Female Adolescents with Eating Disorders,Parental Psychopathological Risk and Family Functioning

Epidemiological studies on adolescents with eating disorders demonstrate a high prevalence of disordered eating behaviors, with a higher prevalence of eating disorders among girls. Several studies have recently demonstrated an association between female adolescents’ eating disorders, parental psychopathological risk, and an impaired family functioning with poor quality of the relationships among family members. On the basis of these premises, we conducted a cross-sectional study initially recruiting 243 families of female adolescents affected by anorexia nervosa (Group A), bulimia nervosa (Group B), and binge eating disorder (Group C) (average age 14–17) to assess their psychological profile (SCL90-R), specific representations of their family functioning (FACES-IV), and the possible effect of adolescents’ psychological profiles and parents’ psychopathological risk on family functioning. Our results indicate that adolescents and parents in Groups A, B, and C show an unequivocal psychopathological profile; in particular, adolescents with anorexia present the most severe psychopathological risk. Further, our results show that adolescents and their parents differ in their perception of their family functioning. More specifically, adolescents with anorexia perceive their family as highly disengaged, poorly interwoven, and rigid, in addition cohesion and communication qualities are perceived as low. Interestingly, parental psychopathological risk predicts adolescents’ specific perception of their family functioning. These findings may guide clinical interventions as they suggest that distinct maternal psychopathological symptoms can be associated with a variety of clinical configurations in their offspring, whereas paternal psychopathological risk may be present in adolescents suffering from all forms of eating disorders.     

MMPI-A in the inpatient assessment of adolescents with eating disorders.

The MMPI-A (Butcher et al., 1992), like the older MMPI (Hathaway & McKinley, 1983), distinguishes between anorexia and bulimia. In this study, 245 adolescent girls diagnosed with anorexia, bulimia, or eating disorder not otherwise specified completed the MMPI-A. Multivariate analyses revealed significant differences between anorexia and bulimia on the MMPI-A's validity, clinical, content, and supplementary scales, particularly suggesting multiple impulse control problems among bulimic patients. However, profiles were also more homogeneous across eating disorder groups than in studies using the older MMPI, with high points involving some combination of Scales 1, 2, 3, and 0 for two thirds of the patients in this study. Implications are considered for understanding the common and differential psychopathology of eating disorders.     

Chapter 3: Beyond the Symptoms: Generalizations and Distinctions between Eating Disorders with Different Symptom Manifestations in Psychoanalysis

ABSTRACT

In this article, I attempt to describe in detail the eating disorders of anorexia and bulimia. Although often lumped together as the same kind of eating-disordered pathology, I explore, in part by using my personal experience, how their origins and symptoms are different and why their psychoanalytic treatment modalities need to be responsive to these differences.     

Protecting Women from the Negative Effects of Body Dissatisfaction: The Role of Differentiation of Self

ABSTRACT

Body dissatisfaction is a prevalent and concerning issue among college age women. Due to its strong association with eating pathology, identification of moderating variables is a crucial line of inquiry. The present study investigated the ability for an intrapersonal differentiation-of-self variable (“I” position) to attenuate the impact of body dissatisfaction on anorexia and bulimia symptoms among college women participants. Study findings indicated that an “I” position moderated the body dissatisfaction-bulimia relationship and the body dissatisfaction-anorexia relationship. These findings signified the protective influence of a high “I” position for women with high levels of body dissatisfaction. Research and therapeutic implications are discussed.     

Les troubles des comportements alimentaires chez des étudiants de première année : une étude prospective multigroupes

There is increasing use of the phrase “campus eating symptoms” to describe regular binge eating (together with frequent exercise, and occasional reliance on vomiting or laxatives), concerns about body image, depressive symptoms, stress, and university adjustment problems among students. Incidence of eating disorders in the early grades of university is increasing, and the period from age 17–19 years (peak of bulimia) which corresponds to the beginning of study at university is critical. Given the stressful environment that is the 1st academic year, it is useful to consider eating disorders risk factors.

