Short- and long-term behavioral effects of neonatal exposure to bombesin.

Subcutaneous (sc) administration of the tetradecapeptide bombesin (BN) (1-10 mg/kg) elicited grooming in rat pups of 1-10 days of age and the magnitude of this response decreased as a function of age. The form of grooming induced was qualitatively different from that seen following central injection of BN to adult rats. Subchronic neonatal exposure to BN (5 or 10 mg/kg; sc, twice daily for the first 8 postnatal days) had no effect on subsequent adult behavior displayed under mildly stressful or novel conditions, in the open field or in an elevated plus maze. However, both saline and the high dose of BN (10 mg/kg) pretreatments increased adult sensitivity to central BN (0.1 micrograms; icv) as compared to noninjected but neonatally handled controls or those rats neonatally pretreated with the lower dose of BN (5 mg/kg). This was best demonstrated by increases in scratching activity at the 0.1-micrograms dose of icv BN. Neonatal pretreatments had no effect on later adult sensitivity to BN injected intraperitoneally (ip). These data indicate that BN receptors in the rat central nervous system are pharmacologically functional from an early stage in ontogeny. Systems utilizing BN-like peptides are, to a degree, plastic early in ontogeny and altered adult sensitivity to BN icv can be achieved via subchronic exposure to BN during infancy. Endogenous BN-based mechanisms did not appear to play a role in the development and/or expression of behavior(s) elicited under mildly stressful or novel conditions.     

An exploratory assessment of theory of mind and psychological impairment in patients with bulimia nervosa

This study aimed to investigate psychosocial functioning and different dimensions of theory of mind (ToM) in people with bulimia nervosa (BN) and Eating Disorder Not Otherwise Specified‐BN type (EDNOS‐BN). Psychosocial functioning and ToM were assessed in a sample of young adult females, 16 BN and 16 EDNOS‐BN outpatients and 16 healthy controls (HCs). They were assessed using the Eating Disorder Inventory‐Symptom Checklist‐2 (EDI‐2 SC) for evaluating psychological traits associated with eating disorders; the Symptom Checklist‐90‐Revised (SCL‐90‐R) for evaluating psychopathological status; and the Theory of Mind Assessment Scale (Th.o.m.a.s.), a semi‐structured interview aimed at assessing a person's different dimensions of ToM. The BN and EDNOS‐BN groups exhibited worse performance than the control group on all dimensions of the SCL‐90‐R, and on all dimensions of the EDI‐2 SC. The only difference for perfectionism was that BN obtained higher scores than EDNOS‐BN group. Our results also revealed an impairment of third‐person and second‐order ToM in patients with bulimia (BN and EDNOS‐BN) with respect to control subjects. These preliminary data have important implications for future empirical work, in that they provide valuable information regarding the importance of investigating the various facets of ToM ability separately, in order to provide a more detailed profile of ToM functioning in the clinical samples.     

Relation between the syndromes of bulimia nervosa and obsessive compulsive disorder

Bulimia nervosa (BN) has been conceptualized as similar to obsessive compulsive disorder (OCD). The results of studies investigating the relation between BN and OCD, however, are inconclusive. Our goal was to attempt to clarify the relation between the syndromes of BN and OCD. The Padua Inventory (PI), a measure of OCD, and the Bulimia Test—Revised (BULIT-R), a measure of bulimic behaviors, were administered to 981 women and 722 men. A significant relationship, equal in magnitude for women and men, was found between BN and OCD. Bulimic symptoms also had a stronger relation to obsessions than compulsions. Finally, 6 of 23 women (26%) who met the diagnostic criteria for BN also met the criteria for OCD, while 1 of 1 man who met the criteria for BN also met the criteria for OCD. Implications for similarities between the two disorders as well as future issues in the study of comorbidity are discussed.This report is based on the first author's masters thesis, which was supervised by the second author.     

Exploring possible mechanisms of change in family‐based treatment for adolescent bulimia nervosa

Objective: Mediators of treatment for family‐based treatment are explored for outcomes among adolescents with bulimia nervosa (BN). Method: Using data from a recently completed randomized clinical trial (RCT) comparing family‐based treatment (FBT) to supportive psychotherapy (SPT) we examined possible mediators of treatment outcome. Results: Results suggest that FBT‐BN was more effective than SPT in producing remission by virtue of achieving greater reductions in eating disorder psychopathology by mid‐treatment. Specifically, reductions in cognitions related to BN as assessed by the EDE appeared to be the differentiating mechanism. Conclusion: It is reasonable to hypothesize that change in the EDE subscales mediates outcome for FBT‐BN. Future studies with sufficient power to examine this possibility as an a priori hypothesis would help to better understand how FBT‐BN works and may also help to guide future treatment refinement and development.     

