Validity of the Eating Attitudes Test and the Eating Disorders Inventory in bulimia nervosa.

Assessed criterion and concurrent validity of the Eating Attitudes Test (EAT) and the Eating Disorders Inventory (EDI) in 82 women (mean age 24.3 yrs) with bulimia nervosa. Both tests demonstrated criterion validity by discriminating bulimia nervosa Ss from normal Ss. However, only weak support was found for the concurrent validity within bulimia Ss. Generally there was little association between the EAT or the EDI and behavioral measures, including vomiting frequency, duration of disorder, eating during test meals, thoughts while eating, and body-size distortion. It is suggested that self-report questionnaires in conjunction with direct behavioral-measures of eating and vomiting would provide the most complete assessment for bulimia nervosa. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The process of change in couples therapy: a qualitative investigation

OBJECTIVE: To evaluate the cross-cultural validity of the Chinese version of the Eating Disorder Inventory (EDI) in a clinical sample of patients with eating disorders in Hong Kong. METHOD: After comprehensive clinical assessment, a consecutive series (1990-1996) of Chinese patients with bulimia nervosa (N = 17) and broadly diagnosed anorexia nervosa (N = 26) completed the Chinese EDI. Results were compared with those of Chinese female undergraduates (N = 606) and Canadian patients with eating disorders. RESULTS: The EDI profiles of bulimic and fat phobic anorectic patients were remarkably and modestly similar to those of their Canadian counterparts. The EDI meaningfully distinguished bulimic patients and fat phobic anorectic patients from local undergraduates, but exhibited deficient criterion-related validity in nonfat phobic anorectic patients. DISCUSSION: The questionable validity of certain EDI subscales in nonfat phobic patients reflects the ethnospecific constructs upon which they are based, and weakens the efficacy of the EDI in screening for anorexia nervosa in Chinese populations. Apart from illustrating some of the conceptual and methodological issues that need to be tackled in the cross-cultural study of the eating disorders, this study furnishes empirical support for the syndromal homogeneity of bulimia nervosa, and the clinical grouping of anorexia nervosa into fat phobic and nonfat phobic subtypes.     

A study of personality in eating disorders

Some evidence suggests that temperament and personality traits could influence the development and severity of eating disorders. This study was designed to study these aspects. METHODS: 72 patients with DSM-IV eating disorders including 25 anorexia nervosa restricting type, 17 with anorexia nervosa binge eating-purging type and 30 with bulimia nervosa were studied and compared with thirty healthy controls. Personality disorders and temperament were studied with the Eysenck's EPQ, Cloninger's TCI and SCID-II. Impulsive and clinical features were studied with specific rating scales. RESULTS: 61.8% of patients had at least one personality disorder. Avoidant personality disorder was the most commonly diagnosed in anorexia restricting type (25%). Borderline personality disorder was the most frequent in bulimia nervosa and in the binge eating-purging type of anorexia nervosa. Dimensionally, the group of eating disorders presented high scores in neuroticism and low scores in self-directedness. Higher harm avoidance was found in bulimic patients and higher persistence was associated with anorectic patients. Bulimic patients were significantly more impulsive than anorectic and controls. CONCLUSIONS: Temperament and personality traits differ in anorectic and bulimic patients. Bulimic symptoms are linked to impulsive temperament traits and to impulsive personality features. Anorectic symptoms are linked to persistent temperament traits and anxious personality features.     

Recovery and relapse in former bulimics.

21 undergraduate women who met criteria for bulimia nervosa (BN) for 3 mo completed the SCL-90 (Revised), the Eating Disorders Inventory (EDI), and a recovery questionnaire. From among 3 definitions of recovery in BN, the majority of the Ss endorsed the definition "I am recovered but still struggle with food, weight, and/or body image." Elevated scores on the EDI were correlated with feeling an increased likelihood of relapse, an increased level of psychological distress, and a shorter period of being recovered. However, the Body Dissatisfaction, Perfectionism, and Interpersonal Distrust subscales of the EDI may not be reliable indicators of distress or confidence in one's recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The social self in bulimia nervosa: Public self-consciousness, social anxiety, and perceived fraudulence.