Method

Our study is longitudinal. At the beginning, the participants consisted of 1110 freshmen. Data regarding adjustment to university, gender, body image, BMI, transactional variables (perceived stress and coping) and eating disorders (EAT-26) were collected. At T2 (end of academic year), 556 students were recruited to reassess their eating behaviours. The aim of the study was to test gender invariance of a theoretical eating disorders model including all these variables and eating disorders measured a year apart from a mixed population integrating the university for the first times. This model assumes that these variables exert direct effects on eating disorders as measured in time one who in turn will affect the stability of these troubles a year later. Although very little research include boys in the study of eating disorders, the results of our multi-group analysis support the idea of the existence of sex differences in eating disorder predictors: the only common predictor of eating disorders among girls and boys was the use emotion-focused coping. Among boys, the best predictors of eating disorders were problem-focused coping, and seeking social support. Among girls, our results revealed that body mass index, body image, and academic adjustment and stress were the predictors of eating disorders. Finally, we found a temporal stability of eating disorders. This study showed that personal and contextual aspects have a direct impact on students’ eating behaviour. However, among boys, neither body image nor perceived stress affect the eating behaviour but how they cope with stress. The gender gap in the explanation of eating disorders suggest to not exclude the male population in this type of study and to treat the data separately.     

体像困扰与社会文化因素

数据显示大多数人对自己的体像不满意,而对体像的不满意可能形成困扰。存在体像困扰的个体更多体验抑郁、焦虑等负面情绪,且体像困扰和进食障碍、体像障碍等精神疾病均存在密切的关系。在介绍概念的同时,本文还对体像困扰相关社会文化因素的影响进行了综述。已有研究表明女性较男性更容易受到体像困扰的影响;体像困扰存在跨文化的一致性,也存在文化差异;家庭、同伴和媒体对于体像困扰均有影响。     

LOVING THEM TO DEATH: THE ANOREXIC AND HER OBJECTS

The author suggests that eating disorders function to reinforce phantasies of control of the internal parents, a feature of Klein's view of the manic defence. Using this hypothesis, she attempts to differentiate between anorexia and bulimia. It is argued that in anorexia objects are felt to be permanently in thrall, suspended or frozen, whereas in bulimia they are attacked in a frenzied and intermittent way. Using case material from three seriously ill patients, the author draws attention to some important differences between them. Two of the patients were treated in psychoanalysis, while the third was seen for an extended consultation and once-weekly treatment thereafter. It is suggested that the nature and degree of the murderous attack on the internal couple may determine the severity of the illness as well as the patient's capacity to benefit from treatment. The conclusions drawn are discussed in relation to some contemporary views on eating disorders as well as writings on the difficulties of working through the Oedipus complex more generally. The author suggests that eating disorders may represent a special case of oedipal illusions.     

Relation of early menarche to depression, eating disorders, substance abuse, and comorbid psychopathology among adolescent girls

This prospective study tested whether early menarche partially accounts for the increases in depression, eating pathology, substance abuse, and comorbid psychopathology that occur among adolescent girls, with structured interview data from a community sample (N = 496). Early menarche (prior to 11.6 years) was associated with elevated depression, substance abuse, and "any" disorder but did not confer increased risk for anorexia nervosa, bulimia nervosa, or binge eating disorder. Although there was significant comorbidity across all three classes of pathology, early menarche was associated only with comorbid depression and substance abuse. Results provide partial support for the assertion that early menarche is a general risk factor for psychopathology among adolescent girls but suggest that this risk may not apply to certain disorders and that the effects are modest in size.     

Values for gender roles and relations among high school and non‐high school adolescents in a Maya community in Chiapas,Mexico

In the current study, I describe values for gender roles and cross‐sex relations among adolescents growing up in a southern Mexican Maya community in which high school was introduced in 1999. A total of 80 adolescent girls and boys, half of whom were attending the new high school, provided their opinions on two ethnographically derived vignettes that depicted changes in gender roles and relations occurring in their community. Systematic coding revealed that adolescents not enrolled in high school tended to prioritise ascribed and complementary gender roles and emphasise the importance of family mediation in cross‐sex relations. Adolescents who were enrolled in high school tended to prioritise equivalent and chosen gender roles, and emphasised personal responsibility and personal fulfillment in cross‐sex relations. Perceptions of risks and opportunities differed by gender: girls favourably evaluated the expansion of adult female role options, but saw risks in personal negotiations of cross‐sex relations; boys emphasised the loss of the female homemaker role, but favourably evaluated new opportunities for intimacy in cross‐sex relations.     

