Katherine A. Halmi

Binge-eating and vomiting: a survey of a college population.

A survey of 355 college students was carried out to determine the prevalence of the psychiatric disorder bulimia (the binge-eating syndrome). Results of the survey indicate that, within the normal college population, 13% experienced all of the major symptoms of bulimia as outlined in the DSM-III. Within the bulimia population, 87% were females (19% of the female population) and 13% were males (5% of the male population). Although self-induced vomiting may accompany other symptoms of bulimia, the result suggest that self-induced vomiting is not a necessary symptom for diagnosis. A significant relationship between laxative use and self-induced vomiting was detected. These forms of behaviour, termed purging behaviour, occurred in an average of 10% of the students. Individuals who experienced the symptoms of bulimia had a history of being overweight or tended to be in the upper portion of their normal weight range (age, sex, and weight corrected) when compared with those individuals who had not experienced the symptoms of bulimia. No significant weight history differences were detected between vomiters and non-vomiters.

Psychiatric comorbidity in patients with eating disorders

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.

Ten-year follow-up of anorexia nervosa: clinical course and outcome

The clinical course and outcome of anorexia nervosa are presented in a 10-year follow-up study of 76 severely ill females with anorexia nervosa who met specific diagnostic criteria and had participated in a well-documented hospital treatment study. Information was obtained on 100% of the subjects. A comprehensive assessment was made in 93% of the living subjects in specific categories of weight, eating and weight control behaviours, menstrual function, anorexic attitudes, and psychological, sexual, social and vocational adjustment. Five subjects had died, which gives a crude mortality rate of 6.6%. Standardized mortality rates demonstrated an almost 13-fold increase in mortality in the anorexia nervosa subjects. Only eighteen (23.7%) were fully recovered. Sixty-four per cent developed binge-eating at some time during their illness, 57% at least weekly. Twenty-nine (41%) were still bulimic at follow-up. The high frequency and chronicity of the bulimic symptoms plus the high rate of weight relapse (42% during the first year after hospital treatment) suggest that intensive intervention is needed to help anorexics restore and maintain their weight within a normal range and to decrease abnormal eating and weight control behaviours.

Anorexia nervosa: demographic and clinical features in 94 cases.

&NA; A comprehensive chart study was made of numerous clinical and demographic features in 94 patients with anorexia nervosa. Unlike other large series, this survey included the pediatric age group. A significantly greater maternal and paternal age at time of the patients birth and a greater incidence of both low and high birth weights compared with the general population was found. A relatively high occurrence of premorbid feeding problems was present. Anxiety and obsessive‐compulsive traits were frequent premorbid symptoms. Precipitating events were identified more frequently in patients with a greater age at onset of illness. Characteristic behavior noted during the course of this illness is described.

Evidence for a Susceptibility Gene for Anorexia Nervosa on Chromosome 1

Eating disorders, such as anorexia nervosa (AN), have a significant genetic component. In the current study, a genomewide linkage analysis of 192 families with at least one affected relative pair with AN and related eating disorders, including bulimia nervosa, was performed, resulting in only modest evidence for linkage, with the highest nonparametric linkage (NPL) score, 1.80, at marker D4S2367 on chromosome 4. Since the reduction of sample heterogeneity would increase power to detect linkage, we performed linkage analysis in a subset (n=37) of families in which at least two affected relatives had diagnoses of restricting AN, a clinically defined subtype of AN characterized by severe limitation of food intake without the presence of binge-eating or purging behavior. When we limited the linkage analysis to this clinically more homogeneous subgroup, the highest multipoint NPL score observed was 3.03, at marker D1S3721 on chromosome 1p. The genotyping of additional markers in this region led to a peak multipoint NPL score of 3.45, thereby providing suggestive evidence for the presence of an AN-susceptibility locus on chromosome 1p.

