Tatiana Zanetti

Prevalence of Eating Disorders in Italy: A Survey on a Sample of 16-Year-Old Female Students

BACKGROUND To date, the number of epidemiological studies on eating disorders (ED) in Italy and in other Mediterranean countries is still limited. This study evaluated the eating attitudes and the prevalence of eating disorders in a sample of 359 16-year-old Italian schoolgirls. METHODS The study followed a two-stage procedure consisting in a first screening stage followed by clinical interviews. A third stage consisting in a case register study and a 1-year followup confirmed the importance of evaluating subjects who chose not to participate in the survey. RESULTS Prevalence rates found in our sample are consistent with those of other prevalence studies conducted on adolescent girls: 0% for anorexia nervosa, 0.5% for bulimia nervosa and 3.7% for ED not otherwise specified. Also some important features associated with the presence of an ED appeared to be present in Italian female students, as in Anglo-Saxon populations: the tendency towards denial that led to an overrepresentation of ED among nonrespondents, and the ascertainment that just a small proportion of people seeks help for ED. The Italian sample reported higher scores on eating attitudes test compared to Anglo-Saxon samples. CONCLUSIONS No evidence of different rates of ED was found in our Italian sample in comparison with non-Mediterranean samples. The importance of using a two-stage design and a third control stage in prevalence studies is emphasized by our findings.

A preventive intervention program in adolescent schoolgirls: a longitudinal study.

Background: To explore the impact of a prevention program on the eating and body attitudes of a sample of adolescent schoolgirls. Methods: The program involved lessons and group discussions of general adolescent problems and eating disorders. A total of 254 16-year-old schoolgirls were evaluated, of whom 154 participated in the program and a further 154 subjects formed the control group. Variations in weight, Eating Attitudes Test and Eating Disorders Inventory at a 1-year follow-up were compared for the two groups. Results: Among high-risk subjects, no significant differences were found between the prevention and the control group. The preventive program appeared to reduce significantly body dissatisfaction and to decrease the risk of bulimic attitudes in low-risk subjects. Conclusions: Providing schoolgirls with the correct information about eating disorders did not encourage unhealthy attitudes to eating and weight regulation practices. However, for high-risk subjects more intensive and specific intervention may be required, for which further research is needed.

The Relationship Between Temperament and Impulsive Behaviors in Eating Disordered Subjects

To date, few studies have examined the personality characteristics and clinical predictors of impulsive behaviors in eating disorders (ED). The aim of this work was to study the prevalence of a wide range of impulsive behaviors in a sample of 554 ED subjects and to examine the predictors of these behaviors. Subjects were diagnosed according to DSM-IV criteria as having anorexia nervosa restricting type (ANR; n = 183), anorexia nervosa binge eating/purging type (ANBP; n = 65), bulimia nervosa purging type (BNP; n = 244), and bulimia nervosa nonpurging type (BNNP; n = 62). Nine different types of impulsive behaviors were assessed in these groups. About 55% of the whole sample reported at least one type of impulsive behavior, 35% more than one, and about 13% more than three. According to findings, impulsive and multi-impulsive subjects are characterized by the presence of purging behavior and by specific temperamental features such as high levels of novelty seeking and low persistence. The prediction of impulsive behavior is further improved by considering the presence of a history of childhood abuse, maternal psychiatric morbidity, and some specific psychological symptoms such as maturity fears, perfectionism, depression, and obsessive-compulsive symptoms. The presence of impulsive behavior appears to be associated with overall higher levels of psychiatric symptomatology and eating psychopathology, thus indicating that they are an important feature to be considered in the assessment and treatment of ED.

Clinical and temperamental correlates of body image disturbance in eating disorders.

OBJECTIVE Although body image disturbance (BID) is considered a core symptom in anorexia nervosa (AN) and bulimia nervosa (BN), little is known about its psychopathological correlates. The present study aimed at analysing the correlation of aspects of BID with psychopathological and temperamental characteristics. METHOD A sample of 1288 patients (538 AN and 750 BN) were assessed through a structured diagnostic interview, the Eating Disorders Inventory and Tridimensional Personality Questionnaire. Cognition of body image distortion, weight checking, fear of weight gain and body dissatisfaction were assessed by specific questions during the interview. RESULTS Various aspects of BID formed similar, but not identical, dimensions in AN and BN. In both groups, anticipatory anxiety and interoceptive awareness were significantly and independently associated with body image distortion, whereas ineffectiveness was associated with weight checking. DISCUSSION Body image disturbance is a multidimensional characteristic linked to psychological features, such as anticipatory anxiety, ineffectiveness and interoceptive awareness. These findings have scientific and treatment implications, and should be considered by clinicians in adopting successful treatment strategies.

Prevalence of body image disturbance in a female adolescent sample: a longitudinal study.

