Objective: The current study examined risk factors in women with binge eating disorder (BED) who began binging before dieting (binge-first [BE]) compared with women with BED who began dieting before hinging (diet-first [DF]). It further aimed to replicate findings regarding eating disorder and general psychopathology among BE versus DF subtypes.Method: One hundred fifty-five women with BED completed the Oxford Risk Factor Interview to retrospectively assess risk factors occurring before eating disturbance onset. Clinical interview assessed eating disorder and general psychopathology.Results: Overall, no significant differences in risk factors emerged between the groups. The BE group had a significantly earlier onset of BED than the DF group. In contradistinction to previous studies, the DF group endorsed more eating disorder psychopathology and lifetime diagnosis of any substance use disorder.Conclusion: Limited support was seen for different risk factors in BF versus DF women, suggesting similar etiologic pathways in both subtypes. (c) 2005 by Wiley Periodicals, Inc.

Objective : Two studies explored in nonclinical samples variables that may influence meal size assessments. Research Methods and Procedures : In Study 1, the contribution of dietary restraint, weight, depressive symptoms, and gender to ratings on the Food Amount Rating Scale was examined in 153 white women and 121 white men; in Study 2, the contribution of dietary restraint, weight, ethnicity, and ethnic group identification to Food Amount Rating Scale ratings was examined in 67 Asian, 81 Hispanic, and 107 white women. Results : Study 1 indicated that food amounts were rated as larger when rated by male rather than female raters (male rater, mean = 62.37, SD = 1.14; female rater, mean = 59.28, SD = 0.89), for female rather than male targets (male target, mean = 56.16, SD = 0.97; female target, mean = 64.87, SD = 1.02), and by restrained rather than unrestrained eaters (restrained, mean = 63.14, SD = 1.11; unrestrained, mean = 58.69, SD = 0.91). Study 2 indicated that food amounts were rated as larger when rated by restrained eaters (restrained, mean = 67.53, SD = 1.21; unrestrained, mean = 64.99, SD = 1.09), Hispanic women (Asian, mean = 64.59, SD = 1.61; Hispanic, mean = 68.71, SD = 1.30; white, mean = 65.41, SD = 1.34), and underweight women (underweight, mean = 70.38, SD = 1.68; normal weight, mean = 64.52, SD = 0.93; overweight: mean = 64.23, SD = 1.64). Discussion : Food amount judgments may be influenced by personal characteristics. Future research should examine whether variation in food amount judgments is related to dieting behavior, disordered eating, or obesity.

OBJECTIVE The current study examined the prevalence and clinical significance of night eating syndrome (NES) in a community cohort of Black and White women. METHOD We assessed 682 Black and 659 White women for NES, eating disorders, and psychiatric symptomatology. RESULTS The prevalence was 1.6% (22 of 1,341; Blacks [n = 20]; Whites [n = 2]). Comparisons between identified Black women and the remaining Black participants revealed no significant differences in obesity, psychiatric comorbidity, or self-reported psychiatric distress. Comorbidity with eating disorders as outlined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (Washington, DC: American Psychiatric Association) was low (n = 1 [4.5%]). Black NES women were significantly less likely than Black non-NES women to be overweight and significantly more likely to have two or more children. DISCUSSION NES was rare in this sample of young women. Low comorbidity of NES with other eating disorders suggests that NES may be distinct from the DSM-IV recognized eating disorders. Longitudinal data are needed to determine the long-term health implications of this behavioral pattern.

Depression in adolescent girls may result in negative consequences in young adulthood. The Center for Epidemiologic Studies Depression Scale (CES-D) was administered to 1,727 Black and White girls ages 16 to 18 years who participated in the National Heart, Lung, and Blood Institute's Growth and Health Study. Three years later, women in the depressed groups were more likely to be current smokers, had attained a lower level of education, and reported lower self-worth relative to the nondepressed group. Body dissatisfaction, eating concerns, and loneliness were greater in the depressed groups. Relative to Black women, White women who were moderately depressed during adolescence reported more health care services utilization in young adulthood. Prevention efforts for depressed adolescents should be broadly focused to improve young adult outcomes.