Temperament and character in women with anorexia nervosa

The present study examined temperament differences among anorexia nervosa (AN) subtypes and community controls, as well as the effect of body weight on personality traits in women with AN. Temperament and Character Inventory (TCI) scores were compared between 146 women with restrictor-type AN (RAN), 117 women with purging-type AN (PAN), 60 women with binge/purge-type AN (BAN), and 827 community control women (CW) obtained from an archival normative database. Women with AN scored significantly higher on harm avoidance and significantly lower on cooperativeness than CW. Subtype analyses revealed that women with RAN and PAN reported the lowest novelty seeking, RAN women the highest persistence and self-directedness, and PAN women the highest harm avoidance. Body mass index had a nominal effect on subgroup differences, suggesting that personality disturbances are independent of body weight. Findings suggest that certain facets of temperament differ markedly between women with AN, regardless of diagnostic subtype, and controls. More subtle temperament and character differences that were independent of body weight emerged that distinguish among subtypes of AN.

The Yale-Brown-Cornell eating disorder scale: Development, use, reliability and validity

Patients with eating disorders present with a wide range of eating-related preoccupations and or rituals. Yet, eating disorder assessments traditionally have measured a finite number of specific eating-disordered thoughts or actions. The current work presents a new instrument, the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS), that does not limit assessment to a particular set of eating-related concerns or behaviors. Rather, it assesses the severity of illness associated with an individuals unique symptomatology. Reliability and validity of this new, clinician-rated instrument was tested in two independent samples of DSM-III-R eating disorder patients. The YBC-EDS eight-item scale assessing severity of preoccupations and rituals, and a set of six provisional items for assessing motivation for change were both frequently endorsed and found to have excellent interrater reliability. Internal consistency was shown to be good for the set of eight core items and the set of six items related to motivation for change. The eight-item scale demonstrated aspects of convergent validity with other assessments of eating disorder symptomatology. The set of six provisional items for assessing motivation for change was inversely related to measures to diet restriction, drive for thinness, and body dissatisfaction. This paper presents the eight-item Yale-Brown-Cornell Eating Disorder Scale for assessing illness severity in eating-disordered patients with an extensive range of symptomatology. An accompanying set of six provisional items for assessing motivation for change are also presented. Initial findings showed excellent reliability and indications of validity for both the eight-item YBC-EDS and the set of six provisional items.

More males seek treatment for eating disorders

OBJECTIVE This study compares males and females with DSM-IV-defined eating disorders who were admitted to the inpatient eating disorders service at The New York Hospital, Cornell between 1984 and 1987. METHODS During this period, 51 males and 693 females presented for their first admission. Demographic information, questionnaires, and SCID interviews were used to compare the male and female samples. RESULTS Males were significantly more likely than females to have a later onset of their eating disorder (20.56 vs. 17.15 years), and to be involved in an occupation or sport in which weight control influences performance. There were no significant gender differences in other characteristics or comorbid diagnoses. Males constituted an increasing percentage of total admissions between 1984 and 1997 (r = .692, p = .009). DISCUSSION The similarities of core eating disorder psychopathology and comorbid illness in male and female patients encourage the continued use of similar detection and treatment strategies with both groups.

Depression in anorexia nervosa

SYNOPSI S In three collaborating institutions 105 hospitalized female anorexia nervosa patients were assessed for depressive symptomatology periodically during treatment. As a whole, patients were mildly to moderately depressed, being as depressed as anxious neurotics and less depressed than depressed neurotics. The more depressed patients showed a variety of characteristics, many of which have previously been shown to be indicators of poor prognosis. Over the course of treatment patients became less depressed. Weight gain was correlated with a decrease in depression.

Prediction of outcome in anorexia nervosa from neuropsychological status

To evaluate the possibility that subtle brain dysfunction may exist in anorexia nervosa and indicate a poor prognosis, 20 anorexia nervosa patients received neuropsychological assessments covering a broad array of cognitive performances. The patients were examined at admission and again at the end of an inhospital treatment program when they were at normal weight for their age and height. Pretreatment performance on the assessment battery was not associated with outcome 1 year after discharge. However, posttreatment performance and significantly associated with outcome. A majority (71%) of patients with two or more cognitive deficits showed an unfavorable outcome (i.e., did not maintain their weight). In contrast, a majority (85%) of patients with less than two cognitive defects had a favorable outcome (i.e., maintained or increased their weight). The findings suggest that the hypothesis of a central nervous system disorder limiting the capacity for anorectics to recover deserves further exploration.