M. Di Bernardo

Psychopathological and clinical features of outpatients with an eating disorder not otherwise specified

In order to investigate similarities and differences between Eating Disorder Not Otherwise Specified (EDNOS) and Anorexia Nervosa (AN) and Bulimia Nervosa (BN), we studied a consecutive series of 189 female outpatients attending two Eating Disorder Units. The data were collected by means of interviews (Eating Disorder Examination, EDE 12.0D), the Structured Diagnostic Interview for DSM III-R, (SCID), and self-reported questionnaires (Beck Depression Inventory, BDI, and State and Trait Anxiety Inventory, STAI 1–2). The diagnosis of EDNOS was as frequent as that of AN and BN (43.8% versus 43.2%). There were no significant differences between EDNOS and AN/BN patients in terms of their general and specific psychopathological features, but significant differences were observed between bulimic-like and anorectic-like EDNOS patìents, as well as between those with AN and BN. In conclusion, in our clinical setting, the patients with EDNOS and those with typical eating disorders have similar psychopathological features, thus suggesting that EDNOS patients should be further divided into two groups, anorectic-like (similar to AN) and bulimic-like (similar to BN) patients.

Screening for binge eating disorder in obese outpatients

The prevalence of binge eating disorder (BED) in clinical samples of obese patients is controversial, and sensitive diagnostic protocols for use in routine clinical practice need to be further defined. Three hundred forty-four obese (body mass index [BMI] > or =30 kg/m2) patients were studied with the Structured Clinical Interview for DSM-III-R to investigate the lifetime prevalence of mental disorders. The current prevalence of BED was assessed using DSM-IV criteria. Eating attitudes and behavior were investigated with the Bulimic Investigation Test, Edinburgh (BITE) and the Binge Eating Scale (BES). The Beck Depression Inventory (BDI) and Spielbergs State-Trait Anxiety Inventory (STAI) were also applied. The prevalence of BED was 7.5%. Patients with BED had a higher BMI compared with obese patients without BED. Differences in the lifetime prevalence of mental disorders in patients with and without BED were not statistically significant. Using the BES as a screening instrument for BED with a threshold of 17, the sensitivity was 84.8%, specificity 74.6%, positive predictive value 26.2%, and negative predictive value 97.9%. Using the BITE with a threshold of at least 10, the sensitivity was 91%, specificity 51.4%, positive predictive value 71.8%, and negative predictive value 98.2%. The BITE can be a valid alternative to the BES as a screening method for BED in obese patients.

Eating behavior in obese patients with and without type 2 diabetes mellitus

Objective: Aim of this study was the assessment of the prevalence of eating disorders, and of eating disorder symptoms, in obese patients with type 2 diabetes, compared to non-diabetic subjects.Design: Three samples of individuals were studied: a series of 156 (76 male, 80 female) overweight and obese type 2 diabetic patients, aged 30–65 y, with a body mass index (BMI)>28 kg/m2 (DM); a series of 192 (20 male, 172 female) obese (BMI>30 kg/m2) non-diabetic patients aged 30–65 y seeking treatment for weight loss (OC); and a non-clinical sample of 48 (22 male, 26 female) obese (BMI>30 kg/m2) subjects aged 30–65 y selected from the lists of two general practices (OP). Eating behavior was assessed using the Eating Disorder Examination (EDE 12.0D).Results: The prevalence of Binge Eating Disorder was lower than 5% in all the three samples. Median EDE scores in females were significantly higher in OC (3.0) and OP (3.4) than in DM (1.7), while diabetic patients showed higher scores on Restraint than both non-diabetic samples. Among diabetic patients, a significant correlation of EDE scores with HbA1c was observed.Conclusions: Type 2 diabetes is unlikely to induce relevant eating disturbances in obese patients, apart from an increase in restraint. Abnormalities of eating attitudes and behavior are associated with an impairment of metabolic control.

Psychometric properties of EDE 12.0D in obese adult patients without binge eating disorder

The aim of the present study is to assess the psychometric properties of the Eating Disorder Examination (EDE) 12.0D in obese adult patients without Binge Eating Disorder (BED). A consecutive series of 115 obese patients without BED (23 M; 92 F), seeking treatment for obesity at the Outpatient Clinic of the Section of Metabolic Diseases and Diabetology of the University of Florence was studied using the EDE 12.0D. Patients had a mean (±SD) age of 40.8±15.1 years, and a Body Mass Index (BMI) of 36.3±5.9 Kg/m2. Interna consistency of EDE and its scales was evaluated through Cronbach’s α; factor structure o EDE 12.0D was studied with factor analysis. EDE total and Shape Concern (SC) scores were found to be higher in females than in males. EDE total, SC and Eating Concern (EC) scores were inversely correlated to age, but not BMI. Factor analysis suggested the grouping o items in two subscales. The first scale includes all the items from EC, Weight Concern (WC and SC except reaction to prescribed weighing; the second scale consists of all the items from Restraint. Data obtained show that items from EC, WC and SC all converge into the same factor analysis derived scale in obese patients without BED. EDE 12.0D provides relevant information about psychopathological features of obese patients, but a grouping o items into subscales different from those originally described could be indicated.

