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Objective: This paper aims to examine the efficacy of virtual reality (VR)‐enhanced cognitive behavioural therapy (CBT) in the treatment of binge‐purging type eating disorders compared to CBT. Method: Four electronic literature databases were searched to retrieve eligible randomised controlled trials (RCTs). The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses was used to select eligible studies. Meta‐analyses of extracted data were then conducted by RevMan 5.3 software. Results: Six RCTs totalling 297 participants were included. Results showed significantly larger decreases in the frequency of binges in participants who underwent VR‐enhanced CBT compared to CBT. However, there was no statistically significant difference in the change in body mass index or frequency of purges. Additionally, there were significantly larger decreases in situation‐induced body dissatisfaction in participants who underwent VR‐enhanced CBT compared to CBT, but no significant difference in improvement of overall body satisfaction. Conclusion: VR‐enhanced CBT shows greater efficacy than CBT in reducing situation‐induced body dissatisfaction and frequency of binges. Our results highlight the potential of VR in helping patients develop coping strategies to food/situational triggers. Future RCTs may benefit from recruiting more participants to reduce the impact of drop‐outs on outcome data and blinding post‐intervention assessors to reduce risk of bias. HIGHLIGHTS: Patients who underwent VR‐enhanced CBT had a statistically significant larger decrease in situation‐induced body dissatisfaction compared to patients who underwent CBT, although there was no statistically significant difference in the increase in overall body satisfaction between the two groupsThere was a larger decrease in frequency of binges for patients who underwent VR‐enhanced CBT, but no statistically significant decrease in frequency of purges. There appear to be no statistically significant differences between the physical outcomes of patients undergoing VR‐enhanced CBT and CBTFurther research needs to be done on the evaluation of long‐term physical, behavioural and psychological outcome measures of VR‐enhanced CBT, but current results show promise in the potential of using VR to help patients develop coping strategies to food and situational triggers [ABSTRACT FROM AUTHOR]

Understanding the factors that influence physical activity in persons with binge eating disorders can aid the design of more effective interventions. In order to address this, the present paper provides a systematic quantitative review of the correlates of physical activity in people with binge eating disorder. We searched PsycINFO, PubMed and PEDro from inception until June 2013. Keywords included 'binge eating' with 'physical activity' or 'exercise', or 'physical inactivity' or 'sedentary'. Nine papers involving 636 (489 women) persons with binge eating disorders and evaluating 24 correlates were included. No consistent physical activity correlates were reported in four or more studies. The only significant correlate with lower physical activity participation reported in more than one study was a negative body attitude. Further research is required to address this current gap in literature. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Abstract: The aim of the current paper is to evaluate clinical characteristics of 30 children with early onset anorexia nervosa (EO‐AN; age = 12.2 ± 1.6 years) compared with 30 patients with adolescent onset AN (AO‐AN; age = 15.9 ± 0.7 years) and 60 age‐matched healthy controls. Statistical analyses included one‐way analyses of variance with three planned comparisons and chi‐square tests. Compared with AO‐AN, EO‐AN patients displayed more restrictive eating behaviour (p = 0.038), received more tube‐feeding (p = 0.024), and had less problems with self‐esteem (p < 0.001) and perfectionism (p = 0.001). EO‐AN patients have similar eating disorder pathology (p = 0.183), body‐image distortion (p = 0.060), and number of hospitalizations (p = 0.358) as AO‐AN. Only a third of EO‐AN patients suffer from low self‐esteem. Overall, core AN pathology seems similar in EO‐AN and AO‐AN. However, EO‐AN patients show differences in their pathological eating behaviour and the need for tube‐feeding. [ABSTRACT FROM AUTHOR]

Purpose The study investigates the predictive value of body image, self-esteem and gender for adolescent dieting at ages 15, 18 and 21 and whether adolescents' self-esteem moderates the relationship between body image and dieting. Method Data stem from the Norwegian Longitudinal Health Behaviour Study (NLHB study): Adult by the Year 2000 (‘Voksen i år 2000’). The NLHB study is a 10-year prospective cohort study based on self-completed questionnaires investigating health behaviour and lifestyle patterns among Norwegian adolescents. This paper presents data from Wave II (1992), Wave IV (1995) and Wave VI (1998), thus covering the ages 15, 18 and 21. Analyses are based on the 487 respondents participating at all three timepoints. Results At all ages included, 25% of the girls reported they had dieted several times over the past year, while the corresponding figure for boys was 5%. Among boys, self-esteem and body image contributed to the same extent in the prediction of dieting, while only body image proved a significant predictor among girls, increasing in importance over time. Interaction between self-esteem and body image was present among young boys (ages 15 and 18) only. Conclusions Self-esteem and body image play quite different roles in the prediction of dieting among girls and boys. The difference is not only related to strength of association between the variables, but, more importantly, to qualitatively different underlying processes. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Hilde Bruch's foundation lecture in 1982 is a milestone from which to survey current theory and treatment for anorexia nervosa. Bruch described problems in body perception, emotion processing and interpersonal relationships as core theoretical aspects of the illness and built her theory of psychopathology on these aspects, as well as on animal studies on attachment. She also noted that many psychological problems result as consequence of starvation. In the first part of this paper, we parse Bruch's clinical descriptions into elements of psychopathology (disturbances in body perception, attachment, emotion expression, perception and regulation, social comparison, interpersonal, and family and therapeutic relationships), in order to assemble and update the theoretical evidence for a model of the illness. In the second part, we describe and extend her description of three core targets of treatment: family relationships, patient's inner confusion and nutritional restoration. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Art therapy is a from of psychotherapy in which the patient's own image or artwork is the focus of interaction between the therapist and patient. This paper examines the artwork of a 27-year-old woman with a long history of anorexia nervosa with bulimic symptoms. during her in-patient treatment, she attended art therapy and body image therapy, where her ratings of her own body size were recorded. Various aspects of the psychopathology of anorexia nervosa including body image disturbance, depression and obsessive compulsive features are well illustrated her by the images produced curing art therapy. [ABSTRACT FROM AUTHOR]

