Setting the scene for eating disorders: childhood care, classification and course of illness

1993 ◽  
Vol 23 (3) ◽  
pp. 663-672 ◽  
Author(s):  
Ulrike Schmidt ◽  
Jane Tiller ◽  
Janet Treasure
Keyword(s):  
Anorexia Nervosa ◽  
Bulimia Nervosa ◽  
Family Environment ◽  
Parental Control ◽  
Childhood Adversity ◽  
Normal Weight ◽  
Semistructured Interview ◽  
Childhood Experiences ◽  
Course Of Illness ◽  
Childhood Care

SynopsisThe aim of this study was to determine whether the childhood experiences of patients with anorexia nervosa and bulimia nervosa differ and affect the course of the illness. A semistructured interview developed by Harris et al. (1986) was used to assess the childhood family environment of 64 patients with restricting anorexia nervosa (RAN), 23 patients with bulimic anorexia nervosa (BAN), 37 bulimic patients with a history of anorexia nervosa (BN/HistAN) and 79 patients with normal weight bulimia nervosa (BN).There were no significant differences between groups in terms of parental mental disorder, low parental control or childhood sexual abuse. BN patients had had significantly more family arrangements and had experienced more parental indifference, excessive parental control, physical abuse, and violence against other family members than RAN patients with the BAN and BN/HistAN group being intermediate. There was a trend for BN-patients to have had more intra-familial discord than the other groups. Different aspects of adversity tended to cluster in the same patients and 65% of the bulimic group had experienced two or more types of childhood adversity. These results suggest that childhood experiences contribute to the form of eating disorder which later develops.

Perception of Autonomy and Connectedness Prior to the Onset of Anorexia Nervosa and Bulimia Nervosa

2012 ◽  
Vol 40 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Julia Huemer ◽  
Maria Haidvogl ◽  
Fritz Mattejat ◽  
Gudrun Wagner ◽  
Gerald Nobis ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Risk Factor ◽  
Bulimia Nervosa ◽  
Family Environment ◽  
Significant Influence ◽  
Diagnostic Interview ◽  
Individual Autonomy ◽  
Mothers And Fathers ◽  
Image Test ◽  
Restrictive Type

Objective: This study examines retrospective correlates of nonshared family environment prior to onset of disease, by means of multiple familial informants, among anorexia and bulimia nervosa patients. Methods: A total of 332 participants was included (anorexia nervosa, restrictive type (AN-R): n = 41 plus families); bulimic patients (anorexia nervosa, binge-purging type; bulimia nervosa: n = 59 plus families). The EATAET Lifetime Diagnostic Interview was used to establish the diagnosis; the Subjective Family Image Test was used to derive emotional connectedness (EC) and individual autonomy (IA). Results: Bulimic and AN-R patients perceived significantly lower EC prior to onset of disease compared to their healthy sisters. Bulimic patients perceived significantly lower EC prior to onset of disease compared to AN-R patients and compared to their mothers and fathers. A low family sum – sister pairs sum comparison – of EC had a significant influence on the risk of developing bulimia nervosa. Contrary to expectations, AN-R patients did not perceive significantly lower levels of IA compared to their sisters, prior to onset of disease. Findings of low IA in currently ill AN-R patients may represent a disease consequence, not a risk factor. Conclusions: Developmental child psychiatrists should direct their attention to disturbances of EC, which may be present prior to the onset of the disease.

Eating Disorders: Implications for the 1990's*

1987 ◽  
Vol 32 (7) ◽  
pp. 624-631 ◽  
Author(s):  
Paul E. Garfinkel ◽  
David M. Garner ◽  
David S. Goldbloom
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Bulimia Nervosa ◽  
Treatment Strategies ◽  
Risk Groups ◽  
Normal Weight ◽  
Stepped Care ◽  
Endogenous Opiates ◽  
Populations At Risk ◽  
The Relationship

In the past decade much has been learned about the clinical features, diagnosis and understanding of people with anorexia nervosa and bulimia nervosa. In order to provide the next level of improvement in our care for these patients, our understanding of certain problems must be addressed by empirical research. Areas which require further study include the definition of high risk groups, the refinement of diagnoses, understanding factors which result in chronicity, determining the complications of chronicity and comparative evaluations of different treatments. These five areas are outlined in this article. Populations at risk for anorexia nervosa and bulimia nervosa may be those who must be thin and achieve according to career choice, those with a particular family and personal psychiatric history; obesity and chronic medical illnesses may be further risks. Improved diagnostic understanding has occurred by the differentiation of bulimic from restricting subtypes of anorexia nervosa. Further work must determine the relationship between the bulimic subtype of anorexia nervosa and bulimia in normal weight women and to further clarify the relationship between eating disorders and affective disorders. A number of factors may result in a chronic illness. These have been described on a variety of levels. The consequences of starvation in altering an individual's thinking, feeling and behaviour do play a role. It is not clear what factors at a neurochemical level contribute to this. Elevated endogenous opiates decreased noradrenergic function and decreased serotonin may be important. Information about the chronic complications is required for clinicians to understand the broad range of difficulties that may develop over time so that clinicians may use this information in planning treatment strategies. Two examples, those of osteoporosis and the pregnant woman with an eating disorder, highlight this problem. Finally, treatment is briefly reviewed in terms of options available and the idea of developing a stepped-care approach to treatment.