Gender differences in the role of alexithymia and emotional expressivity in disordered eating

Disordered eating habits such as binge-eating, purging, and extreme diet restriction have been linked to a variety of deficits in emotion regulation. Two such aspects of emotion regulation are alexithymia and emotional expressivity, although much of the research is limited to females. This study examines associations between these aspects of emotion regulation and symptoms of bulimia nervosa (BN) in men and women. Participants were 201 female and male undergraduates who completed self-report measures of emotion regulation and BN symptoms. Consistent with prior research, results indicate that alexithymia predicted BN symptoms in females, but not in the presence of emotional expressivity, which proved to be the only unique predictor of BN symptoms. In the male sample, alexithymia predicted BN symptoms over and above emotional expressivity. These findings suggest that BN symptoms in males may partly be explained by one facet of emotion regulation, but they also highlight important gender differences in disordered eating. Future research should further examine the role of emotion regulation in eating pathology in males.     

Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology

The authors explore the extent to which eating disorders, specifically anorexia nervosa (AN) and bulimia nervosa (BN), represent culture-bound syndromes and discuss implications for conceptualizing the role genes play in their etiology. The examination is divided into 3 sections: a quantitative meta-analysis of changes in incidence rates since the formal recognition of AN and BN, a qualitative summary of historical evidence of eating disorders before their formal recognition, and an evaluation of the presence of these disorders in non-Western cultures. Findings suggest that BN is a culture-bound syndrome and AN is not. Thus, heritability estimates for BN may show greater variability cross-culturally than heritability estimates for AN, and the genetic bases of these disorders may be associated with differential pathoplasticity.     

Effects of Posttraining Intrahippocampal Injections of Platelet-Activating Factor and PAF Antagonists on Memory

The present experiments examined the effects of posttraining intrahippocampal injections of the degradative enzyme-resistant methylcarbamyl analog of the bioactive phospholipid platelet-activating factor (mc-PAF) and the platelet-activating factor (PAF) receptor antagonists BN52021 and BN 50730 on memory in male Long-Evans rats trained in a hidden platform version of the Morris water maze. Following an eight-trial training session, rats received a unilateral intrahippocampal injection of mc-PAF (0.5, 1.0, or 2.0 μg/0.5 μl), lyso-PAF (1.0 μg/0.5 μl), the cell surface PAF receptor antagonist BN 52021 (0.25, 0.5, or 1.0 μg/0.5 μl), the intracellular PAF receptor antagonist BN 50730 (2.0, 5.0, or 10.0 μg/0.5 μl), or vehicle (50% DMSO in 0.9% saline; 0.5 μl). On a retention test conducted 24 h after training, the escape latencies of rats administered mc-PAF (1.0 or 2.0 μg) were significantly lower than those of the vehicle-injected controls, demonstrating a memory-enhancing effect of mc-PAF. Injections of lyso-PAF, a structurally similar metabolite of PAF, had no influence on memory, indicating that the memory-enhancing effect of mc-PAF is not caused by membrane perturbation by the phospholipid. The retention test escape latencies of rats administered BN 52021 (0.5 μg) and BN 50730 (5.0 or 10 μg) were significantly higher than those of the controls, indicating a memory impairing effect of both PAF antagonists. When mc-PAF, BN 52021, or BN 50730 was administered 2 h posttraining, no effect on retention was observed, indicating a time-dependent effect of the neuroactive substances on memory storage. The findings suggest a role for endogenous PAF in hippocampal-dependent memory processes.     

Sociocultural Experiences of Bulimic and Non-Bulimic Adolescents in a School-Based Chinese Sample

From a large school-based sample (N?=?3,084), 49 Mainland Chinese adolescents (31 girls, 18 boys) who endorsed all DSM-IV criteria for bulimia nervosa (BN) or sub-threshold BN and 49 matched controls (31 girls, 18 boys) completed measures of demographics and sociocultural experiences related to body image. Compared to less symptomatic peers, those in the BN group reported higher levels of appearance pressure from their network of close relationships and mass media, appearance comparisons and conversations, and fear of negative appearance evaluation. A hierarchical logistic regression analysis based seven predictors resulted in the correct identification of 82.7% of respondents, including 83.7% of the BN group and 81.7% of controls. Responses on sociocultural measures, especially those reflecting appearance pressure, added to the classification rate, after controlling for body mass index and household socioeconomic status. When repeated within each sex, classification accuracy was 90.3% for girls and 86.1% for boys. This study establishes clear links between sociocultural influences and BN among urban adolescent girls and boys living in the People’s Republic of China.     