Background. This study sought to identify in white women risk factors specific to binge-eating disorder (BED) and for psychiatric disorders in general, and to compare black and white women on risk factors for BED. Method. A case-control design was used. Participants were recruited from the community and included 162 women who met DSM-IV criteria for BED and two comparison groups of women with no history of clinically significant eating disorder symptoms. The comparison women were matched to BED women on age, education and ethnicity and divided into a healthy comparison (HC) group, who had no current psychiatric disorder, and a psychiatric comparison (PC) group, who had a diagnosis of a DSM-IV Axis I psychiatric disorder. The study sample size was determined by the group with the least members (PC), including 107 women with BED and 214 matched comparison women. A broad range of risk factors was assessed with a Risk Factor Interview and the Parental Bonding Instrument. Results. No significant effects for ethnicity by diagnostic group were found. BED women reported higher exposure to childhood obesity, family overeating or binge-eating, family discord, and high parental demands than PC women. The combined BED and PC group scored significantly higher than the HC group on measures of negative affect, parental mood and substance disorders, perfectionism, separation from parents, and maternal problems with parenting. Conclusions. These findings indicate that childhood obesity and familial eating problems are reliable specific risk factors for BED. Ethnicity does not appear to moderate risk for BED.

Objective: This study examined health services use in community samples of 102 white and 60 black women with binge eating disorder (BED), 164 white and 85 black healthy comparison women, and 86 white and 21 black women with a noneating Axis I psychiatric disorder.Research Methods and Procedures: Participants were matched on age, ethnicity, and education and were asked about/their use of emergency room visits, outpatient physician visits for medical care, outpatient psychotherapy visits, and days spent in the hospital over the previous 12 months. Total health services use was computed.Results: There were no between-group differences. in outpatient physician visits or inpatient hospital days. Relative to healthy comparison women, women with BED and women with other Axis I disorders had increased total health services use, psychotherapy visits, and emergency department visits. Relative to women with noneating Axis I disorders, women with BED had less use of psychotherapy visits. Although obese white women were more likely to report emergency department visits than obese black women were, nonobese white women were less likely to report emergency department visits than nonobese black women were.Discussion: That health services use by women with BED compared more with that of women with other Axis I disorders than with that of healthy women suggested that BED has clinical significance and is not benign in terms of its impact on the health care system. It appeared, however, that despite the availability of effective treatments, few women with BE received psychotherapy.

OBJECTIVE The current study examined health services use during the past 12 months in a sample of young women with a history of an adolescent eating disorder (bulimia nervosa [BN] or binge eating disorder [BED]). METHOD A community sample of 1,582 young women (mean age = 21.5 years) was classified, based on a screening interview (and, for eating disorder diagnosis, confirmatory diagnostic interview), into one of three groups: BN or BED (n = 67), other psychiatric disorder (n = 443), and no adolescent psychiatric disorder (n = 1,072). RESULTS A history of BN/BED in adolescence was associated with elevated health services use, but this was a general effect associated with having a psychiatric disorder, not an effect specific to the diagnosis of an eating disorder. Total service days, outpatient psychotherapy visits, and emergency department visits were elevated in the combined group of BN/BED and other psychiatric disorder participants relative to the healthy comparison group. The women with BN/BED did not differ significantly from the women with a non-eating-related psychiatric disorder in the use of these services. DISCUSSION The similarity of health services use in young women with BN or BED and those with other psychiatric disorders underscores the clinical and economic impact of these eating disorders.

OBJECTIVE:Epidemiological studies of eating disorders in the United States have focused on white women and girls, and the prevalence of eating disorders in ethnic minority groups is unknown. This study examined the prevalence of anorexia nervosa, bulimia nervosa, and binge eating disorder in a geographically and economically diverse community sample of young white and black women who previously participated in the 10-year National Heart, Lung, and Blood Institute (NHLBI) Growth and Health Study.METHOD:All NHLBI Growth and Health Study participants were recruited for this study. A two-stage case finding method was used, consisting of a telephone screening (sensitivity=0.90, specificity=0.98) and an in-person confirmatory diagnostic interview.RESULTS:A total of 86.0% of the original NHLBI Growth and Health Study cohort participated, including 985 white women (mean age=21.3) and 1,061 black women (mean age=21.5). Fifteen white (1.5%) and no black women met lifetime criteria for anorexia nervosa; more white women (N=23, 2.3%) than black women (N=4, 0.4%) met criteria for bulimia nervosa; binge eating disorder also was more common among white women (N=27, 2.7%) than black women (N=15, 1.4%). Few women (white: N=16, 28.1%; black: N=1, 5.3%) ever had received treatment for an eating disorder.CONCLUSIONS:Results suggest that eating disorders, especially anorexia nervosa and bulimia nervosa, are more common among white women than among black women. The low treatment rates in both groups suggest that health professionals need to be more alert to the possibility of eating disorders in women.

