Query: bulimia

title: Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia.
abstract: The development and validation of a new measure, the Eating Disorder Inventory (EDI) is described. The EDI is a 64 item, self report, multiscale measure designed for the assessment of psychological and behavioral traits common in anorexia nervosa (AN) and bulimia. The EDI consists of eight sub scales measuring: 1) Drive for Thinness, 2) Bulimia, 3) Body Dissatisfaction, 4) Ineffectiveness, 5) Perfectionism, 6) Interpersonal Distrust, 7) Interoceptive Awareness and 8) Maturity Fears. Reliability (internal consistency) is established for all subscales and several indices of validity are presented. First, AN patients (N 113) are differentiated from female comparison (FC) subjects (N 577) using a cross validation procedure. Secondly, patient self report subscale scores agree with clinician ratings of subscale traits. Thirdly, clinically recovered AN patients score similarly to FCs on all subscales. Finally, convergent and discriminate validity are established for subscales. The EDI was also administered to groups of normal weight bulimic women, obese, and normal weight but formerly obese women, as well as a male comparison group. Group differences are reported and the potential utility of the EDI is discussed.

title: Recovery From Anorexia Nervosa and Bulimia Nervosa at 22 Year Follow Up.
abstract: The course of eating disorders is often protracted, with fewer than half of adults achieving recovery from anorexia nervosa or bulimia nervosa. Some argue for palliative management when duration exceeds a decade, yet outcomes beyond 20 years are rarely described. This study investigates early and long term recovery in the Massachusetts General Hospital Longitudinal Study of Anorexia and Bulimia Nervosa.  Females with DSM III R/DSM IV anorexia nervosa or bulimia nervosa were assessed at 9 and at 20 to 25 years of follow up (mean [SD] 22.10 [1.10] years; study initiated in 1987, last follow up conducted in 2013) via structured clinical interview (Longitudinal Interval Follow Up Evaluation of Eating Disorders [LIFE EAT II] Seventy seven percent of the original cohort was re interviewed, and multiple imputation was used to include all surviving participants from the original cohort (N 228) Kaplan Meier curves estimated recovery by 9 year follow up, and McNemar test examined concordance between recovery at 9 year and 22 year follow up.  At 22 year follow up, 62.8% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa recovered, compared to 31.4% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa by 9 year follow up. Approximately half of those with anorexia nervosa who had not recovered by 9 years progressed to recovery at 22 years. Early recovery was associated with increased likelihood of long term recovery in anorexia nervosa (odds ratio [OR] 10.5; 95% CI, 3.77 29.28; McNemar kh21 31.39; P .01) but not in bulimia nervosa (OR 1.0; 95% CI, 0.49 2.05; McNemar kh21 0; P 1.0)  At 22 years, approximately two thirds of females with anorexia nervosa and bulimia nervosa were recovered. Recovery from bulimia nervosa happened earlier, but recovery from anorexia nervosa continued over the long term, arguing against the implementation of palliative care for most individuals with eating disorders.

title: Medical Complications of Anorexia Nervosa and Bulimia.
abstract: Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic. We review the medical complications that are associated with anorexia nervosa and bulimia nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders.

title: Food Addiction and Bulimia Nervosa: New Data Based on the Yale Food Addiction Scale 2.0.
abstract: Previous research on 'food addiction' as measured with the Yale Food Addiction Scale (YFAS) showed a large overlap between addiction like eating and bulimia nervosa. Most recently, a revised version of the YFAS has been developed according to the changes made in the diagnostic criteria for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders fifth edition. The current study examined prevalence and correlates of the YFAS2.0 in individuals with bulimia (n 115) and controls (n 341) Ninety six per cent of participants with bulimia and 14% of controls received a YFAS2.0 diagnosis. A higher number of YFAS2.0 symptoms was associated with lower interoceptive awareness, higher depressiveness, and higher impulsivity in both groups. However, a higher number of YFAS2.0 symptoms was associated with higher body mass and weight suppression in controls only and not in participants with bulimia. The current study is the first to show a large overlap between bulimia and 'food addiction' as measured with the YFAS2.0, replicating and extending findings from studies, which used the previous version of the YFAS. Compensatory weight control behaviours in individuals with bulimia likely alleviate the association between addiction like eating and higher body mass. Thus, the large overlap between bulimia and 'food addiction' should be taken into consideration when examining the role of addiction like eating in weight gain and obesity.

