Eating Disorders and Depression.
Z Kinder Jugenpsychiatr 1987;15(3):198-207
[Anorexia nervosa and depression--a case study].
[Article in German]
Herpertz-Dahlmann B
Klinik und Poliklinik fur Kinder- und Jugendpsychiatrie, Philipps-Universitat
Marburg.
Associations between anorexia nervosa and affective disorders have often been
suggested. A case is described of a 14-year-old girl who develops anorexia
nervosa on the basis of major depressive disorder. After improvement of
anorectic symptomatology during inpatient treatment depressed mood becomes
present again. Etiologic aspects are discussed. As demonstrated by this case
report patients with anorexia nervosa might not only exhibit depressive
symptoms at follow-up, but also in the premorbid state during early childhood.
Compr Psychiatry 1988 Jul;29(4):427-432
Differential diagnosis of anorexia nervosa and depressive illness: a review of
11 studies.
Rothenberg A
Department of Research, Austen Riggs Center, Stockbridge, MA 01262.
A review of differential diagnostic information from 11 studies of patients
with anorexia nervosa is provided. Both intercurrent depressive and
obsessive-compulsive features are most frequently reported overall. In seven of
these studies providing information about premorbid and intercurrent
personality disturbances, obsessive-compulsive characteristics are reported as
most frequent in four. It is suggested that presumed connections between
anorexia nervosa and depressive illness may be secondary to a more direct link
with the obsessive-compulsive syndrome.
Am J Psychiatry 1984 Dec;141(12):1594-1597
Are anorexic and bulimic patients depressed?
Herzog DB
The presence of depression was assessed in 82 female outpatients with anorexia
nervosa and bulimia by means of a structured interview. The Research Diagnostic
Criteria for major depressive disorder were met by 55.6% of the anorexic
patients and 23.6% of the bulimic patients. On the Extracted Hamilton
Depression Rating Scale, 40.7% of the patients with anorexia and 23.6% of those
with bulimia had scores in the moderately or severely depressed range.
J Psychosom Res 1994 Oct;38(7):773-782
Depression in anorexia nervosa and bulimia nervosa: discriminating depressive
symptoms and episodes.
Kennedy SH, Kaplan AS, Garfinkel PE, Rockert W, Toner B, Abbey SE
Department of Psychiatry, University of Toronto, Toronto Hospital, Canada.
In a clinical sample of 198 female patients with anorexia nervosa (N = 83) and
bulimia nervosa (N = 115), 43% met criteria for major depression using the
Structured Clinical Interview for DSMIII-R. This group had a mean score of 30.9
+/- 8.7 on the Beck Depression Inventory (BDI) which was significantly higher
than the BDI mean score of 20.5 +/- 8.9 among the remainder of the sample (p <
0.0001). A score of 26 yielded the highest levels of sensitivity and
specificity, while five items from the BDI (loss of satisfaction,
discouragement, weight loss, suicidal ideation and decision-making) correctly
classified approximately 80% of subjects into "depression-positive" or
"depression-negative" categories. Detection of co-morbid depression in patients
with eating disorders may have practical implications for treatment.
Am J Psychiatry 1985 Dec;142(12):1495-1497
Depressive disorders in relatives of anorexia nervosa patients with and without
a current episode of nonbipolar major depression.
Biederman J, Rivinus T, Kemper K, Hamilton D, MacFadyen J, Harmatz J
The first-degree relatives of anorexia nervosa patients with current nonbipolar
major depression had a higher rate of depression than the relatives of anorexic
patients without current depression, whose rate was similar to that for
relatives of normal control subjects.
Am J Psychiatry 1987 Mar;144(3):362-364
Short-term course of depressive symptoms in patients with eating disorders.
Wamboldt FS, Kaslow NJ, Swift WJ, Ritholz M
After inpatient treatment focused on aberrant eating behavior, six depressed
normal-weight bulimic patients showed little improvement in depressive or
eating symptoms. Four depressed anorexic patients with bulimic behavior
improved in both areas, and five restricting anorexic patients had an
intermediate response.
Pharmacopsychiatry 1997 May;30(3):85-92
Effects of fluvoxamine on depression, anxiety, and other areas of general
psychopathology in bulimia nervosa.
Fichter MM, Leibl C, Kruger R, Rief W
Klinik Roseneck, Hospital fur Behavioral Medicine, Prien, Germany.