Abstract Studies of nonclinical samples show a high frequency of body dissatisfaction and drive for thinness in female adolescents, but to date no study has evaluated the psychological characteristics and evolution of body image disturbance (BID) when it is not associated with an eating disorder. A two-stage study (with follow-up after one year) showed that, in the short term, there was no greater risk of developing an eating disorder in the BID group than in normals.

In utero exposure to virus infections and the risk of developing anorexia nervosa.

BACKGROUND The study aims to explore, using indirect ecological measures of exposure, the role of viral infections in the development of anorexia nervosa (AN). METHOD The cohort of participants consisted of all female subjects born in the Veneto region in the period between 1970 and 1984, and residing in the urban and suburban area of Padua (27,682 female subjects in an area of 424 km2). The main outcome measure was the diagnosis of AN resulting from the Public Mental Health Database, the Register of Hospital Admissions, and the Register of the Eating Disorders Unit (n=402, 1.4%). The number of cases of rubella, chickenpox, influenza and measles was ascertained for each month for the 15-year period. RESULTS Exposures during the sixth month of pregnancy to the peaks of chickenpox [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.2-2.0] and rubella infections (OR 1.5, 95% CI 1.1-2.0) were significantly associated with an increased risk of developing AN, even after controlling for socio-economic status, urbanization and month of birth. We found weak evidence of a season-of-birth bias. CONCLUSIONS In utero exposure to viral infection could be a risk factor for developing AN. We need further epidemiological and serological studies to confirm this hypothesis.

Predictors of binge eating in restrictive anorexia nervosa patients in Italy

The aim of the present study was to investigate the predictive factors for the development of binge eating in restricting anorexia nervosa patients who underwent an outpatient treatment. The sample was a group of 168 patients with restricting anorexia nervosa, consecutively admitted to an outpatient unit. All the patients underwent a routine baseline assessment. Information regarding binge eating onset and duration of treatment was prospectively recorded in clinical records. Twenty-three patients developed binge episodes during outpatient treatment. High scores on the Eating Disorders Inventory body dissatisfaction subscale and early age at menarche significantly predict the risk of developing binge eating. High levels of ineffectiveness, as measured by the Eating Disorders Inventory, and early age at menarche are significant predictors of a shortened time to develop binge eating. The identification of subjects at risk for developing binge eating should be considered an important step for a successful treatment of restricting anorexic patients.

Pregnancy in Severe Anorexia Nervosa

OBJECTIVE Anorexia nervosa among Arabian girls seems to be rare and pregnancy in condition of extreme underweight seems to be rare as well. METHOD We report the case of a 19-year-old Arabian girl living in Italy who referred to an Eating Disorder Unit for her anorexic condition. RESULTS She arrived for a consultation when she was at her 33rd week of pregnancy at a Body Mass Index lower than 14. CONCLUSION The present case aims to underline the need of medical and psychological attention to pregnancy in anorexia nervosa cases.

Childhood Obsessive–compulsive Traits in Anorexia Nervosa Patients, Their Unaffected Sisters and Healthy Controls: A Retrospective Study

Although there is evidence that childhood perfectionistic traits predate the onset of eating disorders, few studies to date have examined the prevalence and clinical correlates of these traits in patients with anorexia nervosa (AN) and their unaffected sisters. The aim of this work was to study the prevalence of childhood obsessive-compulsive traits in patients with lifetime AN, their unaffected sisters and healthy women. A total of 116 AN patients, 32 healthy sisters and 119 controls were assessed by the EATATE Interview to assess traits such as perfectionism, inflexibility, rule-bound traits, drive for order and symmetry, and excessive doubt and cautiousness. Both self-report and maternal reports were collected. AN patients reported more childhood obsessive-compulsive traits than their healthy sisters and controls. In contrast, no differences between healthy controls and unaffected sisters emerged. In patients with AN, a dose-response relationship was found between the number of childhood obsessive-compulsive traits and psychopathology, including body image distortion, thus indicating that these traits are an important feature to be considered in assessing and treating eating disorders.

Stressful Life Events and Binge Eating Disorder

Although there is evidence about the role played by stressful life events (SE) in the pathogenesis of eating disorders, few studies to date have explored this problem in binge eating disorder (BED). The aim of the present study was to examine SE preceding the onset of BED. A retrospective interview-based design was used to compare 107 patients with BED and 107 patients with bulimia nervosa (BN), matched for duration of illness. Compared with patients with BN, those with BED reported a greater number of traumatic events in the 6 months preceding onset, revealing more often three types of events: bereavement, separation from a family member and accidents. The presence of SE before onset showed a dose-response relationship with the severity of psychopathology at the time of referral for treatment. Study of SE in patients with BED may be important for better understanding of the pathogenetic pathway to this disorder and to provide adequate treatment.