Despite a substantial body of research over the last two decades the nature and role of body-image distortion in the variety of eating disorders is unclear. The purpose of the present paper is to review the evidence and largely on the basis of mare recent work to suggest a reconceptualization of the problem. Five sets of studies/observations, which are described in this paper, have led us to the following formulation: individuals suffering flora either anorexia or bulimia nervosa do not have a fixed and implacable distorted image of their own bodies, but rather have an ‘uncertain, unstable and weak body-image’, and that in making size estimation judgments they err on the side of caution and in consequence exhibit a bias towards overestimation of body size. It is further proposed that this judgemental bias is primarily influenced by social and cultural factors. The therapeutic implications of this reconceptualization are briefly highlighted. [ABSTRACT FROM AUTHOR]

Binge eating disorder (BED) is characterized by frequent binge eating without compensatory behaviour and is thus often associated with obesity. Whereas for the eating disorders anorexia nervosa and bulimia nervosa, one of the main diagnostic features is a negative body image, the research criteria for BED do not include body image disturbance. Although several studies have been conducted on the occurrence of body image disturbance in BED, no review has yet summarized and integrated these findings. Therefore, the present paper reviews studies on the cognitive-affective, perceptual and behavioural components of body image. Many of the reviewed studies reveal that individuals with BED display a higher degree of weight and shape concerns than obese persons without BED. Concerning the perceptual component, no evidence exists to date that persons with and without BED differ in terms of the perception of their own body size. While many studies have examined the cognitive-affective body image component, research on the behavioural manifestations of body image disturbance is generally lacking. However, there is first evidence that persons with BED display an enhanced degree of body checking and avoidance. The results of this review indicate that body image disturbance seems to be a symptom of BED but which still requires further exploration. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective The purpose of this paper was to review the existing literature regarding the contribution of parental influences to the sociocultural pressures on body image disturbance and disordered eating so as to highlight principal findings so that parents can be given practical information and identify areas that require further research. Methods Relevant articles were located through Pubmed, Sciencedirect and PsychInfo, as well as the screening of bibliographies. Results The available data suggest that parents are strong communicators of sociocultural pressures. Parental influences via verbal messages and active encouragement have been shown to have more impact on offspring's body concerns and eating behaviours than modelling effects. Both mothers and fathers are important sources of influence for their offspring. Conclusion Considering the role of parents could help improve public health management. Futher exploration of the way adolescents and young adults interpret and perceive parental attitudes and of potential protective factors is necessary. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

This paper examines the outcomes of 631 patients who were assessed at the Oxford Adult Eating Disorders Service between May 1994 and December 2002. After treatment, significant improvements were reported across the total sample for body mass index (BMI), the Beck Depression Inventory, the Beck Anxiety Inventory and the Robson Self Concept Questionnaire. Significant improvements were also reported for all measures of the Eating Disorder Questionnaire (EDE) and for all measures of the Eating Disorder Inventory (EDI) except for perfectionism. Patients with anorexia nervosa showed improvements in both BMI and associated psychopathology. Patients with bulimia nervosa showed a reduction in the number of self-induced vomiting occasions and the number of objective binges and improvements in the associated psychopathology. Further research is required to identify factors associated with improvements in symptomatology. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective: Eating expectancies (EE) are the anticipation of various benefits or detriments from eating, with mood regulation being a salient type of EE associated with eating disorders. This study examined the convergent and predictive validity of ecological momentary assessment (EMA) mood regulation EE items, including mood improvement and mood worsening EE. Methods: Thirty women with binge‐eating pathology completed a 14‐day EMA protocol, which included measures of mood regulation EE, affect, appetite, appearance‐ and body‐related factors and disordered‐eating behaviours. Results: Greater within‐subjects hunger and lower within‐subjects positive affect and fullness were related to elevated mood improvement EE. Higher within‐subjects appearance concerns, fullness, body social comparisons and thinness pressure were associated with higher mood worsening EE. Greater within‐subjects mood worsening EE predicted greater likelihood of vomiting at the subsequent time point, but there were no within‐subjects associations between mood improvement EE and behaviours. Yet, greater between‐subjects mood worsening EE were associated with more restraint/restriction and binge eating, and greater between‐subjects mood improvement EE were associated with more binge eating. Conclusions: Findings support the convergent validity of EMA mood regulation EE items. There was limited predictive validity evidence, suggesting complexities in how mood regulation EE predict behaviour in daily life. Highlights: The convergent and predictive validity of ecological momentary assessment (EMA) mood regulation eating expectancy (EE) items was examined.Analyses supported the convergent validity of EMA mood regulation EE items.There was limited evidence for the predictive validity of EMA mood regulation EE items. [ABSTRACT FROM AUTHOR]

