Ann Von Holle

Attitudes towards anorexia nervosa: The impact of framing on blame and stigma

OBJECTIVE We examined experimentally the way in which exposure to a sociocultural versus a biological/genetic explanation of the etiology of anorexia nervosa (AN) differentially affected attitudes towards AN. METHOD Undergraduate nursing students were randomly assigned to read information emphasizing either biological/genetic or sociocultural factors in the development of AN. They then completed a series of questionnaires assessing their attitudes towards individuals with AN. Nonparametric tests were used to evaluate attitudinal differences between groups. RESULTS Those who were exposed to a biological/genetic explanation of the causes of AN tended to blame individuals with AN less than those exposed to a sociocultural explanation, although all results were not robust to correction for multiple comparisons. CONCLUSION If these results are replicated in larger, population-based samples, wider dissemination of information regarding the biological and genetic underpinnings of AN should be considered as a possible pathway in decreasing the blame-based stigma associated with AN.

Birth outcomes in women with eating disorders in the Norwegian Mother and Child cohort study (MoBa).

OBJECTIVE We explored the impact of eating disorders on birth outcomes in the Norwegian Mother and Child Cohort Study. METHOD Of 35,929 pregnant women, 35 reported broad anorexia nervosa (AN), 304 bulimia nervosa (BN), 1,812 binge eating disorder (BED), and 36 EDNOS-purging type (EDNOS-P) in the six months before or during pregnancy. The referent comprised 33,742 women with no eating disorder. RESULTS Pre-pregnancy body mass index (BMI) was lower in AN and higher in BED than the referent. AN, BN, and BED mothers reported greater gestational weight gain, and smoking was elevated in all eating disorder groups. BED mothers had higher birth weight babies, lower risk of small for gestational age, and higher risk of large for gestational age and cesarean section than the referent. Pre-pregnancy BMI and gestational weight gain attenuated the effects. CONCLUSION BED influences birth outcomes either directly or via higher maternal weight and gestational weight gain. The absence of differences in AN and EDNOS-P may reflect small numbers and lesser severity in population samples. Adequate gestational weight gain in AN may mitigate against adverse birth outcomes. Detecting eating disorders in pregnancy could identify modifiable factors (e.g., high gestational weight gain, binge eating, and smoking) that influence birth outcomes.

Eating disorder symptoms and weight and shape concerns in a large web‐based convenience sample of women ages 50 and above: Results of the gender and body image (GABI) study

OBJECTIVE Limited research exists on eating disorder symptoms and attitudes and weight and shape concerns in women in midlife to older adulthood. We conducted an online survey to characterize these behaviors and concerns in women ages 50 and above. METHOD Participants (n = 1,849) were recruited via the Internet and convenience sampling. RESULTS Eating disorder symptoms, dieting and body checking behaviors, and weight and shape concerns were widely endorsed. Younger age and higher body mass index (BMI) were associated with greater endorsement of eating disorder symptoms, behaviors, and concerns. DISCUSSION Weight and shape concerns and disordered eating behaviors occur in women over 50 and vary by age and BMI. Focused research on disordered eating patterns in this age group is necessary to develop age-appropriate interventions and to meet the developmental needs of an important, growing, and underserved population.

Temporal patterns of recovery across eating disorder subtypes.

Objective: To compare patterns of recovery in individuals with index episodes of anorexia nervosa (AN) and bulimia nervosa (BN). Method: Using Kaplan–Meier methods and Cox proportional hazards models, comparisons were conducted that were conditional on duration of eating disorder from onset and included a conservative recovery criterion of 3 asymptomatic years. Data collection was retrospective and from two of the international Price Foundation genetic studies on 901 individuals with eating disorders. Results: Using Kaplan–Meier methods, 11% of those with index AN and 10% of those with index BN met recovery criteria at 10 years. At 15 years, 16% of those with index AN and 25% of those with index BN met recovery criteria. In a Cox proportional hazards model the index BN group had three times the rate of recovery at 10–14 years (p=0.01) than the index AN group. Conclusions: Initially the probability of recovery was greater for those with index AN, but as the duration of the eating disorder lengthened those with BN had higher probabilities of recovery. Replication of these results with prospective data using similarly stringent recovery criteria and methods is required to confirm trends.

Body Dissatisfaction in Women Across the Lifespan: Results of the UNC-SELF and Gender and Body Image (GABI) Studies

To explore age differences in current and preferred silhouette and body dissatisfaction (current - preferred silhouette discrepancy) in women aged 25-89 years using figural stimuli [range: 1 (very small) to 9 (very large)]. Data were abstracted from two online convenience samples (N = 5868). t-tests with permutation-adjusted p-values examined linear associations between mean silhouette scores (current, preferred, discrepancy score) and age with/without stratification by body mass index (BMI). Modal current silhouette was 5; modal preferred silhouette was 4; mean discrepancy score was 1.8. There was no significant association between current silhouette and age, but a positive linear association between preferred silhouette and age remained after stratification by BMI. A significant inverse linear association of silhouette discrepancy score and age was found only prior to stratification by BMI. Body dissatisfaction exists in women across the adult life span and is influenced by BMI.