Bulimic women appear preoccupied not only with their physical presentation but also with their "social self," how others perceive them in general. This study examined the relationship of the social self to body esteem and to bulimia nervosa. In Phase 1, in which 222 nonclinical women (aged 16–50 yrs) participated, the social-self measures of Perceived Fraudulence, Social Anxiety, and Public Self-Consciousness were negatively associated with body esteem. In Phase 2, 34 bulimic women were compared with 33 Ss scoring high on the Eating Attitudes Test (EAT) and 67 matched controls. Bulimic Ss, high-EAT Ss, and control Ss all differed on Perceived Fraudulence, and bulimic Ss and high-EAT Ss scored higher than control Ss on Public Self-Consciousness and Social Anxiety. The findings strongly support the hypothesized link of social self concerns to body dissatisfaction and bulimia nervosa. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: Meta-analysis and implications for DSM.

Eating disorder not otherwise specified (EDNOS) is the most prevalent eating disorder (ED) diagnosis. In this meta-analysis, the authors aimed to inform Diagnostic and Statistical Manual of Mental Disorders revisions by comparing the psychopathology of EDNOS with that of the officially recognized EDs: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). A comprehensive literature search identified 125 eligible studies (published and unpublished) appearing in the literature from 1987 to 2007. Random effects analyses indicated that whereas EDNOS did not differ significantly from AN and BED on eating pathology or general psychopathology, BN exhibited greater eating and general psychopathology than EDNOS. Moderator analyses indicated that EDNOS groups who met all diagnostic criteria for AN except for amenorrhea did not differ significantly from full syndrome cases. Similarly, EDNOS groups who met all criteria for BN or BED except for binge frequency did not differ significantly from full syndrome cases. Results suggest that EDNOS represents a set of disorders associated with substantial psychological and physiological morbidity. Although certain EDNOS subtypes could be incorporated into existing Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) categories, others—such as purging disorder and non-fat-phobic AN—may be best conceptualized as distinct syndromes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autoregulatory vasodilation of parenchymal vessels is impaired during cerebral vasospasm

OBJECTIVE: A recent study (Arnow, Kenardy, & Agras, 1995, Journal of Behavioral Medicine, 15, 155-170) has reported on the development and preliminary validation of the Emotional Eating Scale (EES), a questionnaire measure of the tendency to eat in response to affective state. The EES showed high levels of validity among obese binge eaters, but there was no attempt to validate the measure among nonclinical groups. The present study assessed the validity of the EES among nonclinical women, in order to determine whether or not emotional eating is related to unhealthy eating characteristics among the general population. METHODS: The participants were 51 women with no current or past eating disorder. Each completed the EES and the Eating Disorders Inventory (EDI). Validity of the EES was tested using measures of internal consistency and correlations with EDI scales. RESULTS: The EES scales showed a high level of internal consistency and specific associations with EDI scales (particularly Bulimia, Ineffectiveness, and Interpersonal Distrust). The normative scores for this population were substantially lower than among binge eaters, but similar to those found among other clinical groups. CONCLUSIONS: The EES has good levels of validity. It demonstrates that emotional eating is related to bulimic eating attitudes in the broader population, although issues of causality need to be considered. The EES may have a role in the early identification of eating problems in nonclinical groups. Its utility with other eating-disordered groups remains to be established, but there are potential roles in the targeting and evaluation of treatment.     

Combined cognitive-behavioral, psychopharmacological and nutritional therapy in eating disorders. 2. Anorexia nervosa--binge-eating/purging type

Thirteen women with anorexia nervosa, binge-eating/purging type (AN-BP), 17-43 years old, were treated with a 4-month course of combined cognitive-behavioral, nutritional and antidepressant therapy (7 with amineptine and 6 with fluoxetine). Patients were monitored before and after 1, 2 and 4 months of treatment for body mass index (BMI), for eating disorder symptoms by the Eating Disorder Inventory (EDI) and the Bulimic Investigation Test (BITE) and for depression and anxiety by the Hamilton Rating Scales for Depression and for Anxiety. BMI, EDI scores, depression and anxiety improved significantly and equally in the two groups during the 4 months of therapy, while BITE scores did not change.     

A comparison of behavioral and cognitive-behavioral interventions for bulimia nervosa.

Examined the relative efficacy of cognitive-behavioral and behavioral treatment approaches for bulimia nervosa. Female bulimic Ss were randomly assigned to cognitive-behavioral, behavioral, or attention placebo conditions. At posttreatment, 92% of the cognitive-behavioral group, 100% of the behavioral group, and 69% of the nonspecific self-monitoring group were abstinent from binge eating–purging. At 6-mo follow-up, 69% of the cognitive-behavioral group, 38% of the behavioral group, and 15% of the nonspecific self-monitoring group were abstinent from binge eating and purging. The results support the conceptualization of bulimia nervosa as a multifaceted disorder best treated with an approach that directly addresses maladaptive cognitions, problematic behaviors, and the development of more adaptive coping skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating disorders in the DSM-IV..