title: Altered structural and effective connectivity in anorexia and bulimia nervosa in circuits that regulate energy and reward homeostasis
abstract: Anorexia and bulimia nervosa are severe eating disorders that share many behaviors. Structural and functional brain circuits could provide biological links that those disorders have in common. We recruited 77 young adult women, 26 healthy controls, 26 women with anorexia and 25 women with bulimia nervosa. Probabilistic tractography was used to map white matter connectivity strength across taste and food intake regulating brain circuits. An independent multisample greedy equivalence search algorithm tested effective connectivity between those regions during sucrose tasting. Anorexia and bulimia nervosa had greater structural connectivity in pathways between insula, orbitofrontal cortex and ventral striatum, but lower connectivity from orbitofrontal cortex and amygdala to the hypothalamus (P<0.05, corrected for comorbidity, medication and multiple comparisons) Functionally, in controls the hypothalamus drove ventral striatal activity, but in anorexia and bulimia nervosa effective connectivity was directed from anterior cingulate via ventral striatum to the hypothalamus. Across all groups, sweetness perception was predicted by connectivity strength in pathways connecting to the middle orbitofrontal cortex. This study provides evidence that white matter structural as well as effective connectivity within the energy homeostasis and food reward regulating circuitry is fundamentally different in anorexia and bulimia nervosa compared with that in controls. In eating disorders, anterior cingulate cognitive emotional top down control could affect food reward and eating drive, override hypothalamic inputs to the ventral striatum and enable prolonged food restriction.

title: A randomized controlled trial of psychoanalytic psychotherapy or cognitive behavioral therapy for bulimia nervosa.
abstract: The authors compared psychoanalytic psychotherapy and cognitive behavioral therapy (CBT) in the treatment of bulimia nervosa.  A randomized controlled trial was conducted in which 70 patients with bulimia nervosa received either 2 years of weekly psychoanalytic psychotherapy or 20 sessions of CBT over 5 months. The main outcome measure was the Eating Disorder Examination interview, which was administered blind to treatment condition at baseline, after 5 months, and after 2 years. The primary outcome analyses were conducted using logistic regression analysis.  Both treatments resulted in improvement, but a marked difference was observed between CBT and psychoanalytic psychotherapy. After 5 months, 42% of patients in CBT (N=36) and 6% of patients in psychoanalytic psychotherapy (N=34) had stopped binge eating and purging (odds ratio=13.40, 95% confidence interval [CI]=2.45 73.42; p<0.01) At 2 years, 44% in the CBT group and 15% in the psychoanalytic psychotherapy group had stopped binge eating and purging (odds ratio=4.34, 95% CI=1.33 14.21; p=0.02) By the end of both treatments, substantial improvements in eating disorder features and general psychopathology were observed, but in general these changes took place more rapidly in CBT.  Despite the marked disparity in the number of treatment sessions and the duration of treatment, CBT was more effective in relieving binging and purging than psychoanalytic psychotherapy and was generally faster in alleviating eating disorder features and general psychopathology. The findings indicate the need to develop and test a more structured and symptom focused version of psychoanalytic psychotherapy for bulimia nervosa.

title: A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa.
abstract: Although anorexia nervosa has a high mortality rate, our understanding of the timing and predictors of mortality in eating disorders is limited. The authors investigated mortality in a long term study of patients with eating disorders.  Beginning in 1987, 246 treatment seeking female patients with anorexia nervosa or bulimia nervosa were interviewed every 6 months for a median of 9.5 years to obtain weekly ratings of eating disorder symptoms, comorbidity, treatment participation, and psychosocial functioning. From January 2007 to December 2010 (median follow up of 20 years) vital status was ascertained with a National Death Index search.  Sixteen deaths (6.5% were recorded (lifetime anorexia nervosa, N=14; bulimia nervosa with no history of anorexia nervosa, N=2) The standardized mortality ratio was 4.37 (95% CI=2.4 7.3) for lifetime anorexia nervosa and 2.33 (95% CI=0.3 8.4) for bulimia nervosa with no history of anorexia nervosa. Risk of premature death among patients with lifetime anorexia nervosa peaked within the first 10 years of follow up, resulting in a standardized mortality ratio of 7.7 (95% CI=3.7 14.2) The standardized mortality ratio varied by duration of illness and was 3.2 (95% CI=0.9 8.3) for patients with lifetime anorexia nervosa for 0 to 15 years (4/119 died) and 6.6 (95% CI=3.2 12.1) for those with lifetime anorexia nervosa for >15 to 30 years (10/67 died) Multivariate predictors of mortality included alcohol abuse, low body mass index, and poor social adjustment.  These findings highlight the need for early identification and intervention and suggest that a long duration of illness, substance abuse, low weight, and poor psychosocial functioning raise the risk for mortality in anorexia nervosa.

