Pamela K. Keel

A 10-Year Longitudinal Study of Body Weight, Dieting, and Eating Disorder Symptoms

The article describes a 20-year longitudinal study of body weight, dieting, and disordered eating in women and men. Body weight increased significantly over time in both women and men. However, womens weight perception and dieting frequency decreased over time, whereas mens weight perception and dieting frequency increased, and disordered eating declined more in women than in men from late adolescence to midlife. In both women and men, changes in weight perception and dieting frequency were associated with changes in disordered eating. In addition, adult roles such as marriage and parenthood were associated with significant decreases in disordered eating from late adolescence to midlife in women, whereas few associations were observed in men. Despite different developmental trajectories, women demonstrated more weight dissatisfaction, dieting, and disordered eating compared with men across the period of observation.

Recovery and Relapse in Anorexia and Bulimia Nervosa: A 7.5-Year Follow-up Study

OBJECTIVE To assess the course and outcome of anorexia nervosa (AN) and bulimia nervosa (BN) at a median of 90 months of follow-up in a large cohort of women with eating disorders. METHOD A prospective, naturalistic, longitudinal design was used to map the course of AN and BN in 246 women. Follow-up data are presented in terms of full and partial recovery, predictors of time to recovery, and rates and predictors of relapse. RESULTS The full recovery rate of women with BN was significantly higher than that of women with AN, with 74% of those with BN and 33% of those with AN achieving full recovery by a median of 90 months of follow-up. Intake diagnosis of AN was the strongest predictor of worse outcome. No predictors of recovery emerged among bulimic subjects. Eighty-three percent of women with AN and 99% of those with BN achieved partial recovery. Approximately one third of both women with AN and women with BN relapsed after full recovery. No predictors of relapse emerged. CONCLUSIONS The findings suggest that the course of AN is characterized by high rates of partial recovery and low rates of full recovery, while the course of BN is characterized by higher rates of both partial and full recovery.

Revisiting the affect regulation model of binge eating: a meta-analysis of studies using ecological momentary assessment.

The affect regulation model of binge eating, which posits that patients binge eat to reduce negative affect (NA), has received support from cross-sectional and laboratory-based studies. Ecological momentary assessment (EMA) involves momentary ratings and repeated assessments over time and is ideally suited to identify temporal antecedents and consequences of binge eating. This meta-analytic review includes EMA studies of affect and binge eating. Electronic database and manual searches produced 36 EMA studies with N = 968 participants (89% Caucasian women). Meta-analyses examined changes in affect before and after binge eating using within-subjects standardized mean gain effect sizes (ESs). Results supported greater NA preceding binge eating relative to average affect (ES = 0.63) and affect before regular eating (ES = 0.68). However, NA increased further following binge episodes (ES = 0.50). Preliminary findings suggested that NA decreased following purging in bulimia nervosa (ES = -0.46). Moderators included diagnosis (with significantly greater elevations of NA prior to bingeing in binge eating disorder compared to bulimia nervosa) and binge definition (with significantly smaller elevations of NA before binge vs. regular eating episodes for the Diagnostic and Statistical Manual of Mental Disorders definition compared to lay definitions of binge eating). Overall, results fail to support the affect regulation model of binge eating and challenge reductions in NA as a maintenance factor for binge eating. However, limitations of this literature include unidimensional analyses of NA and inadequate examination of affect during binge eating, as binge eating may regulate only specific facets of affect or may reduce NA only during the episode.

Are Eating Disorders Culture-Bound Syndromes? Implications for Conceptualizing Their Etiology

The authors explore the extent to which eating disorders, specifically anorexia nervosa (AN) and bulimia nervosa (BN), represent culture-bound syndromes and discuss implications for conceptualizing the role genes play in their etiology. The examination is divided into 3 sections: a quantitative meta-analysis of changes in incidence rates since the formal recognition of AN and BN, a qualitative summary of historical evidence of eating disorders before their formal recognition, and an evaluation of the presence of these disorders in non-Western cultures. Findings suggest that BN is a culture-bound syndrome and AN is not. Thus, heritability estimates for BN may show greater variability cross-culturally than heritability estimates for AN, and the genetic bases of these disorders may be associated with differential pathoplasticity.