The efficacy of fluvoxamine in maintaining improvement of general
psychopathology (depression, obsessive-compulsive symptoms, anxieties,
interpersonal trust, and body perception) was tested in a double-blind
placebo-controlled study of 72 patients with bulimia nervosa who were being
treated successfully with inpatient behavioral psychotherapy. Over a period of
about 15 weeks (2-3 weeks inpatient titration phase, 12 weeks outpatient
relapse-prevention phase), fluvoxamine or placebo were given. The
relapse-prevention design was used to avoid potential confounding effects of
other concomitant treatments. Assessments concerning general psychopathology
were made on the basis of expert ratings (CGI, HDRS) and self ratings (HSCL,
Eating Disorders Inventory (EDI)-subscales "ineffectiveness," "perfectionism,"
"maturity fears," "interpersonal distrust," and "interoceptive awareness").
Fluvoxamine had significant effects in preventing relapse as measured on the
basis of the Clinical Global Impression (CGI) scale "severity of illness", and
a positive trend for relapse preventing effects was observed for the HSCL
"general symptomatic index". Further, a relapse preventing effect was observed
for the HSCL subscale "obsessive-compulsive symptoms", but not for the EDI
subscale "perfectionism". Various dependent variables measuring depression
showed no significant relapse-preventing effects of fluvoxamine, but only
positive trends. Fluvoxamine had no relapse preventing effects according to our
results for dependent variables assessing anxieties, interpersonal trust, and
body perception. During a final short (4-week) off-medication phase, no
statistically significant effects of discontinuation of medication, but some
trends in the expected directions, were observed.
J Nerv Ment Dis 1997 Mar;185(3):140-144
Eating disorder symptomatology in major depression.
Fava M, Abraham M, Clancy-Colecchi K, Pava JA, Matthews J, Rosenbaum JF
Depression Clinical and Research Program, Clinical Psychopharmacology Unit,
Massachusetts General Hospital, Boston 02114, USA.
This study evaluated the relationship between eating disorder symptomatology
and severity of depression in depressed outpatients before and after
antidepressant treatment and assessed the effect of treatment on eating
disorder symptomatology. One hundred thirty-nine outpatients (82 women and 57
men) with major depressive disorder (MDD) filled out the eating disorder
inventory (EDI) before and after 8 weeks of treatment with fluoxetine 20
mg/day. Diagnoses of MDD and possible comorbid eating disorders were made with
the Structured Clinical Interview for DSM-III-R-Patient Edition. Several EDI
subscales correlated significantly with severity of depression both at baseline
and endpoint. Additionally, all EDI subscales showed a statistically
significant decrease following fluoxetine treatment, and changes in depression
severity following treatment were significantly related to changes in EDI
bulimia, ineffectiveness, perfectionism, and interpersonal distress subscale
scores. These results suggest that several symptoms characteristic of eating
disordered patients are linked to the severity of depressive symptoms.
Decreases in eating disorder symptomatology following antidepressant treatment
may be related to changes in depressive symptoms.
Acta Psychiatr Scand 1997 Feb;95(2):140-144
Eating disorder in women admitted to hospital following deliberate
self-poisoning.
Kent A, Goddard KL, van den Berk PA, Raphael FJ, McCluskey SE, Lacey JH
Department of Mental Health Sciences, St George's Hospital Medical School,
London, UK.
Measures of abnormal eating behaviour in 48 women referred for psychiatric
assessment following an act of deliberate self-poisoning (subjects) were
compared with those in 50 women attending an accident and emergency department
following minor accidental injury (controls). Disordered eating behaviour was
significantly more prevalent in the subject group, even when the effect of
depression was removed. Four subjects fulfilled the diagnostic criteria for
bulimia nervosa, but none of the subjects met the diagnostic criteria for
anorexia nervosa. The prevalence of obesity was the same in both subject and
control groups. The degree of abnormal eating was very strongly correlated with
a measure of inwardly directed irritability in both subjects and controls, and
was strongly associated with measures of impulsiveness, outwardly directed
irritability and anxiety in subjects.
Int J Eat Disord 1996 May;19(4):399-404
Discriminant function analysis of depressive symptoms in binge eating disorder,
bulimia nervosa, and major depression.
