Pauline S. Powers

Athletes and eating disorders: The national collegiate athletic association study

OBJECTIVE To present findings from a collaborative study with the National College Athletic Association regarding the prevalence of disordered eating among student athletes. METHOD 1,445 student athletes from 11 Division 1 schools were surveyed using a 133-item questionnaire. RESULTS Results indicated that 1.1% of the females met DSM-IV criteria for bulimia nervosa versus 0% for males. None of the student athletes met DSM-IV criteria for anorexia nervosa. 9.2% of the females were identified as having clinically significant problems with bulimia versus .01% of the males. 2.85% of the females were identified as having a clinically significant problem with anorexia nervosa versus 0% for males. 10.85% of the females reported binge eating on a weekly or greater basis versus 13.02% of the males 5.52% of the females reported purging behavior (vomiting, laxatives, diuretics) on a weekly or greater basis versus 2.04% for the males. DISCUSSION Results from the current investigation are more conservative than previous studies of student athletes, but comparable to another large study of elite Norwegian athletes. Reasons for these differences are discussed. Clearly female athletes report more difficulty with disordered eating than male athletes. Some specific risk factors for female athletes are discussed.

Eating pathology before and after bariatric surgery: A prospective study

OBJECTIVE The objectives of the study were (1) to determine the prevalence of eating pathology in patients before bariatric surgery and at follow-up; (2) to assess the relationship of presurgical eating pathology to various measures of psychopathology; and (3) to assess the relationship between presurgical eating pathology and outcome. METHOD One hundred sixteen patients were evaluated prior to surgery and at follow-up an average of 5.5 years after surgery. RESULTS Preoperative binge eating occurred in 52% of patients, 16% met criteria for binge eating disorder, and 10% had the night eating syndrome. All three forms of presurgical eating pathology were statistically associated with cognitive distortions. At follow-up, 33% of patients were vomiting at least weekly. There was no relationship between presurgical eating pathology and weight outcome or presence of vomiting at follow-up. DISCUSSION Although postoperative vomiting usually does not represent purge behavior, it may represent failed attempts to binge.

Outcome of Gastric Restriction Procedures: Weight, Psychiatric Diagnoses, and Satisfaction

Background: Weight losses following bariatric surgery have varied widely, depending on length of follow-up and various pre-surgical characteristics of patients undergoing surgery. Methods: One hundred thirty one patients had a detailed presurgical psychiatric evaluation. Patients were assessed clinically for 2 years after surgery and at follow-up a mean of 5.7 years after surgery. Results: Mean presurgical body mass index (BMI) was 52.9 kg/m2; therefore, many patients had ‘super obesity’. Two-thirds of the patients were located a mean of 5.7 years after surgery. The mean change in BMI at follow-up was 25% and the mean weight loss was 27%. One-third had excellent or good weight outcomes using the Griffen criteria. Five patients had died by follow-up. There was no relationship between age, gender, or fat content presurgically and weight loss at follow-up, although presurgical weight was associated with greater weight loss at follow-up. Weight regain began 2 years after surgery. There was no relationship between the presence or absence of a presurgical psychiatric diagnosis and weight loss at follow-up. There was also no relationship between the presence of a presurgical psychiatric diagnosis and various mental health parameters at follow-up. Satisfaction with the surgery was marginally associated with weight loss but significantly associated with improved mental and physical health. Conclusions: Mean weight losses were less than have been previously reported with gastric restriction procedures but the follow-up was longer than usually reported and many patients had ‘super obesity’ prior to surgery. The implications of ‘super obesity’ for weight loss are discussed.

Other psychiatric disorders among bulimic patients.

Clinical experience suggests that bulimia nervosa is a disorder often accompanied by additional psychiatric symptoms. Based on unstructured clinical interviews, 21 additional Axis I and six Axis II diagnoses were assigned to a sample of 30 bulimic women. The Structured Clinic Interview for DSM-III-Patient Version (SCID-P) generated 47 additional Axis I and 78 Axis II diagnoses. There was little agreement across measures in the assessment of mood disturbance. These results not only suggest a greater degree of pathology in bulimic women, but also raise important questions regarding the measurement and conceptualization of DSM-III-R Axis II disorders.

Inpatient treatment of anorexia nervosa

In this paper the indications for inpatient treatment of anorexia nervosa are reviewed. Although all programs aim at weight gain and normalization of eating habits, the means for achieving these goals vary widely from nursing encouragement, operant conditioning or, rarely, hyperalimentation. Most programs now utilize an integrated treatment program that includes a weight restoration program, individual psychotherapy and family involvement. Nutritional considerations during inpatient treatment are also reviewed. The signs and symptoms that commonly occur during weight restoration are outlined. The major psychodynamic conflicts that occur are described and psychotherapeutic methods for treating each are presented.

Anorexia nervosa presenting as growth retardation in adolescents

Two adolescent males and one adolescent female were referred for evaluation of short stature. Extensive laboratory studies, often performed over several years, were unremarkable. After several years of observation, the diagnosis of anorexia nervosa was established. We emphasize the necessity to consider anorexia nervosa in the differential diagnosis of growth retardation in young adolescents.

