Richard J. Freeman

A naturalistic investigation of eating behavior in bulimia nervosa

Simon Fraser University Department of Psychiatry, University of Toronto, and Burnaby, British Columbia, Canada Toronto General Hospital, Ontario, Canada This study investigated the parameters of eating behavior in subjects meeting the diagnosis of bu- limia nervosa (BN). Twenty BN and 24 female comparison (FC) subjects monitored hourly over a number of consecutive days their food intake, mood, hunger, social circumstances, and experiences of unpleasant events. Compared with FC subjects, BN subjects reported more positive moods rela- tive to their typical moods in the hour prior to consuming a meal. Within the BN group, subjects reported more negative moods in the hour prior to a binge episode compared with their moods prior to consuming a snack or meal. The BN subjects were also calorie deprived in the hour prior to a binge episode relative to FC subjects at an equivalent time of the day. These results are discussed within the framework of restraint theory. Bulimia nervosa (BN) is a psychogenic disturbance in eating behavior characterized by episodes of uncontrolled overeating, termed

THE PREDICTION OF RELAPSE IN BULIMIA NERVOSA

Thirty-nine women successfully treated for bulimia nervosa were followed up six months after the conclusion of treatment and classified as maintaining recovery or partially or completely relapsed. Clinical and psychometric variables including body image disturbance and dissatisfaction were entered into regression equations to identify predictors of relapse. Dissatisfaction with body image at the end of treatment was the most potent predictor of relapse. The finding is interpreted as underscoring the importance of addressing issues of body image in therapy if treatment gains are to be maintained.

A modified video camera for measuring body image distortion: technical description and reliability.

Previously employed techniques for the measurement of body image are briefly described, with a short consideration of methodological or procedural limitations associated with each technique. A new procedure is described which employs a simple modification to a standard video camera to produce an image which appears from 20% thinner to 40% fatter than the actual person, without other distortion of the image. Reliability and preliminary validity data for the new procedure are presented.

The prediction of relapse in bulimia nervosa

Thirty-nine women successfully treated for bulimia nervosa were followed up six months after the conclusion of treatment and classified as maintaining recovery or partially or completely relapsed. Clinical and psychometric variables including body image disturbance and dissatisfaction were entered into regression equations to identify predictors of relapse. Dissatisfaction with body image at the end of treatment was the most potent predictor of relapse. The finding is interpreted as underscoring the importance of addressing issues of body image in therapy if treatment gains are to be maintained.

A comparative psychometric study of anorexia nervosa and obsessive neurosis.

Similarities between anorexia nervosa and obsessive-compulsive disorder have been described by a number of authors but few empirical investigations have been reported. In the current study, 15 female anorexics were compared with 14 age-matched female obsessives on a variety of psychometric tests, psychiatrists ratings and self-rating scales. Obsessives and anorexics obtained similarly high obsessive symptom and trait scores on the Leyton Obsessional Inventory (LOI). Both groups were rated by the psychiatrist as similarly obsessive, and there were no significant group differences in self-ratings of obsessive symptoms. Both groups were characterized by high levels of neuroticism and anxiety and low levels of extraversion. In the anorexic group the 6 abstainers had higher resistance scores on the LOI and higher extraversion scores on the MPI than the 9 bulimics. Findings are discussed with reference to the “sorcerers apprentice” syndrome which appears to characterize both the obsessive and the anorexic.

Mood and food: An analysis of bulimic episodes

The present study examined those factors which differentially lead to normal eating and binge eating. Twenty-one bulimic subjects and comparison subjects monitored their mood, hunger, and food intake hourly over a number of days. The bulimic sample ate fewer meals and had lower overall mood. Positive mood, food abstinence combined with intensified hunger, and being in the company of another person preceded normal eating (i.e. retained meal). Negative mood, recent consumption of food, and being alone preceded bulimic episodes.

The Body Esteem Scale: construct validity of the female subscales.