The main question explored in this study is whether a woman's choice to do research during her career as a clinical psychologist is associated with having had a research mentor. A sample of 616 women, all members of the American Psychological Association holding a Ph.D. in Clinical Psychology, completed a survey about their experience with a research mentor. The data show that research mentoring is positively related to a woman in clinical psychology doing research and whether she, in turn, becomes a research mentor for others. The responses of the participants suggest that a model of mentoring that involves relevant training and practical experience in research may increase the likelihood that female clinical psychologists will choose to do research as part of their careers.

OBJECTIVE:This study evaluated rates of self-harm and substance use in women with either bulimia nervosa (BN) or binge eating disorder (BED) and assessed whether differences in self-harm and substance use are related to sexual or physical abuse.METHOD:Alcohol abuse, self-harm, and use or abuse of various illicit drugs were evaluated in a sample of 53 women with BN and 162 women with BED.RESULTS:Self-harm and substance use generally did not differentiate BED and BN cases, but rates of self-harm and substance use were elevated among women with a history of sexual or physical abuse relative to women without such a history.DISCUSSION:Elevated rates of self-harm and substance use may not be related uniquely to BN diagnostic status, but may be related to a characteristic shared by women with BN and BED, such as a history of sexual or physical abuse.

OBJECTIVE:This study examined whether sexual and physical abuse, bullying by peers, and ethnicity-based discrimination are associated with an increased risk for developing binge eating disorder in black women and in white women and whether any increase in risk is specific for the development of binge eating disorder.METHOD:A community sample of 162 women with binge eating disorder and 251 healthy and 107 psychiatric comparison subjects was interviewed for exposure to the risk factors under investigation.RESULTS:White subjects with binge eating disorder reported significantly higher rates of sexual abuse, physical abuse, bullying by peers, and discrimination than healthy comparison subjects. Only rates of discrimination were significantly higher in white women with binge eating disorder than in matched psychiatric comparison subjects. In black women with binge eating disorder, rates of sexual abuse, physical abuse, and bullying by peers-but not discrimination-were significantly higher than in healthy comparison women. Rates of sexual abuse were significantly higher in black women with binge eating disorder than in psychiatric comparison subjects.CONCLUSIONS:Consistent with previous research examining ethnicity-specific patterns of risk for psychiatric disorder, we found both ethnic similarities (physical abuse and bullying by peers) and differences (sexual abuse and discrimination) in the risk for binge eating disorder.

Objective: To compare the macronutrient intake of females with or without a history of anorexia nervosa (AN) at three times: two years and one year before the onset of AN, and during the first year of the illness. Study design: Prospective cohort study with 3-day food intake records collected over 10 years. Subjects were 154 white females (aged 9 or 10 years at study entry), of whom 14 had AN and 140 were healthy females matched for age at study entry and parental education. Results: Compared with the healthy girls, girls with AN reported significantly lower total energy intake and fat intake during the first year of the illness; the lower total energy intake was evident already at the 1-year (but not the 2-year) pre-onset assessment. Conclusions: To identify AN early on, health practitioners caring for adolescent girls should inquire about food intake and reluctance to eat certain foods, especially those containing fat. (J Pediatr 2002;141:701-5)

The current study explored the relative contribution of exercise, coping responses, cognitive attributions, and emotional experiences to successful weight-loss maintenance in men and women. The data were collected via a large community-based survey on dieting and weight loss commissioned by Consumer Union. Men and women who met our criteria for successful (n = 277 men, n = 329 women) and unsuccessful (n = 277 men, n = 329 women) weight-loss maintenance were included in the sample. Successful weight-loss maintainers (Maintainers) reported having lost at least 10% of their highest adult weight and having maintained that weight loss for at least the three years immediately prior to the survey. Unsuccessful weight-loss maintainers (Regainers) reported not ever having been able to maintain a significant weight loss and having lost and regained a minimum of 10 to 19 pounds at least once. In response to a dietary lapse, Maintainers, as compared with Regainers, reported being more likely to use direct coping and less likely to seek help. The results imply that the most useful variables for differentiating between successful and unsuccessful weight-loss maintainers may involve how they respond to a dietary lapse.