Exploring experience of family relations by patients with anorexia nervosa and bulimia nervosa using a projective family test

Elements of family dynamics have been shown to be related to onset, course, as well as prognosis of anorexia nervosa and bulimia nervosa. The goal was to explore the experience of family relations in a group of patients with eating disorders using a projective family test. The Patient group (anorexia=21, bulimia=16), as well as a healthy Control group, were given a projective family test, the Eating Disorder Inventory-2, as well as Karolinska Scales of Personality. The Patient group expressed more discord within the family picture than the Control group, such as cold and loveless relationships and not feeling validated. The group of patients reporting the most family discord did not show more eating disorder pathology or general psychopathology. They did, however, have higher scores on the Eating Disorder Inventory-2 subscale Maturity Fears, as well as higher values on the Karolinska Scales of Personality subscale Socialization. These results are interpreted within the background of methodological challenges in this area of research.     

Eating patterns and disorders in a college population: Are college women's eating problems a new phenomenon?

This paper examines the relationship between gender differences in eating patterns among college students and the disorders as clinically defined. A considerable number of college women but few men in our sample show behavioral patterns associated with an eating disorder (anorexia or bulimia). Our findings for women are in the moderate to high range for these symptoms, compared with other university populations. Results indicate that the eating difficulties of college women may be an eating problem, which only partially resembles clinical eating disorders. Although our female college sample displays the behavioral symptoms associated with anorexia and bulimia, they exhibit few of the constellation of psychological traits associated with these disorders. Some evidence suggests that the etiology of eating problems may be partly related to women wanting to be thinner than is medically desirable and may represent a response of normal women to the new, more demanding cultural and supercultural standards for thinness. Diagnosis and treatment issues as well as sociocultural implications of these results are discussed.The author wishes to thank Alan Clayton-Matthews, Larry Zaborski, John Downey, Larry Ludlow, the Editor, and an anonymous reviewer for their helpful comments. This research was supported, in part, from a grant from the Office of Research Administration, Boston College.     

School counselors' knowledge of eating disorders

The purpose of this study was to examine school counselors' knowledge of adolescent eating disorders, specifically anorexia and bulimia nervosa. Participants were drawn from the national membership of the American Association of School Counselors; they were requested to complete a 43-item questionnaire on eating disorders. Of the 500 participants randomly selected, 337 (67%) returned usable questionnaires. There were 220 female and 117 male counselors; the mean age was 45.2 years. The majority held a master's degree and counseled high school students; the mean number of years they had been school counselors was 12.2. When asked how competent they were in helping students with eating disorders, 11% rated themselves as very competent, 49% believed they were moderately competent, and 40% believed they were not very competent. The majority (75%) did not believe it was their role to treat students with eating disorders; they were instead referred to an eating disorders program (40%), their parents (34%), or a psychiatrist or other physician (34%). The majority of counselors (72%) had encountered anorexic or bulimic students; the most common method of discovering students with a problem was by being informed by fellow students (35%). The majority of respondents were very knowledgeable regarding the signs and symptoms of anorexia and bulimia nervosa. Examination of their general knowledge of eating disorders revealed that they knew more about anorexia than bulimia. The two sources of eating disorders information utilized by at least half of the respondents were professional journals (70%) and workshops/professional conferences (56%).     

Body images of patients with anorexia nervosa, bulimia nervosa and female control subjects: a comparison with male ideals of female attractiveness

Body images of female patients with anorexia nervosa and bulimia nervosa were assessed against females without eating disorders and compared with male ideals of female attractiveness. A computer program was applied to examine body images of 62 patients with anorexia nervosa, 45 patients with bulimia nervosa, and 40 female and 39 male control subjects. Body size overestimation was most distinct in the two patient groups. Self-ideal discrepancy was highest in bulimia nervosa. Estimation of the society's ideal female body in all three female groups did not differ from men's perception of the most attractive female body. Congruence of ideals of female attractiveness in patients, female, and male control subjects and described differences between patients and female controls support the theory that body image disturbance is a problem of processing self-referential information regarding body image rather than a problem of processing body image related information per se.     

Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.     

