Yael Latzer

Proposed Diagnostic Criteria for Night Eating Syndrome

OBJECTIVE To propose criteria for diagnosis of the night eating syndrome (NES). METHOD An international research meeting was held in April 2008, and consensus criteria for NES diagnosis were determined. RESULTS The core criterion is an abnormally increased food intake in the evening and nighttime, manifested by (1) consumption of at least 25% of intake after the evening meal, and/or (2) nocturnal awakenings with ingestions at least twice per week. Awareness of the eating episodes is required, as is distress or impairment in functioning. Three of five modifiers must also be endorsed. These criteria must be met for a minimum duration of 3 months. DISCUSSION These criteria help standardize the definition of NES. Additional aspects of the nosology of NES yet to be fully elaborated include its relationship to other eating and sleep disorders. Assessment and analytic tools are needed to assess these new criteria more accurately.

Association study of cannabinoid receptor gene (CNR1) alleles and anorexia nervosa: Differences between restricting and bingeing/purging subtypes

Anorexia nervosa (AN) is a severe and disabling psychiatric disorder, characterized by profound weight loss and body image disturbance. Family and twin studies indicate a significant genetic contribution to this disorder although no genetic mutation has yet been identified. The endocannabinoid system has recently been implicated in many physiological functions including appetite regulation. We, therefore, undertook a family based study to test the hypothesis whether a polymorphism of the CNR1 gene, which encodes human CB1 receptor, a subclass of the central cannabinoid receptor, contributes to the susceptibility to AN. Fifty two families (parents with one or two affected siblings) were genotyped for the (AAT) trinucleotide repeat of CNR1 gene. Using the haplotype relative risk (HRR) method, the distribution of alleles transmitted to the patients was not found to be significantly different from the non‐transmitted parental alleles. However, upon dividing the samples to restricting and bingeing/purging subtypes of AN, the extended transmission disequilibrium test (ETDT) revealed that there is preferential transmission of different alleles in each of the subtypes. The 14 repeat allele was preferentially transmitted in the bingeing/purging AN group (P = 0.05) but not in the restricting AN group, whereas the 13 repeat allele was preferentially transmitted in the restricting AN group (almost significant, P = 0.07) but not in the bingeing/purging AN group. Our study suggests that restricting AN and bingeing/purging AN may be associated with different alleles of the CNR1 gene.

Attachment Style and Family Functioning as Discriminating Factors in Eating Disorders

This study sought to examine the extent to which family environment and attachment styles are concurrently related to eating disorders. The Adult Attachment Scale and the Family Environment Scale were administered to 25 anorexic and 33 bulimic female patients at intake in an eating disorder clinic, and 37 age-matched female controls. Eating disorder patients were found to be less secure, more avoidant, and more anxious than controls. The families of eating disorder patients were found to be less cohesive, expressive, and encouraging of personal growth than were controls. Low encouragement of personal growth and uncertain attachment styles may be manifestations of family difficulties in supporting the child during the process of separation individuation, and exploration of the outside world.

Anorexia nervosa and parental bonding: the contribution of parent-grandparent relationships to eating disorder psychopathology.

The present study adopted an intergenerational approach in examining the association between parental bonding and anorexia nervosa. Forty-three anorexic participants and 33 nonclinical comparison participants completed eating disorder questionnaires and the Parental Bonding Instrument (PBI). The participants parents also completed the PBI. The anorexic participants perceived both parents as less caring and fathers as more controlling than nonclinical participants. Among anorexic participants, mother control and father care were associated with symptom severity. Intergenerational effects were present. Among anorexic participants, maternal grandmother care was associated with eating disorder psychopathology. The present findings suggest that parental characteristics of grandparents might play a role in the development of eating disorders in granddaughters.

