Eating Disorders Among Urban and Rural African American and European American Women

Abstract

It is alleged that eating disorders are nonexistent in African American women and that eating disorder symptomatology occurs predominantly among White middle class women (Kumanyika, Wilson, & Guilford-Davenport, 1993; Smolak & Striegel-Moore, 2001). This research attempted to identify differences in eating disorder symptomatology in African American and White American women. An eating disorder is a disability because it can damage the person physically, emotionally and socially. It can be undetected for years and society may reinforce the hidden disorder by being complimentary regarding the thin appearance of the person. The Eating Disorder Inventory (EDI) was used to measure psychological traits and symptom clusters associated with the understanding and treatment of eating disorders (Garner, 1990). Measures of self-esteem, depression and coping were also examined. Findings indicated differences between African American and White women on the Ineffectiveness scale of the EDI, differences between the urban/rural women on Ineffectiveness and Perfectionism, and differences in coping strategies and education among this sample group of women. Successful treatment usually involves psychotherapy and/or medication for depression.     

Disorders of Eating in the Elderly

The most common eating disorder in the elderly in both community and hospital settings is food refusal. This may lead to weight loss and malnutrition with all the adverse consequences on independence and function. The management of disorders of eating in the elderly is a diagnostic and therapeutic challenge, requiring the combined skills of the medical and nursing staff. The causes are often multifactorial and require careful and repeated assessment of the patient's social, psychological, and medical history. Approach to treatment involves these factors, as well as ethical and cultural considerations. Eating is the most basic biological drive for survival in nature. In human societies there are additional cultural and social aspects that may override this instinct, as in the case of hunger strikes for political motives. In the elderly, food is one of the major sources of possible pleasure and it is the challenge for health providers to try and give this enjoyment to their patients for as long as possible.     

Enhanced Cognitive Behavior Therapy: A Single Treatment for All Eating Disorders

Eating disorders are serious mental illnesses affecting a significant proportion of women and a smaller number of men. Approximately half of those with an eating disorder (ED) will not meet the criteria for anorexia or bulimia nervosa, and will be diagnosed with an eating disorder not otherwise specified (EDNOS). Until recently, there were no recommended treatments for EDNOS. This article provides an overview of enhanced cognitive behavior therapy, a validated treatment for all forms of EDs.     

Assessment and Diagnosis of Eating Disorders: A Guide for Professional Counselors

Despite the prevalence of and risk associated with disordered eating, there are few guidelines for counselors on how to conduct an eating disorder assessment. Given the importance of the clinical interview, the purpose of this article is to provide recommendations for the assessment and diagnosis of eating disorders that (a) specifically focus on assessment in the context of a clinical interview and (b) can be used by counselors whether or not they specialize in eating disorder treatment.     

Eating disorders from parent to child: Mothers’ perceptions of transgenerational effect

Primary prevention focuses on the reduction of risk factors. Children of mothers with an eating disorder are a proven “at risk” group, because children internalise their experiences. Prevention in the field of eating disorders has as yet only addressed children of seven or eight upwards and only in school‐based programs which did not incorporate mothers. This project targeted mothers with an eating disorder who had children under the age of thirteen. The hypothesis is that if these mothers can be encouraged to change damaging behaviour that their children are likely to model, we can attempt to break the cycle of dysfunction. This is a qualitative and quantitive research project, carried out with standardised measures and semi‐structured interviews before and after a nineteen week therapy group, with six and twelve month follow ups. The group consisted of eight mothers. This paper describes the group and provides a case study of one participant. The initial analysis suggests that the support of a therapeutic group allowed this mother enough space for reflection. She became aware of her dysfunctional behaviour and was able to begin to understand the underlying reasons behind it. This led to an improvement in her own Eating Disorder (ED) and she was subsequently able to make change in her responses to her children's needs.     