Crow SJ, Zander KM, Crosby RD, Mitchell JE
Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
OBJECTIVES: To examine the frequency and distribution of depressive symptoms
among subjects with binge eating disorder (BED), bulimia nervosa (BN), and
major depression. METHODS: This study examined depressive symptoms from the
Hamilton Depression Scale in 122 BED, 142 BN, and 200 major depression subjects
using discriminant function analysis. RESULTS: All three groups differed
significantly on the Hamilton Depression Scale totals with major depressive
disorder (MDD) subjects having the highest and BED subjects the lowest totals.
Eighteen items differentiated MDD from the eating disorder groups. Three
items-gastrointestinal (GI) somatic symptoms, paranoid symptoms, and
obsessional symptoms-distinguished BED and BN. In each case these symptoms were
more common in BN subjects. DISCUSSION: This study attempted to differentiate
BN from BED on a basis other than eating behavior. The results provide limited
support for the hypothesis that BN and BED can be distinguished on the basis of
depressive symptoms.
J Clin Psychopharmacol 1996 Feb;16(1):9-18
Fluvoxamine in prevention of relapse in bulimia nervosa: effects on
eating-specific psychopathology.
Fichter MM, Kruger R, Rief W, Holland R, Dohne J
Klinik Roseneck, Hospital for Behavioural Medicine, Prien, Germany.
In a double-blind, placebo-controlled study of 72 patients with bulimia nervosa
treated successfully with inpatient psychotherapy, the efficacy of fluvoxamine
in maintaining improvement was tested. Fluvoxamine and placebo, respectively,
were given over a period of about 15 weeks (2-3 weeks inpatient titration
phase, 12 weeks outpatient relapse-prevention [maintenance] phase). The
variables assessed concerned bulimic behavior and other aspects of eating
disorders, global status, depression, anxieties, obsessive-compulsive behavior,
and other aspects of psychopathology. Because the dropout rate was relatively
high (N = 27 [33%]) and because it was considerably higher in the fluvoxamine
group (19 out of 37 subjects), analyses were performed on the intent-to-treat
sample (ideally including all 72 subjects). Results of the completer sample
analyses (including only those subjects who finished the study) are briefly
presented for comparison. In both the intent-to-treat and the completer
analyses, the following scales showed fluvoxamine to have a significant effect
in reducing the return of bulimic behavior: (1) self-ratings: Eating Disorder
Inventory (EDI)-bulimia, urges to binge in previous week and the number of
actual binges in the previous week; (2) expert ratings: Psychiatric Status
Rating Scales for Bulimia nervosa, Structured Interview for Anorexia and
Bulimia nervosa (SIAB)-"total score," SIAB-subscale "fasting," and
SIAB-subscale "vomiting." Two further variables (EDI-total score and
SIAB-subscale "bulimia") showed the superior relapse prevention effects of
fluvoxamine compared with placebo for the completer sample, while they did not
reach significance for group-by-time interactions in the intent-to-treat
sample. During a final, short (4-week) off-medication phase, no effect of the
discontinuation of medication was observed.
J Psychiatry Neurosci 1996 Jan;21(1):9-12
Bulimia and anorexia nervosa in winter depression: lifetime rates in a clinical
sample.
Gruber NP, Dilsaver SC
Department of Psychiatry and Behavioral Sciences, University of Texas-Houston
Health Science Center, USA.
Symptoms of an eating disorder (hyperphagia, carbohydrate craving, and weight
gain) are characteristic of wintertime depression. Recent findings suggest that
the severity of bulimia nervosa peaks during fall and winter months, and that
persons with this disorder respond to treatment with bright artificial light.
However, the rates of eating disorders among patients presenting for the
treatment of winter depression are unknown. This study was undertaken to
determine these rates among 47 patients meeting the DSM-III-R criteria for
major depression with a seasonal pattern. All were evaluated using standard
clinical interviews and the Structured Clinical Interview for DSM-III-R. Twelve
(25.5%) patients met the DSM-III-R criteria for an eating disorder. Eleven
patients had onset of mood disorder during childhood or adolescence. The eating
disorder followed the onset of the mood disorder. Clinicians should inquire
about current and past symptoms of eating disorders when evaluating patients
with winter depression.
Br J Clin Psychol 1995 Feb;34( Pt 1):37-52
Depression and eating disorders following abuse in childhood in two generations
of women.
Andrews B, Valentine ER, Valentine JD
Department of Psychology, Royal Holloway and Bedford New College, University of
London, Surrey, UK.