Psychometric properties of the eating disorders inventory-2 among women seeking treatment for binge eating disorder

Psychometric properties of the Eating Disorders Inventory-2 (EDI-2) when used for women with Binge Eating Disorder (BED) are assessed. The EDI-2 was administered to 144 outpatients seeking treatment for BED and 152 outpatients seeking treatment for Bulimia Nervosa (BN). Most EDI-2 scales had acceptable internal consistence for both the BED and BN samples. EDI-2 scales demonstrated adequate stability within a subsample of those with BED who were retested. Confirmatory factor analyses revealed a hypothesized second-order two-factor structure for the original EDI scales for the BED group but not for those with BN. When the provisional EDI-2 scales were included, a two-factor structure was not supported for any group. Some scales differentiated the BED from the BN sample, and the second-order factors correlated with measures of similar constructs. The original EDI scales can be used reliably for those with BED.     

An evaluation of the enhanced cognitive-behavioural model of bulimia nervosa

The original cognitive-behavioural model of bulimia nervosa (BN) has been enhanced to include four additional maintaining mechanisms: low self esteem, clinical perfectionism, interpersonal problems, and mood intolerance. These models have been used to guide cognitive-behavioural treatment for BN, but the enhanced model has yet to be directly evaluated as a whole in a clinical sample. This study aimed to compare and evaluate the original and the enhanced cognitive-behavioural models of BN using structural equation modelling. The Eating Disorder Examination and self-report questionnaires were completed by 162 patients seeking treatment for BN (N = 129) or atypical BN (N = 33). Fit indices suggested that both the original and enhanced models provided a good fit to the data, but the enhanced model accounted for more variance in dietary restraint and binge eating. In the enhanced model, low self esteem was associated with greater overevaluation of weight and shape, which, in turn, was associated with increased dietary restraint. Interpersonal problems were also directly associated with dietary restraint, and binge eating was associated with increased purging. While the current study provides support for some aspects of the enhanced cognitive-behavioural model of BN, some key relationships in the model were not supported, including the important conceptual relationship between dietary restraint and binge eating.     

Finding MAPs using strongly equivalent high order recurrent symmetric connectionist networks

Belief revision is the problem of finding the most plausible explanation for an observed set of evidences. It has many applications in various scientific domains like natural language understanding, medical diagnosis and computational biology. Bayesian Networks (BN) is an important probabilistic graphical formalism widely used for belief revision tasks. In BN, belief revision can be achieved by finding the maximum a posteriori (MAP) assignment. Finding MAP is an NP-Hard problem. In previous work, we showed how to find the MAP assignment in BN using High Order Recurrent Neural Networks (HORN) through an intermediate representation of Cost-Based Abduction. This method eliminates the need to explicitly construct the energy function in two steps, objective and constraints. This paper builds on that previous work by providing the theoretical foundation and proving that the resultant HORN used to find MAP is strongly equivalent to the original BN it tries to solve.     

Addressing Weight Suppression to Improve Treatment Outcome for Bulimia Nervosa

Cognitive behavioral therapy (CBT) is regarded as the gold-standard treatment for bulimia nervosa (BN), yet despite impressive empirical support for its effectiveness, over 50% of patients fail to achieve abstinence from binge eating and purging by the end of treatment. One factor that may contribute to reduced efficacy rates in CBT is weight suppression (WS; the difference between a person's highest weight ever at their adult height and current weight). A growing body of research indicates that WS in patients with BN may have a clinically significant effect on symptomatology and prognosis. However, the current cognitive behavioral framework for BN does not explicitly acknowledge the role of WS in the onset or maintenance of BN symptoms and does not provide guidance for clinicians on how to address WS during treatment. The relationship between WS, biological pressure to regain lost weight, and the maintenance of BN symptoms suggest that current cognitive behavioral models of BN may be improved by considering the role of WS and exploring needed treatment modifications. Indeed, a reconceptualization of existing models may offer insight into potential strategies that can be used to reduce the susceptibility to treatment dropout, nonresponse, and relapse. It is therefore necessary to consider whether, and how, clinicians' consideration of WS during case conceptualization and treatment planning could serve to improve CBT outcomes. The current review explores ways in which high WS could contribute to poor CBT outcomes, provides preliminary clinical recommendations for incorporating WS into existing cognitive behavioral treatments based on extant data and clinical wisdom, and proposes suggestions for future research needed in this domain.     