Venlafaxine versus fluoxetine in the treatment of atypical anorectic outpatients: a preliminary study.

The efficacy of venlafaxine and fluoxetine in the treatment of atypical anorexia nervosa (AN) was compared in a controlled trial. A consecutive series of 24 atypical anorectic females was assigned to either venlafaxine (75 mg/day) or fluoxetine (40 mg/day) plus cognitive-behavioural therapy (CBT). Eating Disorder Examination (EDE12.0D), Beck Depression Inventory (BDI) and State and Trait Anxiety Inventory (STAI) scores were compared before and after 6 months of treatment. Venlafaxine and fluoxetine determined an increase of body mass index (BMI) and a significant reduction of EDE12.0D and BDI scores venlafaxine alone reduced STAI scores. It would seem that venlafaxine is as effective as fluoxetine when combined with CBT in the treatment of atypical AN.

Sertraline enhances the effects of cognitive-behavioral treatment on weight reduction of obese patients

Serotonin reuptake inhibitors, such as dexfenfluramine, fluoxetine and fluvoxamine, have been proposed as therapeutical tools for the treatment of eating disorders and obesity. Sertraline, a SSRI used in the treatment of depression, interferes with eating behavior in animal models, but it has not been tested in obese humans. Aim of this study is the assessment of the effects of sertraline on eating attitudes and body weight in obese patients with and without mood disorders. A consecutive series of 65 obese out-patients aged 18–65 years, with a body mass index (BMI) >30 kg/m2, was treated for 6 months with sertraline 150 mg/day per os, in addition to a cognitive-behavioral treatment (CBT). A consecutive series of 60 obese patients with similar characteristics, who were treated with CBT only, were used as control group. A greater reduction of BMI (mean±SD) was observed in sertraline-treated patients when compared to controls (from 35.3±5.7 to 32.0±5.4 kg/m2 in sertraline-treated patients, from 37.1 ±7.0 to 36.0±7.1 kg/m2 in controls; 6.5±5.4% vs. 3.0±6.3%; p<0.01), while a similar change in eating attitudes (evaluated through the BITE questionnaire) was observed in both groups. Effects of sertraline on eating attitudes and body weight were similar in patients with and without mood disorders. In conclusion, sertraline, administered together with CBT, seems to be more effective in inducing weight loss in obese patients when compared with CBT alone, and therefore it could be a useful tool in the first months of CBT for severe obesity.

Cognitive-behavioral therapy versus combined treatment with group psychoeducation and fluoxetine in bulimic outpatients.

A series of 51 female bulimic outpatients, aged 23.4±3.9, were assigned either to Cognitive-Behavioral Therapy (CBT) or combined Group Psychoeducation and Fluoxetine (GPF) treatment. The Eating Disorder Examination (EDE) was performed at the beginning o treatment and after 6 months, together with the administration of self reported question naires for depression (BDI) and Anxiety (STAI). A significant (p<0.001) reduction of the number of monthly binge episodes (from 25.0±12.9 to 6.2±3.8 and from 24.8±9.1 to 8.0±4.3) for CBT and GPF respectively were observed. Similar reductions were obtained in the number o episodes of compensatory behaviors. Both treatments reduced depression and anxiety (p<0.001) while CBT only determined a significative improvement of EDE scores. The data obtained suggest that GPF is as effective as CBT in reducing bulimic symptomatology but its long-term efficacy should be evaluated in a follow-up study.

Eating attitudes and behavior throughout the menstrual cycle in obese women: A case-control study

Premenstrual variations of eating behavior are reported in several studies, but their relationship with mood is unclear. Eating behavior and physical and psychological complaints during the menstrual cycle were studied in 107 obese patients and 93 matched controls using retrospective (Weekly Bulimic Test Edinburgh, W-BITE and Premenstrual Assessment Form, PAF) and prospective (Daily Rating Form, DR) questionnaires. Eating disorder symptoms increased in the premenstrual phase, as shown by the W-BITE scores both in patients (6.2±5.3 premenstrual week vs 4.9±4.4 postmenstrual week, p< 0.05) and in control subjects (4.9±4.1 premenstrual week vs 4.2±3.0 postmenstrual week, p<0.05) and were correlated to premenstrual complaints in control subjects (r=0.5; p<0.05) but not in obese women (r=0.2; p=NS). A close relationship between physical and psychological premenstrual disturbances was observed in obese patients only. Premenstrual variation of eating behavior could be the target of specific treatment.