The relation of sexual and physical abuse in childhood to subsequent depression
and eating disorders was explored in a community sample of mothers and their
teenage and young adult daughters respectively. It was hypothesized that age
would be a moderating influence on diagnosis following abuse in that depression
would be more common in the mothers and eating disorders more common in the
daughters. Depression was more common in mothers than daughters, using Bedford
College caseness criteria (Finlay-Jones, et al., 1980), but the difference
decreased when Research Diagnostic Criteria (RDC: Spitzer, Endicott & Robbins,
1978) were used. Bulimia was more common in the daughters using DSM-III
criteria. Both physical and sexual abuse were associated with chronic and
recurrent depression but not with single short episodes of depression in the
mothers. However, the relationship of depression to abuse showed only a weak
trend in the daughter sample. Both physical and sexual abuse were related to
bulimia in the daughters, but not in the mothers, as only one mother had such a
disorder.
Compr Psychiatry 1995 Jan;36(1):53-60
Alexithymia, depression, and treatment outcome in bulimia nervosa.
de Groot JM, Rodin G, Olmsted MP
Toronto Hospital-Western Division, University of Toronto, Department of
Psychiatry, Ontario, Canada.
Disturbances in emotional awareness, sometimes referred to as alexithymia, have
been hypothesized to contribute to the development of binge/purge symptoms
among women with bulimia nervosa (BN) and/or are considered secondary to the
state of depression and/or disordered eating. The present study was designed to
assess alexithymia among women with BN, to evaluate the interrelationship
between alexithymia, depression, and somatic symptoms, and to determine whether
an intensive group psychotherapy program contributes to a reduction in the
degree of alexithymia. Thirty-one of 50 BN women (62%) who completed The
Toronto Hospital Day Hospital Program for Eating Disorders (DHP) were
administered pretreatment and posttreatment questionnaires. Findings from this
clinical sample were compared with those from 20 non-eating-disordered women
who completed the same battery. Using the Toronto Alexithymia Scale (TAS),
significantly more BN women were alexithymic at pretreatment (61.3%) and
post-treatment (32.3%) than in the comparison group (5.0%), even when
depression was controlled for. At discharge, abstinence from binge/purge
episodes was associated with a significant reduction in alexithymia, although
there was a significant correlation between TAS scores, depression, and vomit
frequency. Alexithymia among BN women is not simply a concomitant of disordered
eating. Its partial reversibility following an intensive psychotherapy program
may be a direct effect of the treatment and/or may be secondary to a reduction
in depressive and/or binge/purge symptoms.
Psychol Med 1994 Nov;24(4):859-867
Psychiatric comorbidity in patients with eating disorders.
Braun DL, Sunday SR, Halmi KA
Department of Psychiatry, New York Hospital, Cornell University Medical Center,
White Plains 10605.
The Structured Clinical Interview for DSM-III-R (SCID and SCID II) was
administered to 105 eating disorder in-patients in order to examine rates of
comorbid psychiatric disorders and the chronological sequence in which these
disorders developed. Eighty-six patients, 81.9% of the sample, had Axis I
diagnoses in addition to their eating disorder. Depression, anxiety and
substance dependence were the most common comorbid diagnoses. Anorexic
restrictors were significantly more likely than bulimics (all subtypes) to
develop their eating disorder before other Axis I comorbid conditions.
Personality disorders were common among the subjects; 69% met criteria for at
least one personality disorder diagnosis. Of the 72 patients with personality
disorders, 93% also had Axis I comorbidity. Patients with at least one
personality disorder were significantly more likely to have an affective
disorder or substance dependence than those with no personality disorder.
Br J Clin Psychol 1994 Sep;33( Pt 3):259-276
Bulimia nervosa and depression: a theoretical and clinical appraisal in light
of the binge-purge cycle.
Beebe DW
Psychology Department, Loyola University of Chicago, IL 60626.
This review seeks to familiarize clinicians with several major theoretical
perspectives on the relationship between bulimia nervosa and depression. It
begins by clarifying the affective changes which occur within the binge-purge
cycle. Six hypotheses relating negative affect to bulimia nervosa are then
reviewed in light of these changes, with their strengths, weaknesses and
clinical implications clearly outlined. The author concludes that, although
none of these perspectives has received universal support, recent hypotheses
which focus upon specific portions of the binge-purge cycle are best suited to
integration. These include the restraint, escape and hopelessness hypotheses.
An integrative model is proposed to account for data across the binge-purge
cycle, to assist in understanding the maintenance of bulimia nervosa, and to
guide clinical intervention.