The female subscales of the Body Esteem Scale (BES) have demonstrated convergent and discriminant validity in two previous studies. However, relationships between BES dimensions, weight, and other body-image measures have not been adequately examined. In this study, 200 women with a mean age of 27.6 years completed the BES, the Eating Disorder Inventory, the Self-Consciousness Scale, the Tennessee Self-Concept Scale, a figure rating task, a phototechnical body-size estimation procedure, and items concerning weight satisfaction and attractiveness. BES Weight Concern was most closely related to weight variables and other body image measures where BES Sexual Attractiveness and Physical Condition were more strongly associated with less specific self-perceptions and attitudes. Results support the construct validity of the BES female subscales and their utility for research in populations at increased risk for body-image or eating-disorder disturbances.

Mental Disorder and the Criminal Justice System: A Review

In addressing the United States Congress, the late British Prime Minister Winston Churchill noted that the American and British nations were “two people divided by a common language.” The same might be said about the mental health and legal systems. By virtue of the use of similar language and a failure to note differences in the meaning of words such as “sane” and “mentally ill” when used by legal and health professionals, neither justice nor mental health is well-served. In this paper, we will suggest that the problems of mentally ill offenders arise in part from that groups’ unique position at the intersection of the mental health and legal systems, and that differences in the meaning of the term mental illness as used by the two systems have led to the growth of a largely unstudied population who fall at the semantic dysjunction of the two frameworks. These individuals, who may suffer from significant mental disorders, are not among those whom we shall call the judicially ill, that is, those found unfit to stand trial, or not guilty by reason of insanity, or guilty but insane. To the legal system, the fit and sane convicted are therefore simply criminals. By virtue of their mental disorder, however, they constitute a needy minority within the population of the criminally incarcerated. We will suggest that because of their particular legal and psychological characteristics, their needs are ill-served and their rights may be abrogated. In order to elucidate our thesis, we shall consider some of the issues that arise as the mentally disordered move from the community through arrest, trial and incarceration, and back to the community. As we shall see, this process often proves to be but one revolution in a cycle of many repetitions. Some parts of the process have been well-studied, others are only now emerging as areas of interest for scholars and social policy commentators. As many of these issues are thoroughly addressed in the succeeding contributions to this journal, we shall address them only briefly. Others not covered elsewhere will be discussed in more detail.

In the eye of the beholder: Processing body shape information in anorexic and bulimic patients

Previous body image studies have suggested that dieting-disordered patients (anorexia and bulimia nervosa) differ from normal subjects in their estimation of body size and desired body shape. It was hypothesized that overconcern with body shape in these patients would be reflected in their visual analyses of specific parts of their bodies. This hypothesis was investigated using a system that combines an infrared light source, video camera, dedicated microprocessor, and computer to monitor eye-gaze direction at 50 times per second. Fifteen dieting-disordered patients and 10 control subjects were examined in this way while simultaneously being shown a picture of themselves on a TV screen. Preliminary results suggest that the patients tend to focus on those parts of their body with which they are dissatisfied, while normal subjects scan their whole body shape. Objective assessment of areas of specific bodily concern among dieting-disordered patients, as well as the examination of voluntary and involuntary processing of self-referential stimuli, is offered by the use of such technology.

The comparative psychopathology of anorexia nervosa: Obsessive-compulsive disorder or phobia?

The current study investigates the similarities and differences between anorexic restricters, anorexic bulimics, female obsessives, agoraphobics, social phobics, and specific phobics. Measures of psychopathology were self-ratings of adjustment, the IPAT, FSS, MPI, and LOI. Results indicated that persons suffering from anorexia nervosa and bulimia nervosa were more similar to obsessives than to phobics with respect to obsessional personality traits and neuroticism. Additional research is needed in the examination of the central preoccupation in order to understand the differentiation of the various disorders and to what extent anorexia nervosa is a nosological entity.