Bulimia Nervosa in Hong Kong Chinese Patients

1992 ◽  
Vol 161 (4) ◽  
pp. 545-551 ◽  
Author(s):  
Sing Lee ◽  
L. K. George Hsu ◽  
Y. K. Wing
Keyword(s):  
Anorexia Nervosa ◽  
Hong Kong ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Clinical Features ◽  
Normal Weight ◽  
Hong Kong Chinese ◽  
Chinese Patients ◽  
Case Histories ◽  
The West

In contrast to the West, bulimic disorders are rarer than anorexia nervosa in Hong Kong. Four female normal-weight bulimic patients with mostly typical clinical features and conspicuous morbidity are reported. The case histories support the hypothesis that binge-eating is used to regulate unpleasant affect.

Abuse of Laxatives to Reduce Weight

1988 ◽  
Vol 9 (7) ◽  
pp. 208-234
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Anorexia Nervosa ◽  
Bulimia Nervosa ◽  
Diagnostic Criteria ◽  
Normal Weight ◽  
Intense Fear ◽  
Maintain Body Weight ◽  
Psychiatric Conditions ◽  
Weight For Age

Two psychiatric conditions are commonly associated with laxative and/or diuretic abuse to control weight. They are anorexia nervosa and bulimia nervosa. The newest diagnostic criteria for anorexia nervosa now makes it possible to diagnose this disorder before profound weight loss has occurred. There are four criteria: (1) refusal to maintain body weight greater than a minimum normal weight for age and height, the minimum being 15% below that expected; (2) intense fear of gaining weight; (3) a disturbance in the way one's body weight, size, or shape is experienced; and (4) amenorrhea in girls. Anorexia nervosa usually begins in early to late adolescence. It is primarily a disorder of girls.

Homeless youth in London: I. Childhood antecedents and psychiatric disorder

1998 ◽  
Vol 28 (6) ◽  
pp. 1379-1388 ◽  
Author(s):  
T. K. J. CRAIG ◽  
S. HODSON
Keyword(s):  
Young People ◽  
Psychiatric Disorder ◽  
Educational Attainment ◽  
Homeless Youth ◽  
Homeless People ◽  
Childhood Adversity ◽  
Homeless Population ◽  
Childhood Experiences ◽  
Childhood Care ◽  
Childhood Antecedents

Background. There has been an increase in the numbers of homeless young people in Britain. Little is known of the health and social welfare needs of this population.Method. This case–control study compares a random sample of homeless people aged under 22 years recruited from consecutive attenders at two of London's largest facilities for homeless young people with a contemporaneous sample of domiciled young people recruited through general practice registration lists. The homeless and domiciled groups were compared on measures of childhood care, education and psychiatric disorder.Results. One hundred and sixty-one homeless people (88% of those approached) and 107 domiciled subjects (60% of those approached) were interviewed. Sixty-nine per cent of homeless and a third of the domiciled subjects reported a childhood lacking in affection, with indifferent and often violent carers. Psychiatric disorder was identified in 62% of homeless respondents and a quarter of the domiciled population. A fifth of homeless and 5 domiciled respondents had attempted suicide in the previous year. Multivariate analysis suggest that childhood adversity, low educational attainment and the prior presence of psychiatric disorder all independently increase the likelihood of homelessness in a youthful population.Conclusions. The evidence presented in this paper supports the hypotheses that characterize the young homeless population as experiencing higher rates of childhood adversity and psychiatric disorder than their domiciled contemporaries. A tentative model is suggested whereby childhood experiences, educational attainment and the prior presence of psychiatric disorder all independently increase the likelihood of homelessness in a youthful population.

Binge Eating and Its Management

1982 ◽  
Vol 141 (6) ◽  
pp. 631-633 ◽  
Author(s):  
Christopher G. Fairburn
Keyword(s):  
Anorexia Nervosa ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Weight Control ◽  
Normal Weight ◽  
Loss Of Control ◽  
Normal Range ◽  
Eating Pattern ◽  
Normal Weight Control

It is well recognized that bouts of uncontrolled and excessive eating (binges) occur in both a small proportion of patients who are overweight and in about 50 per cent of patients with anorexia nervosa. However, it has only recently been appreciated that many people who fall into neither category also have an eating disorder which is principally characterized by episodes of binge-eating. These people experience a profound and distressing loss of control over eating which results in a grossly disturbed eating pattern. Despite this, their body weight tends to lie within the normal range. The disorder has attracted various names including ‘the dietary chaos syndrome’ (Palmer, 1979), ‘the abnormal normal weight control syndrome’ (Crisp, 1979), ‘bulimia nervosa’ (Russell, 1979), and simply ‘bulimia’ (DSM III, 1980). The term bulimia nervosa is probably the most satisfactory since it conveys the links with anorexia nervosa and emphasises the central role of binge-eating. Russell (1979) proposed the following diagnostic criteria for this syndrome:

The implicit “Thin Ideal” in eating disorders

2011 ◽  
Vol 26 (S2) ◽  
pp. 720-720
Author(s):  
E. Fadda ◽  
S. Fronza ◽  
E. Galimberti ◽  
L. Bellodi
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Bulimia Nervosa ◽  
Normal Weight ◽  
Control Group ◽  
Implicit Association ◽  
Significant Difference ◽  
Healthy Control ◽  
Negative Attributes ◽  
Concept Attribute

IntroductionGreenwald and co-workers developed The implicit Association Test (IAT) to measure implicit automatic concept-attribute associations. Evidences have suggested that Anorexia Nervosa (AN) and Bulimia Nervosa (BN) were characterized by “Ideal Thin” construct.ObjectivesThe aim of this study was the evaluation, at an implicit level, of Ideal Thin construct in a sample of Eating Disorders (ED) patients.MethodsAn “Ideal thin” Implicit Association Tests (Ideal thin IAT) has been modeled, to evaluate the implicit ideal thin in ED patients compared with an healthy control group. IAT test has been administered to a sample composed by 17 AN patients, 14 BN patients, 17 Binge Eating patients (BED) and 32 healthy controls (HC). The target categories, were “OVERWEIGHT / UNDERWEIGHT” and “POSITIVE / NEGATIVE”. Stimuli included pictures of overweight and normal weight models and positive/negative words. A positive IAT effect underlines an implicit tendency to associate the category “UNDERWEIGHT” with negative attributes, instead a negative IAT effect suggest an implicit tendency to associate the same category with positive attributes.ResultsResults showed no significant difference between HC and clinical groups in implicit “Ideal Thin construct”. All groups showed positive IAT effect. No correlations between implicit attitude and clinical variables were found.ConclusionResults show a common implicit tendency generalized in the sample to positively judge underweight. This implicit tendency was stronger in patients with Anorexia Nervosa (0,30), than patents with Bulimia Nervosa (0,41), than Healthy Control (0,42), followed by patients with BED (0,56).

Bulimia: The Emergence of a Syndrome

1984 ◽  
Vol 18 (2) ◽  
pp. 113-126 ◽  
Author(s):  
G. F. Huon ◽  
L. B. Brown
Keyword(s):  
Anorexia Nervosa ◽  
Bulimia Nervosa ◽  
Disordered Eating ◽  
Normal Weight ◽  
Holistic Perspective

The literature on bulimia, which has regarded it as a psychiatric entity or as a form of disordered eating, suggests that this behaviour is now widespread among the obese, among those with anorexia nervosa and those of normal weight. While physiological, psychological and sociocultural explanations and forms of treatment have been proposed, a holistic perspective on the context in which it occurs can distinguish bulimia nervosa and bulimarexia from ‘simple’ bulimia.

scholarly journals How should DSM-V classify eating disorder not otherwise specified (EDNOS) presentations in women with lifetime anorexia or bulimia nervosa?

2010 ◽  
Vol 40 (10) ◽  
pp. 1735-1744 ◽  
Author(s):  
K. T. Eddy ◽  
S. A. Swanson ◽  
R. D. Crosby ◽  
D. L. Franko ◽  
S. Engel ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Psychosocial Functioning ◽  
Course Of Illness ◽  
Purging Disorder ◽  
Not Otherwise Specified ◽  
Dsm V ◽  
Dsm Iv

ObjectiveAnorexia nervosa (AN) and bulimia nervosa (BN) are marked by longitudinal symptom fluctuations. DSM-IV-TR does not address how to classify eating disorder (ED) presentations in individuals who no longer meet full criteria for these disorders. To consider this issue, we examined subthreshold presentations in women with initial diagnoses of AN and BN.MethodA total of 246 women with AN or BN were followed for a median of 9 years; weekly symptom data were collected at frequent intervals using the Longitudinal Interval Follow-up Evaluation of Eating Disorders (LIFE-EAT-II). Outcomes were ED presentations that were subthreshold for ⩾3 months, including those narrowly missing full criteria for AN or BN, along with binge eating disorder (BED) and purging disorder.ResultsDuring follow-up, most women (77.6%) experienced a subthreshold presentation. Subthreshold presentation was related to intake diagnosis (Wald χ2=8.065, df=2, p=0.018). Individuals with AN most often developed subthreshold presentations resembling AN; those with BN were more likely to develop subthreshold BN. Purging disorder was experienced by half of those with BN and one-quarter of those with AN binge/purge type (ANBP); BED occurred in 20% with BN. Transition from AN or BN to most subthreshold types was associated with improved psychosocial functioning (p<0.001).ConclusionsSubthreshold presentations in women with lifetime AN and BN were common, resembled the initial diagnosis, and were associated with modest improvements in psychosocial functioning. For most with lifetime AN and BN, subthreshold presentations seem to represent part of the course of illness and to fit within the original AN or BN diagnosis.

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