Psychol Rep 1993 Jun;72(3 Pt 1):1003-1010
Factors related to depression and eating disorders: self-esteem, body image,
and attractiveness.
Grubb HJ, Sellers MI, Waligroski K
East Tennessee State University.
To test hypotheses that women suffering from some form of eating disorder would
experience lower self-esteem and higher depression and that women with lower
self-esteem and greater depression would rate their attractiveness lower and
see themselves as heavier than less depressed individuals, 42 college
undergraduate women were individually administered the Eating Disorders
Inventory, Beck Depression Inventory, Coopersmith Self-esteem Inventory, and a
Body Image/Attractiveness Perception Scale. A Pearson correlation indicated a
substantial relation between scores on depression and scores on eating
disorders, but nonsignificant values between self-esteem scores and scores on
either eating disorders or on depression. Depression scores correlated
significantly with rated body size, but not attractiveness, while self-esteem
scores were significantly correlated with rated attractiveness, not body size.
These results contradict literature on the relation between self-esteem and
depression. Directions for additional research are discussed.
Compr Psychiatry 1993 Jan;34(1):70-74
Effects of depression and borderline personality traits on psychological state
and eating disorder symptomatology.
Sunday SR, Levey CM, Halmi KA
Department of Psychiatry, Cornell University Medical College, Westchester
Division, White Plains, NY.
The incidence of current or lifetime affective disorder and borderline
personality characteristics were measured in bulimia nervosa patients. The
relationship of these variables to the severity of eating disorder
symptomatology (Eating Disorder Inventory [EDI]) and general psychiatric
symptoms (Hopkins Symptom Checklist [SCL]) was examined. Categorical diagnostic
assessments of affective disorder and borderline personality disorder (BPD)
were made by Structured Clinical Interviews for DSM-III-R (SCID-I and -II).
Affective disorder diagnosis (both current and lifetime) strongly influenced
EDI and SCL profiles, while borderline personality characteristics had little
influence. An understanding of the broad psychological symptomatology in
bulimics requires the consideration of comorbid psychiatric illnesses,
especially affective disorders.
J Am Acad Child Adolesc Psychiatry 1992 Sep;31(5):810-818
Psychiatric comorbidity in treatment-seeking anorexics and bulimics.
Herzog DB, Keller MB, Sacks NR, Yeh CJ, Lavori PW
Harvard Medical School, Massachusetts General Hospital, Boston 02114.
Current and lifetime psychiatric diagnoses were compared in 229 female patients
seeking treatment for current episodes of anorexia nervosa (N = 41), bulimia
nervosa (N = 98) and mixed anorexia nervosa and Schizophrenia-Lifetime Version,
which was modified to include a section for DSM-III-R eating disorders, the
Longitudinal Interval Follow-up Evaluation, and the Structured Interview for
DSM-III Personality Disorders. Seventy-three percent of the anorexia nervosa
subjects, 60% of the bulimia nervosa subjects, and 82% of the mixed anorexia
nervosa and bulimia nervosa subjects had a current comorbid Axis I diagnosis.
Major depression was the most commonly diagnosed comorbid disorder. Low rates
of alcohol and substances abuse disorder were diagnosed, and personality
disorder occurred in a minority of the sample. The subjects with mixed disorder
manifested a higher lifetime prevalence of kleptomania than either the
anorexics or the bulimics. High levels of comorbidity were noted across the
eating disorder samples. Mixed disorder subjects manifested the most comorbid
psychopathology and especially warrant further study.
Psychol Med 1992 Aug;22(3):617-622
Bulimia nervosa and major depression: a study of common genetic and
environmental factors.
Walters EE, Neale MC, Eaves LJ, Heath AC, Kessler RC, Kendler KS
Department of Psychiatry, Medical College of Virginia/Virginia Commonwealth
University, Richmond.
A genetic analysis of the co-occurrence of bulimia and major depression (MD)
was performed on 1033 female twin pairs obtained from a population based
register. Personal interviews were conducted and clinical diagnoses made
according to DSM-III-R criteria. Additive genes, but not family environment,
are found to play an important aetiological role in both bulimia and MD. The
genetic liabilities of the two disorders are correlated 0.456. While unique
environmental factors account for around half of the variation in liability to
both bulimia and MD, these risk factors appear to be unrelated, i.e., each
disorder has its own set of unique environmental risk factors. Thus, the
genetic liability of bulimia and MD is neither highly specific nor entirely
non-specific. There is some genetic correlation between the two disorders as
well as some genetic and environmental risk factors unique to each disorder.