自我客体化对女大学生限制性饮食行为的影响：一个有调节的中介模型

为探讨自我客体化对女大学生限制性饮食行为的影响及其内在作用机制,采用自我客体化量表、体像比较量表、限制性饮食量表和意志控制量表对487名女大学生进行调查。结果表明：（1）自我客体化、社交网站体像比较和限制性饮食两两之间均存在显著的正相关;意志控制与自我客体化、社交网站体像比较以及限制性饮食均呈显著的负相关;（2）社交网站体像比较在自我客体化对限制性饮食的影响中起中介作用;（3）自我客体化对限制性饮食影响的直接效应以及社交网站体像比较中介效应的后半路径均受到意志控制的调节,即在低意志控制群体中,这两种效应都更为显著。     

A study of temperament and personality in anorexia and bulimia nervosa

Although temperament and personality traits could influence the development and course of eating disorders, only a few studies examined the similarities and differences in personality between anorexia and bulimia nervosa. We compared 72 patients with DSM-IV eating disorders and 30 healthy controls. Dimensions of personality and personality disorders were evaluated with the Eysenck's EPQ, Cloninger's TCI, and the SCID-II questionnaires. The rates of impulsivity and clinical features were evaluated using specific rating scales. A comorbid personality disorder was found in 61.8% of patients with eating disorder. Avoidant personality disorder appeared was relatively common in anorexia nervosa restricting type; borderline personality disorder was most frequent in bulimia nervosa and the binge eating-purging type of anorexia nervosa. From a dimensional perspective, anorexic patients presented high scores in the dimension of persistence. Higher harm avoidance and impulsivity was found in bulimic patients. The overall eating disorders group presented high scores in neuroticism and low scores in self-directedness. Eating disorder patients have heterogeneous features of temperament and personality traits. Cluster C personality disorders seem more common in anorexia nervosa restricting type and impulsive personality features are associated with bulimic symptoms. Impulsivity seems to be a key aspect of temperament of bulimic patients, whereas anorexic symptoms are linked to persistent temperament traits.     

Desire for thinness among high school cheerleaders: relationship to disordered eating and weight control behaviors

The eating disorders of anorexia nervosa and bulimia are increasing in frequency among adolescent females. These increases have been linked to the cultural ideal in American society of thinness. Attempting to control weight is one behavioral manifestation of the desire for thinness. One particular group of adolescents, female cheerleaders, often experience pressure to attain and maintain weight that is lower than other adolescents of the same height. This study examined cheerleaders' desire for thinness in relationship to disordered eating and weight control behaviors. A Desire for Thinness Scale and selected scales from three eating disorders instruments were administered to 751 high school cheerleaders from the Midwest. Cheerleaders who scored in the upper third on the Desire for Thinness Scale were compared with those who scored in the lower third. Cheerleaders who expressed a strong desire for thinness had significantly higher scores (p less than .0001) on 7 of 8 eating disorders scales. The greater the desire for thinness, the more likely the tendency to report disordered eating and weight control behaviors associated with bulimia. Implications from this study include an awareness of how a cultural ideal of thinness may indirectly increase disordered eating and weight control behaviors by making weight loss a salient goal. A proactive approach to modifying negative aspects of the cultural emphasis on thinness is proposed.     

Perceived acceptability of anorexia and bulimia in women with and without eating disorder symptoms

Perceptions of the acceptability of eating‐disordered behaviour were examined in young adult women with (n = 44) and without (n = 268) eating disorder symptoms. All participants viewed vignettes of anorexia nervosa (AN) and bulimia nervosa (BN) and responded to the same series of questions—addressing different possible ways in which the conditions described might be seen to be acceptable—in relation to each vignette. Participants with eating disorder symptoms perceived eating‐disordered behaviour to be more acceptable than asymptomatic participants, and this was the case for both AN and BN vignettes and for a range of different items. Differences on items tapping the perception that it ‘might not be too bad’ to have an eating disorder and that an eating disorder is ‘nothing to be concerned about’ were particularly pronounced. The findings could not be accounted for by between‐group differences in body weight. The findings indicate the ambivalence towards eating‐disordered behaviour that exists among a subgroup of young women in the community and the clear association between such ambivalence and actual eating disorder symptoms. The perceived acceptability of eating‐disordered behaviour may need to be addressed in prevention and early‐intervention programs for eating disorders.     

Sex differences in language first appear in gesture

Children differ in how quickly they reach linguistic milestones. Boys typically produce their first multi‐word sentences later than girls do. We ask here whether there are sex differences in children’s gestures that precede, and presage, these sex differences in speech. To explore this question, we observed 22 girls and 18 boys every 4 months as they progressed from one‐word speech to multi‐word speech. We found that boys not only produced speech + speech (S+S) combinations (‘drink juice’) 3 months later than girls, but they also produced gesture + speech (G+S) combinations expressing the same types of semantic relations (‘eat’ + point at cookie) 3 months later than girls. Because G+S combinations are produced earlier than S+S combinations, children’s gestures provide the first sign that boys are likely to lag behind girls in the onset of sentence constructions.