Mae Lynn Reyes-Rodríguez

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.

Depression symptoms and stressful life events among college students in Puerto Rico

BACKGROUND The transition from adolescence to adulthood is associated with stressful adaptation experiences that may increase symptoms of depression. We explored the prevalence and sex differences of depressive symptoms and suicidal ideation in freshmen Latino college students in Puerto Rico, and identified stressful life events that could contribute to symptoms of depression. METHODS Two thousand one hundred sixty-three freshmen college students from the University of Puerto Rico (UPR) public education system were assessed for depression symptoms using the Beck Depression Inventory (BDI) and stressful life events using open questions. RESULTS Nine percent of the sample reported depression symptoms at a moderate or severe level (BDI>20). Chi square analyses revealed a significantly higher prevalence for three of the stressful life events in females than males: relocation (10.2% females vs. 7.3% males; X(2) (1)=4.13, p=.042), break-up of a significant relationship (25.3% females vs. 17.8% males; X(2) (1)=13.76, p<.001), and illness (11.2% females vs. 7.3% males; X(2) (1)=7.23, p=.007). The model that best explained the variance of BDI scores among females was the presence of suicide risk, relationship break-up, illness, and relocation for college, whereas for males a similar model without the relationship break-up variable resulted in a better fit. CONCLUSIONS Freshmen college students present a broad range of depression symptoms and certain stressful life events are associated with an increased prevalence of depression symptoms. Early detection of depression and tailored prevention programs should be developed to improve both mental health and academic performance among the college population.

Diet and Physical Activity in Women Recovered from Anorexia Nervosa: A Pilot Study

OBJECTIVE After recovery, women with anorexia nervosa (AN) tend to maintain lower body mass indices (BMI) than women in the general population. Reasons for this are unknown as little is known about diet, food choices, physical activity levels (PAL), and reasons for exercise in women recovered from AN. METHOD Diet, reasons for food choice, PAL, and reasons for exercise were measured in an exploratory study of 15 women recovered from AN and 22 women with no eating disorder history. RESULTS In these hypotheses generating analyses, mean BMI in recovered women was numerically lower than control women [21.4 kg/m(2) (2.0) and 23.6 kg/m(2) (4.4); respectively (p < .06)]. Recovered women were more likely to base food choice on health benefits (p < .04) compared with control women. DISCUSSION Pathological behaviors that are pathognomonic of AN may resolve into healthy food and activity choices that help maintain BMIs lower in the healthy range in recovered individuals.

Eating Disorders, Trauma, PTSD and Psychosocial Resources

The frequency of traumatic events and comorbid post-traumatic stress disorder (PTSD) in women with eating disorders (ED) was assessed. Also, patients with anorexia nervosa (AN) and bulimia nervosa (BN) were compared; post-traumatic symptomatology and the role of psychosocial resources were analyzed. One hundred three ED patients (29.1±10.5 years) were studied through the use of standardized questionnaires. We found that 23.1% of AN and 25.5% of BN patients fulfilled the study definition for a current diagnosis of PTSD. Cumulative traumatization led to more severe symptomatology. Psychosocial resources were found to have strong associations with symptomatology. These findings provide additional support for the association between traumatization and ED. Clinical interventions for traumatized ED patients may benefit from a focus on post-traumatic stress symptomatology and personal resources.

A Description of Disordered Eating Behaviors in Latino Males

Abstract Objective: To explore disordered eating and eating disorders (EDs) in Latino males. Participants: Participants are 722 male college students from a larger prevalence study conducted in the University of Puerto Rico system. Methods: Participants were selected from a list of sections of required courses for first-year students on each campus. Self-report instruments were used to explore ED symptoms (the Eating Attitudes Test [EAT-26] and the Bulimia Test–Revised [BULIT-26-R] and the Beck Depression Inventory depression (BDI). Results: Overall, 2.26% scored above the cut-off point on the BULIT-R and 5.08% score above the cut-off point on the EAT-26. Of the males, 4.43% reported sufficient frequency and severity to approximate DSM-IV criteria for bulimia nervosa. Depression symptomatology was found in those who scored above the cut-off point on both instruments of EDs. Conclusion: College health practitioners should be aware of disordered eating in Latino males and include them in efforts to detect disordered eating behaviors in college students.

Culturally Sensitive Intervention for Latina Women with Eating Disorders: A Case Study

OBJECTIVE We describe cognitive-behavioral therapy for bulimia nervosa (CBT-BN) with a Latina woman that incorporates culturally relevant topics. METHOD A single case report of a 31-year-old monolingual Latina woman with BN describes the application of a couple-based intervention adjunctive to CBT-BN. RESULTS The patient reported no binge and purge episodes by session 20 and remained symptom free until the end of treatment (session 26). Improvement was observed in the Eating Disorders Examination (EDE) comparing baseline (EDE=5.74) with post treatment (EDE=1.25). CONCLUSIONS The case illustrates how cultural adaptations such as including a family member, being flexible on topics and scheduling, and providing culturally relevant interventions can lead to successful completion of a course of therapy and facilitate ongoing interventions to ensure continued recovery.

Race, Ethnicity, and Eating Disorder Recognition by Peers

We investigated racial/ethnic stereotyping in the recognition and referral of eating disorders with 663 university students. We explored responses to problem and eating disorder recognition and health care referrals after subjects read a vignette concerning a patient of a different race/ethnic background presenting with eating disorders. A series of three 4 × 3 ANOVAs revealed significant main effects for eating disorders across all three outcome variables. There were no significant main effects across the four different race/ethnicity conditions and no significant race by condition interactions. Lack of general eating disorder recognition and health care referrals by student participants were found. [Supplemental files are available for this article. Go to the publisherss online edition of Eating Disorders for the following free supplemental resource: online appendix containing vignettes 1–3, as described in the “Methods” section].