Health-Related Quality of Life in Women with Eating Disorders: Association with Subjective and Objective Binge Eating

This study examined health-related quality of life (QOL) and its association with different forms of binge eating in 53 women with eating disorders. Participants had enrolled in treatment for anorexia nervosa, bulimia nervosa, binge eating disorder, or other eating disorders not otherwise specified and completed measures of QOL, eating-related psychopathology, and mood disturbance. Eating- and mood-related psychopathology, and to a lesser extent, mental-component QOL scores, were severely impaired in this sample relative to population norms. QOL was significantly and independently predicted by subjective bulimic episodes and compensatory behaviors, including food avoidance, laxative abuse, and self-induced vomiting, accounting for 32% of the variance. Subjective bulimic episodes and food avoidance also independently predicted the physical-component QOL, accounting for 27% of the variance. These findings suggest that subjective bulimic episodes may be independently associated with impairment in QOL and may require specific attention as targets of treatment.     

Speed of Processing Time Slowing in Eating Disorders

We applied Brinley (1965 Brinley, J. F. (1965). Cognitive sets, speed and accuracy of performance in the elderly. In A. T. Welford, &; J. E. Birren (Eds.), Behavior, aging and the nervous system (pp. 114–129). Springfield, IL: Charles C. Thomas. [Google Scholar]) plot analysis to the eating disorders field. Across 23 studies and 165 experimental conditions [experienced by a total of 773 eating disorder (ED) participants, including anorexia nervosa (AN), binge eating (BE), bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS) and 995 controls], the best-fit regression equation was Y (ED) = 1.08 X (CONTROL) – 31. This equation accounted for 98.2% of the variance. Thus, the ED subjects were only 1.08 times slower than the control subjects, suggesting little processing speed slowing in ED. We also examined simple reaction time [SRT; Y (ED) = .91 X (CONTROL) + 63; variance accounted for = 93.6%] and choice reaction time (CRT; Y (ED) = 1.12X (CONTROL) – 43, variance accounted for = 99.7%). These slopes are significantly different. ED subjects are more impacted when the task involves a decision component (CRT) than when it does not (SRT).     

A Relational Cultural Approach to Working With Clients With Eating Disorders

The authors examine eating disorders through the conceptual framework of relational cultural theory (RCT). Taking into account the importance of relationships and connection, it is suggested that RCT may be a useful lens for conceptualizing and working with people who are experiencing eating disorders. Ways that RCT can be applied to enhance prevention efforts and recommendations for combining relationally focused counseling with evidence‐based individual eating disorder treatment are presented.     

Young Women at Risk for Eating Disorders: Perceived Family Dysfunction and Parental Psychological Problems

These results of this study are consistent with theories of eating disorders that highlight the role of family factors in the etiology and maintenance of eating disorders. When 27 young women at risk for eating disorders who scored above the clinical cut-off score on the EDI-II were compared with age and SES matched controls, they were found to obtain more dysfunctional scores on the Family Assessment Device and on ratings of perceived maternal and paternal symptomatology on the SCL-90-R.     

Social Competence and Eating Disorders: Development and Validation of the Anorexia and Bulimia Problem Inventory

Incompetence at solving interpersonal problems is a possible antecedent of anorexic and bulimic behaviors in college-age women. A role-play measure of interpersonal competence, the Anorexia and Bulimia Problem Inventory (ABPI), was developed empirically and then was tested in two validation studies. ABPI scores for two samples of college women were compared: a subclinical sample [extremely high scores on the Eating Attitudes Test (EAT)] and a control sample (extremely low EAT scores). Groups differed as predicted. The second study replicated and extended these findings. The ABPI scores of clinical, subclinical, and control samples of college women differed significantly. Bulimic bingers, purgers, and laxative users were least competent on the ABPI. A lack of group differences on the Helping Situations Inventory supported the ABPI's discriminant validity. A correlation between the ABPI and Beck Depression Inventory supported the ABPI's convergent validity. ABPI competence appears to be related to certain subtypes of eating disorders.     

The Role of Cognitive Deficits in the Development of Eating Disorders

Eating disorders (ED), including anorexia and bulimia nervosa, are chronic illnesses with periods of symptom exacerbation and remission. Because symptoms are usually present from 6 to 24 months before a diagnosis is made, aetiological agents are believed to be active well before symptoms appear. It is proposed that neuropsychological deficits in various cognitive domains preexist and underlie the aetiology of ED. This paper provides a comprehensive review of the literature relevant to neuropsychological deficits in ED patients and explores the relationship between cognitive deficits, psychosocial development, and the development of ED. Although the role of neuropsychological deficits in the evolution of ED requires further research, the proposed association has significant implications for clinical practice.     