Limitations and directions for future research are discussed.
Addict Behav 1991;16(5):295-301
Depression, dietary restraint, and binge eating in female runners.
Prussin RA, Harvey PD
St. Lukes Hospital/Columbia University, New York, NY.
Female runners (n = 174) were assessed on their levels of dietary restraint,
depression, and binge eating, as well as a number of exercise variables.
Thirty-eight (19%) of the women in the sample were found to meet diagnostic
criteria for DSM-IIIR Bulimia Nervosa. The level of exercise was unassociated
with any of the affective and eating variables as was the risk for meeting
diagnostic criteria for bulimia nervosa. Severity scores for depression in
bulimic runners were notably lower than in earlier nonexercising samples. The
relationships between the variables were similar to those found in previous
research, with dietary restraint, particularly in interaction with depression,
predicting the severity of binge eating in both bulimic and nonbulimic runners.
These data suggest that bulimia, rather than anorexia, may be the most
prevalent eating problem in female runners.
Psychosomatics 1997 Mar;38(2):126-131
Temperament in juvenile eating disorders.
Shaw RJ, Steiner H
Department of Psychiatry and Behavioral Sciences, Stanford University School of
Medicine, Palo Alto, California, USA.
Previous studies have suggested an association between temperament and eating
disorder pathology. The purpose of this study was to differentiate on the basis
of temperament among patients with anorexia, bulimia, and major depression. In
this study, 101 adolescent girls completed the Revised Dimensions of
Temperament Survey (Self), a self-report measure that identifies nine
dimensions of temperament. Significant differences were found between the
diagnostic groups while controlling for disturbances in mood and defensiveness.
Specific subscales differentiated the subjects with anorexia from those with
bulimia. These data support the concept of using temperament to differentiate
patients with related psychiatric syndromes.
Br J Psychiatry 1991 Oct;159:562-565
The prevalence of eating disorders in recently admitted psychiatric
in-patients.
Hay PJ, Hall A
Department of Psychological Medicine, Wellington School of Medicine, New
Zealand.
Of 107 recently admitted psychiatric patients screened for eating-disorder
symptoms by questionnaire, 17% met DSM-III-R criteria for eating disorders.
Eight patients (one male) had bulimia nervosa. Ten patients had eating disorder
not otherwise specified: seven (three male) bulimic type, and three (one male)
anorexia nervosa type. The most common concurrent diagnoses were mood and
personality disorders. As eating-disorder symptoms are relevant to the
diagnosis and management of other psychiatric disorders they should be assessed
routinely in all psychiatric patients.
J Nerv Ment Dis 1992 Nov;180(11):719-722
Bipolar II affective disorder in eating disorder inpatients.
Simpson SG, al-Mufti R, Andersen AE, DePaulo JR Jr
Department of Psychiatry, Johns Hopkins University School of Medicine,
Baltimore, Maryland.
We examined the association between affective disorders and eating disorders in
22 eating disorder inpatients who were interviewed using the Schedule for
Affective Disorders and Schizophrenia-Lifetime Version. The first series of 11
were interviewed as part of an interrater reliability study; the second series,
done as follow-up to the first, consisted of 11 consecutive admissions.
Overall, there were 15 bulimics and seven anorexics. Nineteen patients had a
major affective disorder, and 13 (59%) had bipolar II affective disorder.
Bipolar II affective disorder appears to be a common finding in hospitalized
patients with severe persistent eating disorders.
Acta Paedopsychiatr 1992;55(3):185-186
Defense style and adaptation in adolescents with depressions and eating
disorders.
Smith C, Thienemann M, Steiner H
Division of Child Psychiatry and Child Development, Stanford University School
of Medicine, Palo Alto, CA 94304.
Maturity of defense style has been associated with the level of adaptive
functioning, but few studies have assessed defense style using self-report
questionnaires which can provide ratings with great reliability and
objectivity. We compared self-perception of defense style (using Bond's Defense
Style Questionnaire) with ratings of adaptation assessed retrospectively by two
independent raters (using the DSM III-R Global Assessment of Functioning scale)
in a population of 100 adolescent girls diagnosed as having either an eating
disorder or depression. There was significant correlation between maturity of
defense style and level of adaptation, with greater maturity of defense style
being associated with higher levels of adaptive functioning. This effect was
independent of diagnosis within this population.