Eating Disorder Symptomatology in Normal-Weight vs. Obese Individuals With Binge Eating Disorder

Although normal‐weight individuals comprise a substantial minority of the binge eating disorder (BED) population, little is known about their clinical presentation. This study sought to investigate the nature and severity of eating disturbances in normal‐weight adults with BED. We compared 281 normal‐weight (n = 86) and obese (n = 195) treatment‐seeking adults with BED (mean age = 31.0; s.d. = 10.8) on a range of current and past eating disorder symptoms using ANOVA and χ2 analyses. After controlling for age and sex, normal‐weight participants reported more frequent use of a range of healthy and unhealthy weight control behaviors compared to their obese peers, including eating fewer meals and snacks per day; exercising and skipping meals more frequently in the past month; and avoiding certain foods for weight control. They also endorsed more frequent attempts at dieting in the past year, and feeling more frequently distressed about their binge eating, at a trend level. There were no group differences in binge eating frequency in the past month, age at onset of binge eating, overvaluation of shape/weight, or likelihood of having used certain weight control behaviors (e.g., vomiting, laxative use) or having sought treatment for an eating disorder in the past. Based on our findings, normal‐weight individuals appear to be a behaviorally distinct subset of the BED population with significantly greater usage of both healthy and unhealthy weight control behaviors compared to their obese peers. These results refute the notion that distress and impairment in BED are simply a result of comorbid obesity.

Empirical identification and validation of eating disorder phenotypes in a multisite clinical sample.

Identified problems with the classification system of eating disorders (EDs), including its imperfect application to clinical samples, challenge its validity and limit its utility. The present study aimed to empirically identify and validate ED phenotypes in a multisite clinical sample using latent profile analysis (LPA). ED symptom data collected from 687 individuals were included in LPA. Identified latent profiles (LPs) were compared on clinical validators. Five LPs were identified: LP1 (n = 178), objective bingeing and multiple purging methods; LP2 (n = 172), objective bingeing without purging; LP3 (n = 130), objective bingeing and vomiting; LP4 (n = 108), low/normal weight and excessive exercise; LP5 (n = 99), low/normal weight and absence of ED symptoms. Validation analyses demonstrated the most extreme psychopathology/medical morbidity in LP1 and the least in LP5. LP1 and LP3 were most likely to report medication treatment for EDs. Identified LPs imperfectly resembled diagnostic and statistical manual of mental disorders-IV-TR EDs. Multiple purging methods and the absence of ED cognitions marked differences in severity across groups, whereas low weight did not. Clinical differences in psychopathology, medical morbidity, and treatment utilization validated groups. Future research should examine longitudinal stability of empirically-derived phenotypes and incremental validity of alternative classification schema to inform DSM-V.

Academy for eating disorders

academy for eating disorders academy for eating disorders clinical practice academy for eating disorders position paper: the role of academy for eating disorders position paper: eating neda parent toolkit national eating disorders association eating university of rochester academy of eating disorders 2013 beelo academy for eating disorders dioro the treatment of eating disorders sgh academy for eating disorders credentialing task force academy for eating disorders bebooki academy for eating disorders undermystreet 3. eating disorders leg5ate academy for eating disorders adammaloyd academy for eating disorders snowlog academy of eating disorders international conference screening for eating disorders parents’ guide to eating disorders american academy of aed report 2012 2 edition eating academy for eating aed report 2011 2 edition eating academy for eating disorders international conference on eating disorders practice parameters american academy of eating disorders awareness in the public school setting american academy of pediatrics academy for eating disorders cofp preventing obesity and eating disorders in adolescents academy for eating disorders answerz eating disorders university of maryland school of medicine eating disorders medical guide aed report 2016 eating disorders institute graduate certificate program ethical considerations when students experience an active academy for eating disorders binge eating disorder assoc from the association adolescent health what are eating disorders? eating disorders stepupprogram questions to ask when interviewing a therapist children’s education brief eating disorders by richard e. kreipe, md complementary, holistic, and integrative medicine: eating no. 02 august 2013 teenagers with eating disorders mdc subj: prevention and management of eating disorders usna eating disorders in adolescents home – sahm binge eating osumc academy for eating disorders oeges.or a f.e.a.s.t. family guide to eating disorder treatment academy of nutrition and dietetics: scope of practice for the art of binge eating disorder: assessment, risks, treatment eating disorders scott county school policy midshipmen development center united states naval academy australia & new zealand academy for eating disorders

The psychometric properties of several measures of body image

Despite the recent upsurge of interest in the construct of body image, there is relatively little information on the psychometric properties of the instruments used to measure it. This study investigated the reliability and validity of several measures of body image and compared bulimics and normals on these measures. One hundred ten normal weight females, half of whom were diagnosed as bulimic, were administered two measures of affect toward ones body, two measures of perceptions of ones entire body, and three measures of perceptions of the size of specific body sites (face, shoulders, waist, and hips). In themain, the measures provided reliable indices of body image. Examination of the correlation matrix for the measures disclosed convergence for the affective measures of body image and for all but one of the perceptual measures of body image. There was also significant covariation between the affective and the perceptual measures. The multitrait-multimethod technique was used to investigate the construct validity of the measures concerned with perceptions of the size of body sites. The multitrait-multimethod matrices disclosed substantial convergence between perceptions of face, shoulder, waist, and hip size across the three measures. However, the measure which used kinesthetic estimates of body-site size produced low reliabilities and all three of the measures showed substantial method variance. Bulimics and normals differed significantly on both the affective and the perceptual components of body image.