Development and validation of the Eating Disorders Screen for Athletes (EDSA): A brief screening tool for male and female athletes

ObjectivesTo develop and validate the Eating Disorders Screen for Athletes (EDSA), a brief eating disorders screening tool for use in both male and female athletes. Methods: Data from Division I athletes at a Midwestern university (N = 434) were used to conduct exploratory factor analysis (EFA) by gender. Data from athletes competing at various levels at universities across the United States (N = 862) were then used to conduct confirmatory factor analysis (CFA) and receiver operator characteristic (ROC) curve analysis by gender. Athletes from a range of lean and non-lean sports were included. Gender-specific empirically derived cut-offs on the Eating Disorder Examination-Questionnaire were used to classify high eating disorder risk for ROC curve analysis. Measurement invariance by gender, level of competition, and sport type was also examined. Results: A six-item, one-factor structure for the EDSA was supported by EFA and CFA in both genders, and internal consistency was good for both male (α = 0.80) and female athletes (α = 0.86). ROC curve analyses indicated that the EDSA was highly accurate in predicting eating disorder risk status and identified a score of 3.33 as the optimal cut-off for both male (sensitivity = 0.96, specificity = .80) and female athletes (sensitivity = 0.96, specificity = .64). Results also supported strong measurement invariance for the EDSA by gender, level of competition (Division I versus club), and sport type (lean versus non-lean). Conclusions: The EDSA shows promise as a brief screening tool to identify male and female athletes at risk for eating disorders.     

Reliability and validity of the Norwegian translation of the Child Eating Disorder Examination (ChEDE)

Frampton, I., Wisting, L., Øverås, M., Midtsund, M. & Lask, B. (2011). Reliability and validity of the Norwegian translation of the Child Eating Disorder Examination (ChEDE). Scandinavian Journal of Psychology 52, 196–199. The Child Eating Disorder Examination (ChEDE) is a valid and reliable semi‐structured interview, which measures eating‐disorder specific psychopathology in children and young adolescents. The instrument is an adaptation of version 12.0D of the original Eating Disorder Examination (EDE 12.0) for adults. The Norwegian translation of the ChEDE is currently the only instrument for assessing eating disorder psychopathology in Norwegian children and adolescents. This study aimed to investigate the psychometric properties of the Norwegian translation of the ChEDE 12.0. The Norwegian version of ChEDE 12.0 was administered to 15 Norwegian children with anorexia nervosa (AN), 15 children with diabetes mellitus type 1 (DM) and two groups of 15 age‐matched controls. The groups were compared using a matched pairs design. The results showed that the subscale scores of the AN group were significantly higher than those of the other groups, and the DM comparison group did not differ from its control group. The current AN group scored significantly higher on the Shape Concern subscale than the previous UK sample, with implications for construct validity or cross‐cultural effects worthy of further study. Inter‐rater reliability was generally high (r = 0.91 to 1.00), although there were significant differences between raters on specific items for individual participants. Alpha coefficients for each of the ChEDE subscales indicated a high degree of internal consistency. It was concluded that the Norwegian version of the ChEDE 12 has adequate psychometric properties and can be recommended for clinical and research use with young people with eating disorders in Norway.     

Changes in Television and Magazine Exposure and Eating Disorder Symptomatology

The relationship between girls' media exposure and their development of eating disorder symptomatology was assessed. At Time 1 and Time 2 (16 months later), participants (N = 374; M age = 12.0) completed a questionnaire that assessed eating disorder sympto-matology and television and fashion magazine exposure. Girls were divided into 3 groups: increased, decreased, or no change in eating disorder symptomatology between Times 1 and 2. Girls with increased symptomatology had significantly increased their exposure to fashion magazines but decreased their number of hours of television viewing. Girls with decreased symptomatology had significantly decreased their exposure to both television and fashion magazines.     