Dialectical Behavior Therapy of Anorexia and Bulimia Nervosa Among Adolescents: A Case Series

The aim of this study was to describe a case series of adolescents (mean age = 16.5 years, SD = 1.0) with anorexia nervosa (AN) and bulimia nervosa (BN) who received dialectical behavior therapy (DBT). Twelve outpatients with AN and BN took part in 25 weeks of twice weekly therapy consisting of individual therapy and a skills training group. Family members were involved in the treatment. The patients were compared pre- and posttreatment on behavioral symptoms of AN and BN and symptoms of general psychopathology using standardized instruments (Structured Inventory for Anorectic and Bulimic Syndromes, Eating Disorder Inventory-2, The Symptom Checklist-90-Revised). Posttreatment, significant improvements in behavioral symptoms of eating disorder and symptoms of psychopathology were identified. The application of DBT adapted for the treatment of AN and BN among adolescents was associated with a decrease in behavioral symptoms of eating disorders and symptoms of general psychopathology. However, randomized controlled studies are required to prove the efficacy of this approach.     

Bulimia Nervosa: Professional and Lay People's Beliefs About the Causes

This study examined the explanatory models of bulimia nervosa (BN) held by members of professionals in the medical, psychological, and allied health fields; the general public; and female university students. The participants (N = 787) were presented with 44 potential causal explanations for BN and were asked to rate the importance of each in the development of this condition on a 5‐point rating scale (“unimportant” to “extremely important”). Principal component analysis identified four causal components. These were interpreted as corresponding to (1) socio‐cultural pressure, (2) eating and dieting practices, (3) family dynamics, and (4) psychological vulnerability. A high degree of consistency in the mean ratings for the four causal components was observed among the professional groups. However, important differences were found between the professional and the lay respondents in their beliefs about the role of socio‐cultural pressure, eating and dieting practices, and family dynamics in the development of BN. The congruence in beliefs among the professionals groups would contribute to the ease of interdisciplinary collaboration required in the multi‐modal treatment approach to BN. However, the differences observed between the professional and lay groups may have implications for educational and preventative strategies for BN.     

Feasibility,Acceptability, and Preliminary Target Engagement of a Healthy Physical Activity Promotion Intervention for Bulimia Nervosa: Development and Evaluation via Case Series Design

Bulimia nervosa (BN) is characterized by a pattern of binge eating and compensatory behaviors as well as an overemphasis on body weight and shape in self-evaluation. Although cognitive behavioral therapy (CBT) is efficacious, recent reviews suggest that only 30% of patients reach abstinence at posttreatment. One potential reason for these poor outcomes is that CBT fails to adequately reduce elevated negative affect (NA) and shape and weight concern, which have been shown to be correlated with poorer treatment outcomes in BN. Therefore, novel treatment components that focus on improving NA and shape and weight concern are needed in order to enhance outcomes. Promoting physical activity (PA) is a promising avenue through which to reduce NA and improve body image in healthy individuals, other clinical populations (e.g., individuals with depression or anxiety), and individuals with eating disorders. While prescribing PA for individuals with BN has been controversial (due to concerns that exercise maybe be used to compensate for binge episodes or become driven or compulsive), this approach may have many benefits, including promoting healthy lifetime exercise habits that reduce likelihood of relapse through the improvement of emotion regulation skills and weight regulation.Given the promise of PA for targeting key maintenance factors of BN, we developed a 12-session healthy PA promotion intervention for BN and tested initial feasibility, acceptability, and preliminary target engagement in an iterative case series design (n = 3). The treatment provided cognitive-behavioral skills designed to identify, practice, and achieve behavioral goals while asking patients to engage in up to 150 minutes of moderate-to-vigorous PA per week, which was preplanned during each session with the client’s therapist.Results suggested that the healthy PA promotion intervention was both feasible and acceptable to deliver. In addition, the intervention resulted in a clinically significant decrease in BN symptom frequency in each participant. Further, participants showed clinically significant decreases in NA and shape and weight concern.The current study demonstrates that healthy PA interventions can have beneficial effects on BN symptoms, NA, and shape and weight concern. However, due to the small sample size, conclusions must be treated with caution. Future research should investigate additional approaches for promoting healthy PA and include a larger sample in order to further test initial efficacy of this treatment approach.     