Psychiatr Serv 1996 Apr;47(4):426-429
Comorbidity of DSM-III-R axis I and II disorders among female inpatients with
eating disorders.
Grilo CM, Levy KN, Becker DF, Edell WS, McGlashan TH
Yale Psychiatric Institute, New Haven, Connecticut, USA.
Structured diagnostic interviews were used to determine DSM-III-R axis I and II
diagnoses among 136 female psychiatric inpatients. To distinguish comorbidity
of eating disorders with axis I and II disorders from simple diagnostic
overlap, the frequency and distribution of diagnoses among the 31 patients with
an eating disorder and the 105 without an eating disorder were compared. Social
phobia, substance use disorders, borderline personality disorder, and avoidant
personality disorder were diagnosed in a significantly larger proportion of the
group with eating disorders. Future studies should focus on interpreting the
meaning of the co-occurrence of these disorders in patients with eating
disorders.
J Psychosom Res 1996 Jul;41(1):65-70
Pain sensitivity, alexithymia, and depression in patients with eating
disorders: are they related?
de Zwaan M, Biener D, Bach M, Wiesnagrotzki S, Stacher G
Department of General Psychiatry, University Hospital of Psychiatry, University
of Vienna, Austria. Martina.deZwaan@akh-wien.ac.at
A decreased sensitivity to painful stimuli and high scores for alexithymia and
depression have been observed in patients with eating disorders. We
investigated the relationship between these factors in 22 patients with
anorexia nervosa, 18 patients with bulimia nervosa, and 32 healthy subjects.
Alexithymia was assessed using the 20-item Toronto Alexithymia Scale and
depression using the Beck Depression Inventory. Patients with bulimia exhibited
significantly higher thresholds to mechanically induced pain than healthy
subjects. Thresholds to thermally induced pain in patients with anorexia or
bulimia were similar and significantly higher than in the healthy subjects.
Alexithymia and depression scores were significantly higher in anorexic and
bulimic patients than in the healthy subjects. Analyses of covariance revealed
that the degree of alexithymia did not influence thresholds to thermally and
mechanically induced pain, whereas the severity of depression affected to some
extent the threshold to thermally induced pain.
Am J Psychiatry 1987 Mar;144(3):362-364
Short-term course of depressive symptoms in patients with eating disorders.
Wamboldt FS, Kaslow NJ, Swift WJ, Ritholz M
After inpatient treatment focused on aberrant eating behavior, six depressed
normal-weight bulimic patients showed little improvement in depressive or
eating symptoms. Four depressed anorexic patients with bulimic behavior
improved in both areas, and five restricting anorexic patients had an
intermediate response.
Biol Psychiatry 1988 Apr 1;23(7):719-725
Depression as a correlate of starvation in patients with eating disorders.
Laessle RG, Schweiger U, Pirke KM
Max-Planck-Institute of Psychiatry, Division of Psychoneuroendocrinology,
Munich, F.R.G.
The relationship between depressive symptoms and starvation, reflected by body
weight and biochemical parameters, was investigated in 64 patients fulfilling
DSM-III criteria for anorexia nervosa or bulimia. Multiple regression analysis
revealed significant effects of body weight and beta-hydroxybutyric acid,
respectively, on such specific depressive symptoms as depressed or dysphoric
mood when controlling for severity of psychopathology of the eating disorder.
Int J Eat Disord 1996 May;19(4):399-404
Discriminant function analysis of depressive symptoms in binge eating disorder,
bulimia nervosa, and major depression.
Crow SJ, Zander KM, Crosby RD, Mitchell JE
Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
OBJECTIVES: To examine the frequency and distribution of depressive symptoms
among subjects with binge eating disorder (BED), bulimia nervosa (BN), and
major depression. METHODS: This study examined depressive symptoms from the
Hamilton Depression Scale in 122 BED, 142 BN, and 200 major depression subjects
using discriminant function analysis. RESULTS: All three groups differed
significantly on the Hamilton Depression Scale totals with major depressive
disorder (MDD) subjects having the highest and BED subjects the lowest totals.