A measure for the assessment of eating disorders: reliability and validity studies of the Rating of Anorexia and Bulimia interview - revised version (RAB-R)

The Rating of Anorexia and Bulimia interview (RAB) is a Swedish semi-structured interview for clinical and research purposes for a wide range of eating disorder symptoms and related psychopathology. The objectives were to evaluate the reliability and validity of a revised RAB version (RAB-R). The RAB-R was assessed in terms of internal consistency, inter-rater and test-retest reliability, and criterion and convergent validity. Samples included a clinical sample of eating disorder patients (n = 71) and a sample of randomly drawn female controls (n = 31). The RAB-R showed satisfactory internal consistency, inter-rater and test-retest reliability, correlated well with related measures, and discriminated between patients and normal controls. We conclude that the RAB-R is a promising interview instrument and continued evaluation should focus on comparing subgroups of eating disorder patients with other clinical groups.     

Assessment of Problematic Situations and Coping Strategies in Women with Eating Disorders: Initial Validation of a Situation-Specific Problem Inventory

The current study examined the psychometric properties of the Anorexia and Bulimia Problem Inventory (ABPI; Eason, 1983) in women with and without diagnosed eating disorders. The ABPI was initially constructed in accordance with the Behavior-Analytic model of instrument development (Goldfried & D'Zurilla, 1969). In this investigation, the ABPI was refined to consist of 38 audiotaped problematic situations, including those related to eating and weight, academic, family, and interpersonal relationship issues, and scoring criteria to rate the effectiveness of responses. Convergent and discriminant validity were established between ABPI-R scores and the Eating Disorder Inventory (EDI; Garner, Olmsted, & Polivy, 1983) scales. As evidence of disciminative validity women with eating disorders received less ratings indicating less effective problem-solving on the ABPI-R scales than women without eating disorders. A significant increase in effective coping as measured by the ABPI-R was found for women following an 8-week outpatient eating disorders treatment program. Potential uses of this measure in research and clinical practice are discussed.     

Experiences of Patients in Cognitive Behavioural Group Therapy: A Qualitative Study of Eating Disorders

The aim of this study was to investigate whether there was a difference in skin conductance response between 2 groups of military personnel when exposed to emotionally neutral and charged stimuli. The 2 groups were a combat experience group (n?=?10) with prior experience of emotionally charged war situations and a comparison group (n?=?10) with no such experience. Results showed that the comparison group reacted more strongly to exposure to both charged and neutral pictures than did the combat experience group, regardless of exposure time. The results are discussed in terms of emotional numbing and differences in anxiety state between the 2 groups.     

Molecular Genetic Studies of Eating Disorders: Current Status and Future Directions

ABSTRACT— We review association studies that have examined the genetic basis of eating disorders. Overall, findings suggest that serotonin, brain-derived neurotrophic factor, and estrogen genes may be important for the development of the disorders. These neuronal systems influence behavioral and personality characteristics (e.g., anxiety, food intake) that are disrupted in eating disorders. Future studies would benefit from larger sample sizes and inclusion of behavioral and personality covariates in analyses. Consideration of the mechanisms of genetic effects and interactions between genes and environment is also needed to extend conceptualizations of the genetic basis of these disorders.     

Validation and predictive utility of the Sociocultural Attitudes Toward Appearance Questionnaire for Eating Disorders (SATAQ-ED): internalization of sociocultural ideals predicts weight gain

A widely used measure of societal influences on body image and eating disturbances—the Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ) was validated in women with eating disorders. The original SATAQ and measures of convergence and divergence were administered to 165 eating disordered inpatients. Factor analyses were conducted to determine the underlying structure of the SATAQ. Convergent validity, diagnostic category norms and the predictive utility of the revised SATAQ were examined. Factor analyses indicated three factors: Internalization, Awareness, and Success. Internalization significantly predicted treatment success after controlling for admission BMI and drive for thinness. The revised SATAQ-ED measures multiple aspects of societal influence, predicts short-term outcome, and can be a useful tool for evaluating potential outcome and treatment efficacy.