The guiding principles and operating procedures of the Eating Disorders Work Group are described. Provisional diagnostic criteria for the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for anorexia nervosa and bulimia nervosa are listed, together with an explanation of how and why they differ from the revised 3rd edition (DSM-III—R; American Psychiatric Association, 1987). Consideration of a possible new diagnosis is noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Interview for the Diagnosis of Eating Disorders—IV: Application to DSM–IV diagnostic criteria.

The authors describe the psychometric development of the fourth revision of the Interview for Diagnosis of Eating Disorders (IDED–IV). The IDED–IV was tested for the purpose of differential diagnosis of eating disorders, that is, anorexia nervosa, bulimia nervosa, and binge eating disorder. Evidence for internal consistency was found for symptom ratings relevant to anorexia nervosa, bulimia nervosa, and binge eating disorder. Support was found for the content validity as well as the concurrent and discriminant validity of the IDED–IV. Finally, tests of the interrater agreement for differential diagnosis of eating disorders found the IDED–IV to yield very reliable data. The authors conclude that the IDED–IV yields sufficiently reliable and valid data to be used for determining diagnoses in research studies and clinics specializing in the treatment of eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptom differences in hospitalized, medically ill, depressed psychiatric inpatients and nonmedical controls.

This study compared depressive and anxious symptoms in chronic medically ill individuals and depressed psychiatric inpatients using conceptually based standardized measures of cognitions and symptoms. Seventy-five hospitalized medical patients, 52 depressed psychiatric inpatients, and 25 normal controls were assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987), the Mood and Anxiety Symptom Questionnaire, Hamilton Rating Scales of Anxiety and Depression, Hospital Anxiety and Depression Scales, Beck Depression Inventory, Cognitions Checklist, and Hopelessness Scale. Analysis revealed that depression in medical patients was best distinguished by symptoms of anhedonia, low positive affect, and physiological hyperarousal, whereas syndromal depression in psychiatric inpatients was specifically characterized by negative cognition symptoms. Implications are discussed for assessing depression in medically ill populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Bulimia Test—Revised: Validation with DSM-IV criteria for bulimia nervosa.

The Bulimia Test —Revised [(BULIT-R) M. H. Thelen, J. Farmer, S. Wonderlich, & M. Smith; see record 78:17280] was given to participants who met the criteria in the fourth edition of the Diagnostic and Siatistical Manual of Mental Disorders (DSM-IV) for bulimia nervosa and control participants to determine if the test continues to be a valid measure of bulimia nervosa. Although the BULIT-R was developed and validated with bulimic individuals as determined by the DSM-III-R criteria, it appears to be a valid instrument with which to identify individuals who meet DSM-IVcriteria for bulimia nervosa. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Percutaneous retrieval of transsected rotablator coronary guidewire using Amplatz "Goose-Neck snare"

OBJECTIVE: The cognitive-behavioral model of bulimia nervosa suggests that maladaptive cognitions are associated with the development and maintenance of bulimia nervosa. This study was conducted to evaluate (a) the relation between bulimic symptomatology and the cognitive-personality styles of sociotropy (reflecting themes of acceptance and approval) and autonomy (reflecting themes of independence and achievement), and (b) the specificity of the relation between these two cognitive-personality styles and bulimic versus depressive symptoms. METHOD: 105 undergraduate women were administered self-report measures of sociotropy and autonomy, as well as bulimic and depressive symptomatology. RESULTS: Whereas both sociotropy and autonomy were related to bulimic symptomatology, only sociotropy was uniquely associated with symptoms of bulimia when controlling for the effects of depressive symptoms. DISCUSSION: Themes of acceptance and approval may be important cognitive-personality features of bulimia nervosa.     

Motivations for dieting: Drive for thinness is different from drive for objective thinness.