The aim of this study was to investigate sampling bias as it affects recruited clinic samples of binge eating disorder (BED). Demographic and clinical characteristics of a recruited clinic sample were compared with a community sample. The 2 groups met the same operational definition of BED and were assessed using the same primarily interview-based methods. Ethnicity, severity of binge eating, and social maladjustment were found to increase treatment seeking among participants with BED rather than levels of psychiatric distress or comorbidity. These findings suggest that previous studies using recruited clinic samples have not biased estimates of psychiatric comorbidity in BED.

OBJECTIVE:Binge eating disorder was introduced in DSM-IV as a psychiatric disorder needing further study. This community-based study describes the relationship between race and clinical functioning in black and white women with and without binge eating disorder.METHOD:A group of 150 women with binge eating disorder (52 black, 98 white) and a race-matched group of 150 healthy comparison subjects were recruited from the community. Eating and psychiatric symptoms were assessed through interviews and self-report.RESULTS:Black and white women with binge eating disorder differed significantly on numerous eating disorder features, including binge frequency, restraint, history of other eating disorders, treatment-seeking behavior, and concerns with eating, weight, and shape. Black and white healthy comparison subjects differed significantly in obesity rates.CONCLUSIONS:For both black and white women, binge eating disorder was associated with significant impairment in clinical functioning. Yet, racial differences in clinical presentation underscore the importance of considering race in psychopathology research.

OBJECTIVE:This study examined the relationship between binge eating disorder (BED), a newly proposed eating disorder, and bulimia nervosa (BN).METHOD:Three groups recruited from the community were compared: women with BED (n = 150), women with purging BN (n = 48), and women with nonpurging BN (n = 14).RESULTS:The three groups did not differ significantly in education, weight or shape concern, and current or lifetime prevalence of nine major mental disorders. Women with BED, compared with women with purging BN, were older, less likely to have a history of anorexia nervosa, and less likely to have been treated for an eating disorder. Obesity was more commonly associated with BED than with either subtype of BN.DISCUSSION:Our results lend some support to BED as an eating disorder distinct from purging BN. More research is needed to clarify the position of nonpurging BN relative to BED and purging BN.

Objective: To examine the clinical features of subthreshold binge eating disorder (BED). Method: Participants were recruited directly from the community as part of an ongoing study of risk factors for BED. Forty-four women with subthreshold BED were compared with 44 women with BED and 44 healthy controls on demographic characteristics, body mass index (BMI), eating disorder symptomatology, and psychiatric distress. Diagnoses were established using the Eating Disorder Examination (EDE). Participants completed the EDE-Questionnaire, the Brief Symptom Inventory, and were measured and weighed. Results: Adjusting for significant group differences in BMI, the two eating disorder groups did not differ significantly on measures of weight and shape concern, restraint, psychiatric distress, and history of seeking treatment for an eating or weight problem. Discussion: Given the importance of diagnostic status for access to treatment, further evaluation of the severity criterion specified for BED is needed. (C) 2000 by John Wiley & Sons, Inc.

OBJECTIVE:This study examined eating disorders and their psychiatric comorbidity in a national sample of hospitalized male veterans.METHOD:Review of discharge summaries for 466,590 male patients from Veterans Affairs medical centers for fiscal year 1996 resulted in the identification of 98 men with a current ICD-9-CM diagnosis of an eating disorder. For the comorbidity analyses, eating disorder cases were matched with controls drawn randomly from the pool of male patients without an eating disorder, using age and race as matching variables.RESULTS:There was a high rate of comorbid substance use and mood disorder for men with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). Men with AN were also at high risk for comorbid schizophrenia/psychotic disorder, men with BN were at risk for comorbid personality disorder, and men with EDNOS were at special risk for comorbid organic mental disorder and schizophrenia/psychotic disorder.DISCUSSION:For each eating disorder, there was a distinct pattern of psychiatric comorbidity that deserves further study.