Eighteen items differentiated MDD from the eating disorder groups. Three
items-gastrointestinal (GI) somatic symptoms, paranoid symptoms, and
obsessional symptoms-distinguished BED and BN. In each case these symptoms were
more common in BN subjects. DISCUSSION: This study attempted to differentiate
BN from BED on a basis other than eating behavior. The results provide limited
support for the hypothesis that BN and BED can be distinguished on the basis of
depressive symptoms.
Addict Behav 1987;12(4):357-361
Affective lability versus depression as determinants of bing eating.
Greenberg BR, Harvey PD
Department of Psychology, State University of New York at Binghamton 13901.
The relationships between dietary restraint, various affective disturbances,
and binge eating were assessed in a sample of 73 college women unselected for
bulimia. It was found, replicating earlier results, that the interaction of
dietary restraint and depression was a significant predictor of binge eating.
However, the interaction of dietary restraint and biphasic mood shifts was an
even better predictor of the severity of binge eating and in fact accounted for
all of the variance in the relationship of dietary restraint, depression, and
binge eating. The results were discussed in terms of the possible role of
affective liability in the development of binge eating.
Behav Res Ther 1990;28(3):205-215
The thin ideal, depression and eating disorders in women.
McCarthy M
Department of Psychology, University of Pennsylvania 19140.
It is proposed that a cultural ideal of thinness for women causes depression at
a higher rate among women than among men. This model accounts for five
currently unintegrated trends in the epidemiology of depression. It explains
why: (1) twice as many women as men are likely to be depressed; (2) this sex
difference emerges at puberty; (3) this sex difference is only found in western
countries; (4) there is more depression today; (5) the average age of onset for
depression is younger now than in the past. Four parallel trends in eating
disorders can also be accounted for by the same factor.
J Clin Psychiatry 1988 Jul;49(7):267-270
Diuretic use as a marker for eating problems and affective disorders among
women.
Mitchell JE, Pomeroy C, Seppala M, Huber M
Department of Psychiatry, University of Minnesota Medical School, Minneapolis
55455.
Fourteen female symptomatic volunteers between the ages of 18 and 40 who used
diuretics on a regular basis for reasons that were not medically necessary were
evaluated. Seven (50%) were diagnosed as having a current or past syndromal or
subsyndromal eating disorder, and 9 (64%) were diagnosed as having a current or
past affective disorder. The results of this pilot study suggest that chronic
diuretic use in young women should signal to the clinician the possibility of
an unrecognized eating problem and/or an affective disorder.
Int J Eat Disord 1996 Jan;19(1):45-52
Comorbidity of binge eating disorder and the partial binge eating syndrome with
bipolar disorder.
Kruger S, Shugar G, Cooke RG
Westfalisches Zentrum fur Psychiatrie, University of Bochum, Germany.
OBJECTIVE: The authors examined the prevalence of binge eating disorder (BED),
partial binge eating syndrome, and night binge eating syndrome in subjects with
bipolar disorder (BD). METHOD: Sixty-one subjects in whom BD was established
using DSM-III-R criteria received a semistructured clinical interview including
a detailed description of binge eating behavior and of night binge eating.
Frequencies were compared to prevalence estimates in community samples.
RESULTS: Eight subjects (13%) met DSM-IV criteria for the diagnosis of BED. An
additional 15 subjects (25%) exhibited a partial binge eating syndrome. These
two otherwise identical groups of binge eaters were separated only by the
DSM-IV frequency criterion. The rates found were higher than rates found in
community samples. Ten subjects reported night binge eating in addition to
their usual binge eating behavior. This occurred consistently between 2:00 and
4:00 a.m. CONCLUSIONS: Possible underlying mechanisms for the high frequency of
binge eating among bipolar subjects are discussed including a model of
serotonin-mediated self-modulation of mood. The finding of two groups of binge
eaters separated only by the frequency criterion raises questions as to whether
the frequency criterion as presently defined in DSM-IV is valid or should be
modified.
Compr Psychiatry 1992 Mar;33(2):123-127
Psychiatric diagnoses in recovered and unrecovered anorectics 22 years after
onset of illness: a pilot study.
Hsu LK, Crisp AH, Callender JS
University of Pittsburgh, School of Medicine, PA 15260.
Sixteen female anorectics, nine recovered and seven unrecovered, were
interviewed 22 years after onset of illness. Concomitant psychiatric diagnoses
were much more common among the unrecovered patients, but three recovered
patients have had a major depressive episode occurring after recovery from
their eating disorder. The findings point to a linkage between eating and
affective disorders and the mechanisms of such a linkage are briefly discussed.
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