Drive for thinness is a cardinal feature of bulimia nervosa. However, the widely used Drive for Thinness (DFT) subscale of the Eating Disorder Inventory (Garner, 2004; Garner, Olmstead, & Polivy, 1983) appears to measure a desire to be thinner, not a desire to be objectively thin. We developed the Drive for Objective Thinness (DFOT) Scale and compared unrestrained and restrained eaters and those with bulimia nervosa on the DFT subscale, Goldfarb's Fear of Fat Scale (GFFS; Goldfarb, Dykens, & Gerrard, 1983), and the DFOT Scale. Restrained eaters had higher scores than unrestrained eaters on the DFT subscale and the GFFS, but both groups had low scores on the DFOT Scale. Only the group with bulimia nervosa showed elevated scores on the DFOT Scale. We conclude that restrained eaters diet mostly to avoid weight gain, that individuals with bulimia nervosa diet to achieve thinness and avoid fatness, and that the drive for objective thinness is a unique feature of bulimia nervosa. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of the antigen distribution of two US porcine reproductive and respiratory syndrome virus isolates with that of the Lelystad virus

OBJECTIVE: The present study investigates the comorbidity between bulimia nervosa (BN) and the entire range of American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 3rd rev. ed. (DSM-III-R) personality disorders and controls for the presence of coexisting depression. METHOD: The Personality Disorders Examination (PDE), a structured interview that encompasses all 13 (provisional) DSM-III-R personality disorders, was administered to three groups of subjects: depressed BN patients (n = 15), nondepressed BN patients (n = 15), and nonpsychiatric controls (n = 15). The BN patients were referrals to a dieting disorder unit affiliated with the University of Sydney. They all met DSM-III-R criteria and all had body mass indexes (BMIs) greater than 19. The nonpsychiatric control group were recruited from an undergraduate psychology course. All subjects were given the Bulimic Investigatory Test, Edinburgh (BITE), the Eating Disorders Inventory-2 (EDI-2), the Hamilton Depression Rating Scale (HDRS), and the PDE. RESULTS: 46.7% of depressed BN patients met the criteria for at least one Axis II diagnosis, as assessed by the PDE, and 33.3% of nondepressed BN patients received such a diagnosis, whereas only 6.7% of nonpsychiatric control subjects met this criterion (p < .05). The results of the present study provide support for an increased comorbidity between personality disorders and BN that cannot be attributed to the confounding influence of coexisting depression. DISCUSSION: This finding enables the identification of subgroups of individuals with BN, enabling them to be compared and contrasted. The identification of differences between subgroups may provide information regarding prognosis and differential response to treatment, which could enable more appropriate treatment decisions to be made.     

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)     

The "presyrinx" state: a reversible myelopathic condition that may precede syringomyelia

The purpose of this investigation was to develop a brief self-report inventory which could be used to evaluate treatment outcome for anorexia and bulimia nervosa. The Multifactorial Assessment of Eating Disorders Symptoms (MAEDS) was constructed to measure six symptom clusters which have been found to be central to the eating disorders: depression, binge eating, purgative behavior, fear of fatness, restrictive eating, and avoidance of forbidden foods. The factor structure of the MAEDS was found to be stable and it was found to have satisfactory reliability and validity. Normative data were collected so that raw scores could be converted to standardized scores. While still in the experimental stages, the MAEDS shows promise as a valid and economical measure of treatment interventions for anorexia and bulimia nervosa.     

Revisiting the affect regulation model of binge eating: A meta-analysis of studies using ecological momentary assessment.

The affect regulation model of binge eating, which posits that patients binge eat to reduce negative affect (NA), has received support from cross-sectional and laboratory-based studies. Ecological momentary assessment (EMA) involves momentary ratings and repeated assessments over time and is ideally suited to identify temporal antecedents and consequences of binge eating. This meta-analytic review includes EMA studies of affect and binge eating. Electronic database and manual searches produced 36 EMA studies with N = 968 participants (89% Caucasian women). Meta-analyses examined changes in affect before and after binge eating using within-subjects standardized mean gain effect sizes (ESs). Results supported greater NA preceding binge eating relative to average affect (ES = 0.63) and affect before regular eating (ES = 0.68). However, NA increased further following binge episodes (ES = 0.50). Preliminary findings suggested that NA decreased following purging in bulimia nervosa (ES = –0.46). Moderators included diagnosis (with significantly greater elevations of NA prior to bingeing in binge eating disorder compared to bulimia nervosa) and binge definition (with significantly smaller elevations of NA before binge vs. regular eating episodes for the Diagnostic and Statistical Manual of Mental Disorders definition compared to lay definitions of binge eating). Overall, results fail to support the affect regulation model of binge eating and challenge reductions in NA as a maintenance factor for binge eating. However, limitations of this literature include unidimensional analyses of NA and inadequate examination of affect during binge eating, as binge eating may regulate only specific facets of affect or may reduce NA only during the episode. (PsycINFO Database Record (c) 2011 APA, all rights reserved)