Jill M. Holm-Denoma

The "freshman fifteen" (the "freshman five" actually): predictors and possible explanations.

OBJECTIVEnTo conduct a prospective, longitudinal study examining weight fluctuation and its predictors before and during the first year of college.nnnDESIGNnMen (n = 266) and women (n = 341) enrolled at Dartmouth College (age range: 16 to 26; body mass index range: 15.0 to 42.9) provided self-reports of weight and height and completed measures of self-esteem, eating habits, interpersonal relationships, exercise patterns, and disordered eating behaviors both in their senior year of high school and either 3, 6, or 9 months into college.nnnMAIN OUTCOME MEASUREnSelf-reported weight was the primary outcome indicator.nnnRESULTSnAnalyses indicated that both men and women gained a significant amount of weight (3.5 and 4.0 pounds, respectively). Weight gain occurred before November of the first academic year and was maintained as the year progressed. College freshmen gain weight at a much higher rate than that of average American adults. For men, frequently engaging in exercise predicted weight gain. Having troublesome relationships with parents also predicted weight gain in men, whereas for women, having positive relationships with parents predicted weight gain.nnnCONCLUSIONnUnderstanding the predictors of early college weight gain may aid in the development of prevention programs.

Eating Disorder Symptoms among Undergraduate Varsity Athletes, Club Athletes, Independent Exercisers, and Nonexercisers

OBJECTIVEnTo examine whether differences in eating disorder symptoms exist between women who are varsity athletes, club athletes, independent exercisers, and nonexercisers and to determine whether sports anxiety moderates any observed between-group effects.nnnMETHODnTwo hundred seventy four female undergraduates completed the eating disorders inventory and the physical activity and sport anxiety scale and reported their exercise habits.nnnRESULTSnWomen who participated in sports tended to have higher levels of eating disorder symptomatology than those who did not. Higher levels of sports anxiety were predictive of higher levels of bulimic symptoms and drive for thinness. Finally, the interaction of sports anxiety and level of athletic participation significantly predicted body dissatisfaction and bulimic symptoms.nnnCONCLUSIONnCoaches and clinicians should be aware that athletes experience higher rates of eating disorder symptoms than nonathletes. Moreover, sports anxiety should be considered as a possible target of therapy among athletes.

The Role of Anxiety Sensitivity in Eating Pathology

BackgroundIn past research, anxiety sensitivity (AS) has been identified as a risk factor for anxiety, mood, and alcohol problems. Little work, however, has examined the relationship between AS and eating pathology. We predicted that individuals high in AS would have elevated rates of eating disorder symptoms as measured by the Eating Disorder Inventory (EDI).MethodsParticipants in two studies—one undergraduate sample (Nxa0=xa088) and one clinical sample (Nxa0=xa096)—were assessed for anxiety sensitivity and eating disorder symptoms.ResultsIn both samples, AS was significantly related to EDI-Bulimia scores, controlling for depressive symptoms, trait anxiety symptoms, and impulsivity. In the clinical sample, AS was also significantly related to EDI-Drive for Thinness, controlling for the same covariates. A follow-up analysis suggested that the relationship between AS and EDI eating disorder symptoms was mediated by EDI-Interoceptive Awareness.LimitationsBoth studies were cross-sectional, which prohibits causal interpretations. The follow-up mediational analysis must be interpreted with caution due to overlap between the measures of AS and interoceptive awareness. Because of a small sample size and significant comorbidity, the exploratory results analyzing diagnostic categories in Study 2 must be interpreted with caution.ConclusionsAS has a statistically significant relationship to certain eating disorder symptoms measured by the EDI. Future research should investigate whether high AS individuals utilize certain eating behaviors in an effort to regulate somatic symptoms of anxiety.

Psychological correlates of purging disorder as compared with other eating disorders: An exploratory investigation

OBJECTIVEnKeel et al. introduced the diagnostic category of purging disorder (PD), an eating disorder characterized by recurring purging behaviors in the absence of objective binges. The current study sought to investigate psychological correlates among individuals with a lifetime diagnosis of PD as compared to those with other eating disorders, and those with no eating disorder.nnnMETHODnThe current sample included 294 ethnically diverse undergraduate women. Subjects diagnosed with different types of eating disorders [i.e., anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD)] were compared to one another, as well as to individuals with no eating disorder on a variety of indices.nnnRESULTSnWomen with PD displayed similar levels of drive for thinness as women with AN and BED. Individuals with BN and BED exhibited anxiety levels significantly higher than those with PD. Those with PD displayed levels of impulsivity that were significantly higher than those of individuals with AN or BED, but significantly lower than those of individuals with BN. They also displayed similar levels of bulimic symptoms as those with AN and BED; however, analysis of item 53 on the EDI revealed that those with PD had similar levels of purging ideation as those with BN. Women with any eating disorder diagnosis were more likely to have a comorbid Axis I disorder than women in the non-eating disorder group.nnnCONCLUSIONnOur data replicated and extended the findings of Keel et al. and gave further support to the validity and distinctiveness of PD.

Double depression in adult psychiatric outpatients in Brazil: Distinct from major depression?

This study examines whether distinct symptom profiles, patterns of comorbidity, and suicidal symptoms uniquely characterize individuals diagnosed with double depression (DD) by comparing Brazilians with DD to those with major depressive disorder (MDD). One hundred forty two psychiatric outpatients (ages 20-77 mean=48.8, S.D.=13.2; DD, n=23; MDD, n=119) participated in structured diagnostic interviews and completed self-report measures of depressive symptoms, suicidality, and family history of mental disorders. Patients with DD exhibited a more severe symptom profile than those with MDD, as evidenced by a higher number of depressive symptoms and more intense suicidal ideation. They also appeared to be qualitatively different from individuals with MDD, as evidenced by distinct comorbidity patterns, quality of life reports, and anhedonic features. These results may be important in understanding the phenomenology of DD in psychiatric outpatients by informing diagnostics, psychotherapy, and psychotherapeutic treatment of DD.

A test of an interactive model of bulimic symptomatology in adult women

An interactive model of bulimic symptom development, first suggested by Vohs et al. (1999), was tested in adult women (mean age = 45.19). The following hypothesis was examined in a longitudinal design over 2.5 years: Women high in perfectionism, low in self-esteem, and who perceive themselves as overweight would be the most likely to experience an increase in bulimic symptoms. Results supported the model with regard to maintenance and exacerbation, but not onset, of bulimic symptoms. Furthermore, the interactive model was tested to see if it showed specificity to bulimic, versus depressive or anxious, symptoms. Some support for the models specificity to bulimic symptoms was observed; however, the increase of anxious symptoms was also observed. Clinical and theoretical implications are discussed.

Pretreatment Intervention Increases Treatment Outcomes for Patients with Anxiety Disorders.

The current study evaluated the utility of a pretreatment intervention aimed at increasing treatment attendance. We extended past work by evaluating whether this intervention was associated with less impairment at termination. Given that patients with anxiety disorders demonstrate high rates of premature termination, we assessed whether these patients would be particularly likely to benefit. The sample included 172 patients at a community outpatient mental health clinic. Patients were assigned to the intervention condition (asked to imagine attending therapy sessions) or an information control condition. Number of sessions attended and termination Clinician Global Impressions (CGI) served as outcome variables. Contrary to prior work, the two conditions did not significantly differ on outcomes. Yet, patients with anxiety disorders in the intervention condition attended the most sessions and had least termination symptom severity. This intervention may provide a simple yet powerful method to increase treatment adherence and effectiveness for patients with anxiety disorders.