title: Alterations in brain structures related to taste reward circuitry in ill and recovered anorexia nervosa and in bulimia nervosa.
abstract: The pathophysiology of anorexia nervosa remains obscure, but structural brain alterations could be functionally important biomarkers. The authors assessed taste pleasantness and reward sensitivity in relation to brain structure, which may be related to food avoidance commonly seen in eating disorders.  The authors used structural MR imaging to study gray and white matter volumes in women with current restricting type anorexia nervosa (N=19) women recovered from restricting type anorexia nervosa (N=24) women with bulimia nervosa (N=19) and healthy comparison women (N=24)  All eating disorder groups exhibited increased gray matter volume of the medial orbitofrontal cortex (gyrus rectus) Manual tracing confirmed larger gyrus rectus volume, and volume predicted taste pleasantness ratings across all groups. Analyses also indicated other morphological differences between diagnostic categories. Antero ventral insula gray matter volumes were increased on the right side in the anorexia nervosa and recovered anorexia nervosa groups and on the left side in the bulimia nervosa group relative to the healthy comparison group. Dorsal striatum volumes were reduced in the recovered anorexia nervosa and bulimia nervosa groups and predicted sensitivity to reward in all three eating disorder groups. The eating disorder groups also showed reduced white matter in right temporal and parietal areas relative to the healthy comparison group. The results held when a range of covariates, such as age, depression, anxiety, and medications, were controlled for.  Brain structure in the medial orbitofrontal cortex, insula, and striatum is altered in eating disorders and suggests altered brain circuitry that has been associated with taste pleasantness and reward value.

title: Altered insula response to sweet taste processing after recovery from anorexia and bulimia nervosa.
abstract: Recent studies suggest that altered function of higher order appetitive neural circuitry may contribute to restricted eating in anorexia nervosa and overeating in bulimia nervosa. This study used sweet tastes to interrogate gustatory neurocircuitry involving the anterior insula and related regions that modulate sensory interoceptive reward signals in response to palatable foods.  Participants who had recovered from anorexia nervosa and bulimia nervosa were studied to avoid confounding effects of altered nutritional state. Functional MRI measured brain response to repeated tastes of sucrose and sucralose to disentangle neural processing of caloric and noncaloric sweet tastes. Whole brain functional analysis was constrained to anatomical regions of interest.  Relative to matched comparison women (N=14) women recovered from anorexia nervosa (N=14) had significantly diminished and women recovered from bulimia nervosa (N=14) had significantly elevated hemodynamic response to tastes of sucrose in the right anterior insula. Anterior insula response to sucrose compared with sucralose was exaggerated in the recovered group (lower in women recovered from anorexia nervosa and higher in women recovered from bulimia nervosa)  The anterior insula integrates sensory reward aspects of taste in the service of nutritional homeostasis. One possibility is that restricted eating and weight loss occur in anorexia nervosa because of a failure to accurately recognize hunger signals, whereas overeating in bulimia nervosa could represent an exaggerated perception of hunger signals. This response may reflect the altered calibration of signals related to sweet taste and the caloric content of food and may offer a pathway to novel and more effective treatments.

title: Dimensions of emotion dysregulation in bulimia nervosa.
abstract: The goal of this study was to examine associations between dimensions of emotion dysregulation and eating disorder (ED) symptoms in bulimia nervosa (BN) This investigation used baseline data from a BN treatment study that included 80 adults (90% women) with full or subthreshold BN. Participants completed the Difficulties in Emotion Regulation Scale (DERS) and the Eating Disorders Examination interview. The Eating Disorders Examination global score was significantly correlated with the DERS total score, as well as several DERS subscales: nonacceptance, impulse and strategies. Further, the DERS goals subscale was found to be uniquely associated with frequency of purging and driven exercise, although none of the subscales were associated with frequency of objective binge eating. Findings indicate that emotion dysregulation is associated with ED symptoms in BN, suggesting the utility of interventions that address emotion regulation skills deficits in the treatment of the disorder.