P. J. V. Beumont

How patients describe bulimia or binge eating

Thirty-two patients who complained of episodes of ravenous overeating which they felt unable to control (bulimia) were asked to describe their behaviour and symptoms. There was considerable variation both between and within individuals, but a number of factors were defined which appeared to be common to all with the complaint. It is difficult to set up strict criteria for the recognition of bulimia, and those that have recently been proposed are criticized in the light of our present findings. Bulimia is usually associated with an excessive concern about body weight. It occurs in patients with anorexia nervosa, in whom it is often a relatively early feature of the illness, but it is also found in subjects of normal weight or obese subjects who have never been emaciated. Episodes of bulimia are usually preceded by dysphoric mood states. The gorging may alleviate the dysphoria temporarily, but many patients later experience negative feelings such as depression and self-depreciation. The ability to induce vomiting after a bulimic episode is a major influence determining the clinical presentation.

Excessive physical activity in dieting disorder patients: Proposals for a supervised exercise program

A relationship between starvation and hyperactivity has been observed in animal models, in experiments with human subjects, and in dieting disorder patients. Since the earliest descriptions of anorexia nervosa, excessive physical activity has figured prominently as a symptom of the illness, yet little attention has been directed towards this phenomenon. The aims of this paper are to review the published literature, to report our experience of the role of physical overactivity in the clinical presentation of dieting disorders, to discuss its implications for treatment, and to propose a supervised exercise program by which overactivity may be addressed specifically in the treatment of these patients.

Attentional biases in eating disorders: A visual probe detection procedure

OBJECTIVE To investigate attentional biases for body shape and weight-related stimulus words among subjects with anorexia nervosa, bulimia nervosa, and control subjects classified using a measure of dietary restraint. METHODS A visual probe detection task was used to assess attention toward stimulus words reflecting either a thin or a large physique and positively or negatively valenced emotion words. RESULTS In comparison to controls, subjects with eating disorders detected target probes more slowly when they appeared in the same location as had stimulus words connoting a thin physique. In addition, there was a trend toward faster detection or target probes that appeared in the same location as had stimulus words connoting a large physique. Neither of these effects were observed among restrained eaters. DISCUSSION Our results extend prior work suggesting information-processing biases for body shape and weight-related stimuli among persons with eating disorders.

Development of an instrument to assess readiness to recover in anorexia nervosa.

OBJECTIVE The degree to which patients with anorexia nervosa demonstrate readiness to recover from their illness has received scant theoretical or empirical attention. Investigating the prevalence and degree of amotivation for recovery in anorexia nervosa, its role in outcome, and the effectiveness of interventions designed to enhance readiness to recover necessitates the existence of a reliable and valid measure of motivational issues relevant to the disorder. The present study aimed to develop and evaluate an instrument for assessing readiness to recover in anorexia nervosa, namely, the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), a 23-item self-report questionnaire based on Prochaska and DiClementes stages of change model. METHOD Seventy-one inpatients with anorexia nervosa participated in the study. On several occasions during their admission, participants completed the ANSOCQ as well as questionnaires assessing readiness to recover, anorexic symptomatology, general distress, and social desirability. RESULTS The ANSOCQ demonstrated good internal consistency (.90) and 1-week test-retest reliability (.89). Various aspects of validity were also supported, such as significant relationships with other instruments assessing readiness to recover and the prediction of weight gain during different periods of treatment. DISCUSSION The results suggest that the ANSOCQ is a psychometrically sound instrument that may prove useful in investigating the role of readiness to recover in anorexia nervosa.

Body weight, exercise and menstrual status among ballet dancers in training

Summary. A prospective study of the menstrual pattern and weight changes was made in the first year of training of 29 new female entrants to a professional ballet school. Seventy‐nine per cent of the student girls had menstrual disturbances at entry: primary amenorrhoea, four; secondary amenorrhoea, 11; irregular menses, eight. The incidence of secondary amenorrhoea increase substantially by the end of the year (20), but was not associated with any significant change in body weight. Only three students menstruated regularly during the year. Menstrual regularity improved during periods of injury and long vacation and it appears that deterioration of the menstrual pattern during dancing periods was related to strenuous physical exercise rather than to any change in body weight.