Managing Childhood Overweight: Behavior, Family, Pharmacology, and Bariatric Surgery Interventions

IntroductIon A dramatic rise in overweight has been recently shown to occur among male and female adolescents in many countries, reaching epidemic proportions in Western industrialized countries (1). This increase in childhood obesity places a significant burden on physical, psychological, and social health and calls for an urgent implementation of diverse treatment strategies. It is currently accepted, and probably even required, for professionals to relate to childhood overweight, which signifies a physiological construct, rather than to childhood obesity, which bears considerable derogatory connotation (1). Accordingly, the US Centers for Disease Control and Prevention defines overweight among individuals 2–19 years old as the 95th percentile or greater of BMI-for-age (BMI = weight/height2), and risk for overweight as the 85th to 95th percentile of BMI-for-age (2). In this review we will use the term overweight, unless the use of obesity is required. Treating overweight children is of extreme importance, not only because it affects their physical and psychological well-being and development, but because a considerable proportion of overweight children are at risk to become obese adults (3). Thus, although the indications for medical interventions in overweight children are still not well defined, it is suggested, in accordance with this risk-related definition, that treatment is required in almost all overweight children, and in at risk for overweight children with related medical complications (1). All the authors of the present review article took part in an international multiprofessional consensus meeting dedicated to the issue of pediatric obesity held at the Dead Sea in Israel, in March 2004. The result of this meeting was a comprehensive consensus document where the evidence was summarized, and recommendations developed (1). The present review incorporates the findings of this consensus meeting with respect to currently available treatment options in pediatric obesity with an updated comprehensive systematic literature search of the Cochrane, PUBMED, PSYCHLIT, PSYCHINFO, and ERIC databases. Originally, we aimed to carry out a literature search for the decade before the consensus meeting (1994–2003), but subsequently added comprehensive updated information, including data published between 2004 and 2007. This time period has envisioned the most dramatic increase in the rates of pediatric obesity ever to occur (1). This suggests the presence of a very different treatment environment than before (3), calling for a critical appraisal of currently adequate treatments, promotion of new strategies, and enhancing the conditions for improving treatment outcome. The review is based on a total of 80 articles published between the years 1994 and 2007. The following interventions will be discussed: dieting and nondieting weight reduction programs (15 articles), change in lifestyle (18 articles), behavioral treatment (12 articles), family interventions (18 articles), pharmacotherapy (18 articles), surgical interventions (9 articles), and multidisciplinary in-patient interventions (7 articles) (quite a few articles relate to more than one treatment strategy). The study relates mostly to the findings of randomized control trials (RCTs), or controlled trials, unless otherwise specified.

A review of the psychological and familial perspectives of childhood obesity

Childhood obesity is on the rise in both industrialized and developing countries. The investigation of the psychosocial aspects of childhood obesity has been the focus of long- standing theoretical and empirical endeavor. Overweight in children and adolescents is associated with a host of psychological and social problems such as reduced school and social performance, less favorable quality of life, societal victimization and peer teasing, lower self-and body-esteem, and neuropsychological dysfunctioning. Whereas community samples of obese youngsters usually do not show elevated psychopathology, clinically-referred overweight children show elevated depression, anxiety, behavior problems, attention deficit hyperactivity disorder and disordered eating. Parents’ perceptions of their child’s overweight highly influence the well-being of obese children and the way in which they perceive themselves.The present review paper aims to broaden the scope of knowledge of clinicians about several important psychosocial and familial dimensions of childhood obesity: the psychosocial functioning, self and body esteem and psychopathology of overweight youngsters, the influence of children’s perceptions of overweight, including those of the obese children themselves on their well being, and the influence of parental attitudes about weight and eating on the psychological condition of the obese child.

