissociative states in eating disorders: An empirical Rorschach study.

The study explores the DSM-IV-TR classification of eating disorders that is constituted of four subtypes, two of them defined as anorexia (restricting and binge eating/purging) and two as bulimia (purging and non-purging). This classification is based on body weight as the distinguishing criterion. However, psychoanalytic thinking substantially distinguishes between restricting anorexia and the other three subtypes, all of them involving binge eating. Accordingly, binge eating patients are assumed to present different personality characteristics and different dynamics including dissociation proneness as a core component of the disturbance. The dissociative component of binge eating is examined by using the Rorschach Reality-Fantasy Scale (RFS; Tibon, Handelzalts, & Weinberger, 2005) and other Rorschach measures in a sample of 61 female adolescent inpatients diagnosed with eating disorders. This sample was divided into two groups by using the criterion of whether or not the symptoms involve binge eating behavior. The results support the view that dissociation between reality and fantasy is an important facet of binge eating disorders. A case study that demonstrates the utility of the RFS is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating Disorder Diagnostic Scale: Additional Evidence of Reliability and Validity.

The authors conducted 4 studies investigating the reliability and validity of the Eating Disorder Diagnostic Scale (HDDS; E. Stice, C. F. Telch, & S. L. Rizvi, 2000), a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa, and binge eating disorder. Study 1 found that the HDDS showed criterion validity with interview-based diagnoses, convergent validity with risk factors for eating pathology, and internal consistency. Studies 2 and 3 found that the EDDS was sufficiently sensitive to detect the effects of eating disorder prevention programs. Regarding predictive validity, Studies 3 and 4 found that the EDDS predicted response to a prevention program and future onset of eating pathology and depression. Results provide additional evidence of the reliability and validity of this scale and suggest it may be useful in clinical and research applications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subtyping binge eating disorder.

Cluster-analytic studies of bulimia nervosa and binge eating disorder (BED) have yielded 2 subtypes (pure dietary and mixed dietary-negative affect). The authors aimed to (a) replicate the subtyping with BED, (b) consider alternative approaches to subtyping, and (c) test the stability in individual differences in the subtyping. Cluster analyses of 101 patients revealed a dietary-negative affect subtype (33%) and a pure dietary subtype (67%). The dietary negative affect subtype was characterized by greater eating related psychopathology and psychological disturbance. Cluster analysis produced different results from alternative subtyping approaches (by major depression or by binge eating frequency). Cluster-analytic subtyping of data at 2 time points 4 weeks apart for a subset of 73 patients demonstrated significant consistency (κ=.55). Findings suggest that moderate dieting is characteristic of BED and that affective disturbances occur in a subset of cases that represent a more disturbed variant. The subtypes may represent reasonably stable individual differences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic and environmental influences on global family conflict.

This study examined genetic and environmental influences on global family conflict. The sample comprised 872 same-sex pairs of twin parents, their spouses/partners, and one adolescent child per twin from the Twin and Offspring Study in Sweden. The twins, spouses, and child each reported on the degree of family conflict, and there was significant agreement among the family members’ ratings. These shared perspectives were explained by one common factor, indexing global family conflict. Genetic influences explained 36% of the variance in this common factor, suggesting that twins’ heritable characteristics contribute to family conflict, via genotype-environment correlation. Nonshared environmental effects explained the remaining 64% of this variance, indicating that twins’ unique childhood and/or current family experiences also play an important role. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A risk model for disordered eating in late elementary school boys.

The authors tested the following risk model for disordered eating in late elementary school-age boys: Pubertal status is associated with increases in negative urgency, that is, the tendency to act rashly when distressed; high levels of negative urgency then influence binge eating through psychosocial learning; and binge eating influences purging. A sample of 908 fifth-grade boys completed questionnaire measures of puberty, negative urgency, dieting/thinness and eating expectancies, and eating pathology. Eating disorder symptoms were present in these young boys: 10% reported binge eating and 4.2% reported purging through self-induced vomiting. Each hypothesis in the risk model was supported. Boys this young do in fact engage in the maladaptive behaviors of binge eating and purging; it is crucial to develop explanatory risk models for this group. To this end, it appears that characteristics of boys, including their pubertal status, personalities, and psychosocial learning, help identify boys at risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled evaluation of the distress criterion for binge eating disorder.

Objective: Research has examined various aspects of the validity of the research criteria for binge eating disorder (BED) but has yet to evaluate the utility of Criterion C, “marked distress about binge eating.” This study examined the significance of the marked distress criterion for BED using 2 complementary comparison groups. Method: A total of 1,075 community volunteers completed a battery of self-report instruments as part of an Internet study. Analyses compared body mass index (BMI), eating-disorder psychopathology, and depressive levels in 4 groups: 97 participants with BED except for the distress criterion (BED–ND), 221 participants with BED including the distress criterion (BED), 79 participants with bulimia nervosa (BN), and 489 obese participants without binge eating or purging (NBPO). Parallel analyses compared these study groups using the broadened frequency criterion (i.e., once weekly for binge/purge behaviors) proposed for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) and the 4th edition (DSM–IV) twice-weekly frequency criterion. Results: The BED group had significantly greater eating-disorder psychopathology and depressive levels than the BED–ND group. The BED group, but not the BED–ND group, had significantly greater eating-disorder psychopathology than the NBPO comparison group. The BN group had significantly greater eating-disorder psychopathology and depressive levels than all 3 other groups. The group differences in eating-disorder psychopathology existed even after controlling for depression levels, BMI, and demographic variables, although some differences between the BN and BED groups were attenuated when controlling for depression levels. Conclusions: These findings provide support for the validity of the “marked distress” criterion for the diagnosis of BED. (PsycINFO Database Record (c) 2011 APA, all rights reserved)