Relevance of a standard measurement of undernutrition to the diagnosis of anorexia nervosa: Use of Quetelet's Body Mass Index (BMI)

Quetelets Index provides a measure of nutritional status which is both objective and easy to calculate. A review of the normative data published in the literature indicates that a BMI value of 16 provides a convenient criterion for the recognition of significant undernutrition. This value was applied successfully to a group of 150 anorexia nervosa patients. On the other hand, a BMI of over 18 appeared appropriate in the case of a small group of 22 bulimia nervosa subjects.

The psychosexual histories of adolescent girls and young women with anorexia nervosa

Comprehensive psychosexual histories were elicited from 31 female patients with anorexia nervosa. The subjects showed a wide spectrum of sexual knowledge, attitudes and behaviour. Some appeared to be markedly inhibited, while others were experienced and assertive in regard to sexual matters. Age at interview appeared to be the major factor determining whether individual patients were sexually experienced or not. A majority of patients felt that a sexual challenge had precipitated their illness, and most reported a decrease in sexual interest and enjoyment following weight loss, particularly when this was severe. The effect of the illness on actual sexual behaviour, however, was variable, some patients decreasing and others increasing their sexual activity.

Cross-cultural research on anorexia nervosa : Assumptions Regarding the role of body weight

OBJECTIVE To critically examine two assumptions guiding cross-cultural research on the weight concerns of anorexia nervosa: (1) that weight concerns are specific to contemporary, Western manifestations of the disorder and (2) that the dissemination of Western values regarding thinness is primarily responsible for the development of anorexia nervosa in non-Western contexts. METHOD A review of theoretical and empirical literature on cross-cultural aspects of anorexia nervosa and the medical records of 14 Asian patients treated for eating disorders in Sydney, Australia. RESULTS AND DISCUSSION Regarding the first assumption: It is argued that weight concerns when defined as weight loss that is positively valued (rather than a fat phobia) is a defining characteristic of anorexia nervosa and is not limited to contemporary, Western cases of the disorder. Regarding the second assumption: It is argued that the occurrence of anorexia nervosa in non-Western contexts cannot be solely attributed to the acceptance of Western thinness ideals because values and practices intrinsic to non-Western cultures are also likely to be etiologically relevant.

Conscious and preconscious processing of food, body weight and shape, and emotion‐related words in women with anorexia nervosa

OBJECTIVE The present study was conducted to extend prior research on attention toward food and body weight and shape-related stimuli in women with eating disorders. METHOD A modified Stroop color-naming task was completed by women with anorexia nervosa and by control females subdivided on a measure of dietary restraint. Eating disorder-relevant word categories included words connoting fatness, words connoting thinness, low caloric density food words, high caloric density food words, and neutral, control words. Valence effects were controlled for by including positively and negatively valenced emotion words. Stimuli were presented under both unmasked and masked conditions. RESULTS Using unmasked stimuli, patients with anorexia nervosa, but not unrestrained or restrained eaters, had delayed color-naming latencies for both thin and fat word categories and, to a lesser extent, for high caloric density food words. No differences were observed with masked stimuli. DISCUSSION Our findings suggest that both thinness and fatness are especially salient to women with anorexia. The lack of effects for emotion words suggests that these findings do not reflect a valence effect. We found no evidence for preconscious attentional biases in the masked condition.

Anorexia nervosa (restrictive subtype) is associated with a polymorphism in the novel norepinephrine transporter gene promoter polymorphic region

Long-term weight-restored patients with anorexia nervosa (AN) have lower norepinephrine levels than controls.1,2 Since this may reflect altered reuptake by the norepinephrine transporter (NET), we hypothesised that the NET gene was involved in the genetic component3 of AN. PCR-amplification of an AAGG repeat island (AAGG1) in the NET gene promoter region revealed a novel 343-bp sequence with five additional AAGG repeat islands (AAGG2–AAGG6). We named the sequence from AAGG1 to AAGG6 inclusive, the NET gene promoter polymorphic region (NETpPR). A 4-bp deletion (S4) or insertion (L4) in AAGG4 resulted in the net loss or gain, respectively, of a putative Elk-1 transcription factor site. The transmission disequilibrium test4(TDT) with 87 Australian trios (patient plus parents) demonstrated significant preferential transmission of L4 (McNemars χ2 = 7.806, df = 1, P = 0.0052, odds ratio: 2.1) from parent to child with restricting AN (AN-R), suggesting that L4 or a DNA variant in linkage disequilibrium with it, doubles the risk for developing AN-R.