Update on course and outcome in eating disorders

OBJECTIVE To review recent studies describing eating disorder course and outcome. METHOD Electronic and manual searches were conducted to identify relevant articles published since 2004. RESULTS Twenty-six articles were identified. For anorexia nervosa (AN), most patients ascertained through outpatient settings achieved remission by 5-year follow-up. Inpatient treatment predicted poor prognosis as inpatient samples demonstrated lower remission rates. Outcome differed between bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS), including binge eating disorder (BED), for shorter follow-up durations; however, outcomes appeared similar between BN and related EDNOS by 5-year follow-up. Greater psychiatric comorbidity emerged as a significant predictor of poor prognosis in BN, whereas few prognostic indicators were identified for BED or other EDNOS. DISCUSSION Results support optimism for most patients with eating disorders. However, more effective treatments are needed for adult AN inpatients and approximately 30% of patients with BN and related EDNOS who remain ill 10-20 years following presentation.

Assessment of eating disorders

Abstract Objective: This paper examines diagnostic agreement between interview and questionnaire assessments of women participating in a long-term follow-up study of bulimia nervosa. Methods: Women ( N =162) completed follow-up evaluations comprising questionnaires and either face-to-face or telephone interviews. Results: Consistent with previous research, rates of eating disorders were higher when assessed by questionnaire than when assessed by interview; however, rates of full bulimia nervosa were similar. Overall diagnostic agreement was adequate for eating disorders ( κ =.64) but poor for bulimia nervosa ( κ =.49), with greater agreement between questionnaires and telephone interviews ( κ s range: .67–.71) than between questionnaires and face-to-face interviews ( κ s range: .35–.58). Conclusion: Findings support the possibility that increased rates of eating pathology on questionnaire assessments may be due, in part, to increased candor when participants feel more anonymous. Questionnaire assessments may not be inferior to interview assessments; they may reveal different aspects of disordered eating.

Genetic and environmental influences on anorexia nervosa syndromes in a population–based twin sample

BACKGROUND Genetic and environmental influences on broadly-defined anorexia nervosa (AN) syndrome were examined in a population-based twin sample. METHODS AN syndrome was assessed in 672 female 17 year-old twins using structured interviews and a self-report questionnaire. RESULTS Twenty-six probands with AN syndrome were identified. Biometrical model-fitting analyses indicated that genetic and non-shared environmental factors accounted for 74% and 26% of the variance in AN syndrome, respectively. CONCLUSIONS Findings support previous research indicating significant genetic and non-shared environmental influences on AN syndromes.

Disordered eating precursors in pre- and early adolescent girls and boys

First- and second-year findings from a study of the development of disordered eating in pre- and early adolescents are presented. Fifth- and sixth-grade girls (n = 80) and boys (n = 85) were assessed on depression, body image, self-esteem, and eating behaviors and attitudes in Year 1 and again one year later. Weight, height, and pubertal development were also evaluated in Year 1 and Year 2. Gender differences existed on all measures in Year 2 and indicated consistently poorer scores for girls compared to boys. For girls, Year 1 Body Mass Index and pubertal development predicted Year 2 disordered eating. For boys, poor body image in Year 1 predicted Year 2 disordered eating. The importance of identifying early risk factors for eating disorders is discussed.

Three to Four Year Prospective Evaluation of Personality and Behavioral Risk Factors for Later Disordered Eating in Adolescent Girls and Boys

Findings of a 3- to 4-year prospective investigation of personality, temperament, and behavioral factors predictive of the later development of disordered eating in an adolescent population are presented. The sample consisted of 726 girls and 698 boys who entered the study in grades 7–10 in year 1 or in grade 7 in year 2. Predictors of eating disorder risk score were determined separately by gender. For both girls and boys, the latent variable of negative affect/attitudes determined at study entrance was the only significant predictor of final-year risk score. Semistructured diagnostic interviews confirmed an eating disorder diagnosis in 52.8% of 36 female subjects in the high eating disorder symptom group. A substantial history of lifetime and current comorbidity also was noted in this group. The function of negative affect/attitudes as a generalized psychopathology vulnerability factor and as a specific factor increasing risk for disordered eating is discussed.

Eating disorder diagnoses: empirical approaches to classification

Decisions about the classification of eating disorders have significant scientific and clinical implications. The eating disorder diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) reflect the collective wisdom of experts in the field but are frequently not supported in empirical studies and do not capture the disorders of eating experienced by most people with an eating disorder. Statistical approaches to classification such as latent class analysis and taxometrics can help to create a classification system with greater scientific validity and clinical utility. The field would benefit from direct empirical comparisons of different classification schemes with various clinical and scientific validators. Such studies would enable the creators of the next DSM eating disorder classification to increase understanding of the advantages and disadvantages associated with choosing various diagnostic criteria sets for the eating disorders.