Factors associated with recovery from anorexia nervosa

Previous studies of prognostic factors of anorexia nervosa (AN) course and recovery have followed clinical populations after treatment discharge. This retrospective study examined the association between prognostic factors--eating disorder features, personality traits, and psychiatric comorbidity--and likelihood of recovery in a large sample of women with AN participating in a multi-site genetic study. The study included 680 women with AN. Recovery was defined as the offset of AN symptoms if the participant experienced at least one year without any eating disorder symptoms of low weight, dieting, binge eating, and inappropriate compensatory behaviors. Participants completed a structured interview about eating disorders features, psychiatric comorbidity, and self-report measures of personality. Survival analysis was applied to model time to recovery from AN. Cox regression models were used to fit associations between predictors and the probability of recovery. In the final model, likelihood of recovery was significantly predicted by the following prognostic factors: vomiting, impulsivity, and trait anxiety. Self-induced vomiting and greater trait anxiety were negative prognostic factors and predicted lower likelihood of recovery. Greater impulsivity was a positive prognostic factor and predicted greater likelihood of recovery. There was a significant interaction between impulsivity and time; the association between impulsivity and likelihood of recovery decreased as duration of AN increased. The anxiolytic function of some AN behaviors may impede recovery for individuals with greater trait anxiety.

Patterns of maternal feeding and child eating associated with eating disorders in the Norwegian Mother and Child Cohort Study (MoBa).

The impact of eating disorders on maternal feeding practices and childrens eating behaviors is not well understood. In the prospective Norwegian Mother and Child Cohort Study (MoBa), we compared self-reported feeding behavior in mothers with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and no eating disorders (No ED) as well as child eating behaviors and psychological symptoms. The sample comprised 13,006 women and their children from a prospective population-based study of 100,000 births throughout Norway. Eating disorder status was measured 6 months prior to pregnancy and during pregnancy. Maternal feeding, child eating, and psychological variables were reported by mothers when their child was 36 months old. Mothers with BN and BED were more likely to report restrictive feeding styles and child eating problems than mothers without eating disorders. Regarding the pressure to eat feeding style, no significant differences emerged across groups. Differences in self-reported feeding styles and childrens eating behavior exist between mothers with and without eating disorders. Longitudinal follow-up will assist in determining the implications of feeding style on later growth trajectories and development.

Unplanned Pregnancy in Women With Anorexia Nervosa

OBJECTIVE: To compare the frequency with which unplanned pregnancies occur in individuals with anorexia nervosa relative to women without eating disorders in the Norwegian Mother and Child Cohort Study. METHOD: In a sample of 62,060 women, 62 reported anorexia nervosa. Using data from a questionnaire completed by all participating mothers, we compared mothers age at birth and the frequency with which mothers reported their index pregnancy as being unplanned. RESULTS: Women with anorexia nervosa were younger (26.2 years, standard deviation 4.76) than women with no eating disorder (29.9 years, standard deviation 4.60) at the time of birth. Significantly more women with anorexia nervosa (50.0%) reported unplanned pregnancy than women in the referent group (18.9%). After adjustment for maternal age and infertility treatment, the relative risk of unplanned pregnancy in individuals with anorexia nervosa was 2.11 (95% confidence interval 1.64–2.72). Induced abortion was also significantly more common in women with anorexia nervosa than referent women (24.2% compared with 14.6%). CONCLUSION: The higher rate of unplanned pregnancy and abortion in women with anorexia nervosa is of clinical concern because absent or irregular menstruation may be misinterpreted as decreasing risk of pregnancy. LEVEL OF EVIDENCE: II

Posttraumatic Stress Disorder in Anorexia Nervosa

Objectives: Comorbidity among eating disorders, traumatic events, and posttraumatic stress disorder (PTSD) has been reported in several studies. The main objectives of this study were to describe the nature of traumatic events experienced and to explore the relationship between PTSD and anorexia nervosa (AN) in a sample of women. Methods: Eight hundred twenty-four participants from the National Institutes of Health-funded Genetics of Anorexia Nervosa Collaborative Study were assessed for eating disorders, PTSD, and personality characteristics. Results: From a final sample of 753 women with AN, 13.7% (n = 103) met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for PTSD. The sample mean age was 29.5 (standard deviation = 11.1) years. In pairwise comparisons across AN subtypes, the odds of having a PTSD diagnosis were significantly lower in individuals with restricting AN than individuals with purging AN without binge eating (odds ratio = 0.49, 95% confidence interval = 0.30-0.80). Most participants with PTSD reported the first traumatic event before the onset of AN (64.1%, n = 66). The most common traumatic events reported by those with a PTSD diagnosis were sexually related traumas during childhood (40.8%) and during adulthood (35.0%). Conclusions: AN and PTSD do co-occur, and traumatic events tend to occur before the onset of AN. Clinically, these results underscore the importance of assessing trauma history and PTSD in individuals with AN and raise the question of whether specific modifications or augmentations to standard treatment for AN should be considered in a subgroup to address PTSD-related psychopathology.AN = anorexia nervosa; ANBN = lifetime diagnosis of both anorexia and bulimia nervosa; BAN = anorexia nervosa with binge, with or without purging; BN = bulimia nervosa; BMI = body mass index; DSM-IV = Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition; HPA = hypothalamic-pituitary-adrenal; PAN = purging anorexia nervosa without binge eating; PTSD = posttraumatic stress disorder; RAN = restricting anorexia nervosa; Y-BOCS = Yale-Brown Obsessive Compulsive Scale; YBC-EDS = Yale-Brown-Cornell Eating Disorder Scale.

Eating disorder symptomatology: prevalence among Latino college freshmen students.

This study investigated the prevalence of eating disorder symptoms in first-year students at the University of Puerto Rico. Responses to the Bulimia Test Revised (BULIT-R), the Eating Attitudes Test (EAT-26), and the Beck Depression Inventory (BDI) were analyzed in a sample of 2,163 freshman students. The percentage of students at or above the clinical cut-off points was 3.24% for the BULIT-R and 9.59% for the EAT-26, and 1.88% met the cut-off point for both instruments. The 36.44% of the students who screen positive on eating disorders measures scored 18 or more on the BDI and 5.93% on this group presented high suicidal risk based on their responses to BDI items assessing suicidal thoughts. Eating disorder symptoms occur frequently in Puerto Rican college students, and prevention, detection, and treatment efforts are needed.