Quantitative evidence for distinct cognitive impairment in anorexia nervosa and bulimia nervosa

It is generally agreed that at least some aspects of abnormal eating behaviour is indeed due in part to disordered cognition. The accumulated literature illustrates cognitive impairment in patients with anorexia nervosa (AN) and bulimia nervosa (BN). Yet beyond being inconsistent, these independent studies also do not reveal the magnitude of impairment within and across studies and fail to give due consideration to the magnitude of impairment so as to understand the severity and breadth of impairment and/or differences in cognitive profiles between patients with AN and BN. Hence, the present review on the subject sought to articulate the magnitude of cognitive impairment in patients with AN and BN by quantitatively synthesizing the existing literature using meta-analytic methodology. The results demonstrate modest evidence of cognitive impairment specific to AN and BN that is related to body mass index in AN in terms of its severity, and is differentially impaired between disorders. Together, these results suggest that disturbed cognition is figural in the presentation of eating disorders and may serve to play an integral role in its cause and maintenance. Implications of these findings with respects to future research are discussed.     

The impact of exposure to images of ideally thin models in TV commercials on eating behavior: an experimental study with women diagnosed with bulimia nervosa

This study investigates whether eating behavior in women with diagnosed bulimia nervosa is influenced by prior exposure to images of ideally thin models. Twenty-six participants diagnosed with bulimia nervosa (BN) and 30 normal controls (NC) were exposed to body-related and neutral TV commercials; then food that typically triggers binge eating was provided, and the amount of food eaten was measured. No significant difference for food intake between NC and BN could be found, but food intake for BN was predicted by the degree of thoughts related to eating behaviors during exposure to the thin ideal. No impact of general body image or eating pathology on food intake could be found. The results emphasize the importance of action-relevance of dysfunctional cognitions for the maintenance of eating-disordered behaviors in women with bulimia nervosa, when exposed to eating-disorder-specific triggers.     

Knowledge and Beliefs about Bulimia Nervosa and its Treatment: A Comparative Study of Three Disciplines

Poor Mental Health Literacy (MHL), i.e. knowledge and beliefs about bulimia nervosa (BN), among health professionals may contribute to low rates of recognition and less optimal management. The aim of this study was to investigate the BN-MHL of health professionals. A total of 534 professionals selected randomly from Internet based lists were surveyed with a MHL questionnaire regarding a fictional vignette of a woman with BN. One hundred and thirty-six dieticians, 68 psychologists and 97 counselors, total 56% (n = 301) responded. The majority of respondents indicated the woman in the vignette suffered from BN (49%) or an eating disorder (20%) and endorsed evidenced based approaches. On post hoc between group analyses there was a trend (p = .02) for dieticians and psychologists to be more likely than counselors to accurately identify the diagnosis of BN. Dieticians and psychologists were also more likely than counselors to endorse a psychologist as the most helpful treatment provider (p<.001) and to be more likely to endorse cognitive behavioral therapy as the most helpful treatment (p<.001). These results indicate a need for greater training and support for non specialist primary care health professionals.     

Changes in body image during cognitive-behavioral treatment in women with bulimia nervosa

The purposes of this study were: (1) to examine multidimensional aspects of body image of individuals with bulimia nervosa (BN) at pre-treatment, post-treatment, and at follow-up, compared to a group of participants without BN; and (2) to investigate whether measures of body image predicted outcome at post-treatment and follow-up. The clinical sample consisted of 109 females with BN who were enrolled in a 12-week cognitive-behavioral group treatment program. Participants were assessed at baseline, at the completion of treatment, and at 1- and 6-month follow-up visits. The 82 females who comprised the non-bulimic sample were assessed at comparable time intervals. At baseline, the participants with BN reported greater body dissatisfaction and overestimated body size to a significantly greater degree than the comparison group, and reported a significantly smaller ideal size relative to perceived size. Results at the end of treatment indicated significant improvement in self-reported attitudinal disturbance and size overestimation, with continued reductions at follow-up. Logistic regression analyses did not demonstrate a predictive relationship between body image measures at baseline and outcome at post-treatment or follow-up, or between post-treatment and follow-up. Implications for treatment include specifying the source of body image-related distress and enhancing treatment efforts for perceptual and attitudinal aspects of body image.