Naturalistic sleep monitoring in women suffering from bulimia nervosa

OBJECTIVE Eating disorders may be associated with alterations in sleep. There is evidence that some bulimia nervosa (BN) patients have sleep abnormalities. No studies of their sleep-wake cycles in a natural environment have as yet been reported. The purpose of this study was to evaluate an objective and subjective sleep-wake cycle of BN compared to a healthy age-equated control group (CON). METHOD Twenty-nine BN female and eighteen CON subjects were recruited. Sleep-wake patterns were monitored using ambulatory monitoring, mini-actigraphs (Min-Act), for 1 week. Each subject completed self-report questionnaires. RESULTS The self-reporting questionnaires revealed that BN complained of significantly more sleep disturbances than CON. The ambulatory sleep data revealed significant differences between BN and CON in sleep onset and offset time. DISCUSSION BN had sleep onset and sleep offset of 1 hr later, which may be connected to binge-purge patterns during the day. It is suggested that future research should focus on BN after remission.

Perception of emotion and bilateral advantage in women with eating disorders, their healthy sisters, and nonrelated healthy controls

BACKGROUND Eating disorders (EDs) are characterized not only by disordered eating, but also by other psychopathology. In this exploratory study, we examined the ability of women with different diagnoses of EDs, their unaffected sisters, and healthy unrelated controls to recognize their own and others emotions. We also looked at interhemispheric integration of emotion recognition and its relationship with depression. METHOD Five groups of women participated: 1. anorexia nervosa restricting (AN-R) and 2. (AN-B/B) binge/purge, 3. bulimia nervosa binge/purge, (BN-B/P), 4. healthy sisters of women with ED, and 5. unrelated healthy controls. We used two questionnaires measuring alexithymia and depression, and two lateralized experimental tasks requiring recognition of facial emotion. Unilateral versus bilateral presentation allow the indexing of interhemispheric integration. RESULTS Alexithymia: All the ED groups were found to be more alexithymic and depressed on the self report scales compared to the two healthy groups. Depression completely mediated alexithymia in the AN-R group but not in the AN-B/P and BN-B/P patients. Sisters of ED women were more alexithymic than unrelated controls. Lateralized facial emotion recognition: ED women showed no deficits in recognizing basic emotions. However, the clinical groups did not show a bilateral advantage whereas the two healthy groups did so. CONCLUSIONS We present three conclusions: we show, for the first time, evidence for a deficit in hemispheric integration in EDs. This implies that EDs may be a disconnection syndrome; alexithymia characterizes women with EDs and members of their family; depression is manifested differently in AN-R, than in women who binge/purge.

Pathological Conflict Avoidance in Anorexia Nervosa: Family Perspectives

Conflict avoidance is a common pattern in families of patients with anorexia nervosa (AN), but little systematic controlled research has been conducted to elucidate the formal mechanics of such interaction. Forty family triads with daughters suffering from AN were compared to 40 matched control (CON) triads, on five measures of conflictual family situations. Results revealed that the AN group had significantly more difficulty in choosing the topic of discussion, adhering to the topic, developing and exploring the chosen topic, and reaching a solution—all within a family setting. Findings empirically support previous clinical and research evidence on the pathological avoidance of conflict in families with a member who has AN. Therapeutic implications are discussed.

Level of religiosity and disordered eating psychopathology among modern-orthodox Jewish adolescent girls in Israel.

OBJECTIVE To examine the relation between level of religiosity, grade level, self-esteem, and level of disordered eating-related psychopathology among Modem Orthodox Jewish adolescent girls in Israel. METHOD The sample consisted of 320 Jewish religious adolescent schoolgirls in the 9th to 12th grades of middle and high schools. The girls completed the Eating Disorder Inventory-2 (EDI-2) and the religious questionnaire based on Guttmans instrument. RESULTS The more religious the student, the less eating-related psychopathology was found. The youngest students (grade 9) were found to be the least religious and to have the highest eating-related psychopathology. DISCUSSION The results are discussed in terms of the possibility that level of religiosity might to some extent protect adolescent girls against developing body dissatisfaction and disordered eating pathology. A high level of religiosity is associated with less emphasis on the physical attractiveness of women and less pressure for their success and achievement outside the home.