Objective: Although anorexia nervosa (AN) in males has recently gained attention, knowledge of its psychological and physiological outcomes is still scarce. We explore sex‐specific characteristics of long‐term remitted AN with respect to residual eating disorder (ED) psychopathology, body image, and endocrinology. Method: We recruited 33 patients with AN in remission for at least 18 months (24 women, 9 men) and 36 matched healthy controls (HCs). Eating disorder psychopathology and body image ideals were assessed via clinical interviews, questionnaires, and an interactive 3D body morphing tool. Plasma levels of leptin, free triiodothyronine, cortisol, and sex hormones were quantified. Univariate models controlled for age and weight were used to test for the effects of diagnosis and sex. Results: Both patient groups showed residual ED psychopathology but normal weight and hormone levels relative to HCs. Male remitted patients demonstrated significantly stronger muscularity‐focused body image ideals, evident in interviews, self‐reports, and behavioural data, than both female patients and HCs. Conclusions: Sex‐specific body image characteristics in patients with remitted AN point towards the need to adjust test instruments and diagnostic criteria to male‐specific psychopathology. In the future, sufficiently powered studies should evaluate the risk of men with AN developing muscle dysmorphia in the long term. Highlights: Sex‐specific residual symptoms have been identified in long‐term remitted anorexia nervosa (AN) patients, particularly regarding body image disturbance.The drive for muscularity (DMS) in male remitted patients suggest a possible risk of transition from male AN to muscle dysmorphic disorder.Sex‐specific criteria, especially muscle‐oriented behaviour, need to be included in the description of diagnoses and symptoms in male patients. [ABSTRACT FROM AUTHOR]

Objective: Individuals who are preoccupied with food are more likely to develop maladaptive eating behaviours and eating disorders. Thus, it is advisable to investigate the factors that increase vulnerability to food preoccupation (FP) to prevent its harmful impact on physical and mental health. Our objective in this study was to investigate the relationship between body mass index (BMI) and FP in Polish women (N = 407) and examine a possible pathway through body‐related shame and body‐related guilt and self‐esteem. Method: Participants completed an abbreviated version of the Eating Attitudes Test–26, the Body and Appearance Self‐Conscious Emotions Scale, and the Rosenberg Self‐Esteem Scale. Results: The findings demonstrated a positive indirect effect of BMI on FP through body‐related shame and body‐related guilt. However, this effect was moderated by self‐esteem only for body‐related shame; namely, in women with a low or average level of self‐esteem, higher BMI was related to higher body‐related shame, which, in turn, was associated with higher levels of FP. These associations were not observed in women with a high level of self‐esteem. Discussion: Body‐related shame may help explain the relationship between BMI and FP. Moreover, self‐esteem serves as a protective factor against body‐related shame related to higher BMI and, as a result, against FP. Highlights: We investigated the relationship between body mass index (BMI) and food preoccupation (FP) including body‐related emotions and self‐esteem as potential mediators and a moderator, respectively.Both body‐related shame and body‐related guilt mediated partially the relationship between BMI and FP.Self‐esteem moderated the relationship between BMI and body‐related shame; in women with a low and an average level of self‐esteem, higher BMI was related to higher body‐related shame which, in turn, was linked to FP. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the physiological response of patients with anorexia nervosa (AN) to different types of silhouettes using pupillometry. Methods: We measured the pupil psychosensory reflex (PSR) of 42 patients with AN and 35 healthy controls in response to standardised body silhouettes and to pictures of their own silhouettes digitally modified to represent different body mass indices (BMI). Perceptual distortion and body dissatisfaction were assessed using Anamorphic Micro Software©. Twenty‐three of the recruited patients were tested up to four times during an inpatient treatment programme to assess the impact of weight gain. Results: PSR correlated with the subjective rating of emotional arousal in controls but not in patients. Own silhouettes and standardised silhouettes triggered a different pupil response both in patients with AN and in controls. With pictures of their own silhouettes, pupil response to underweight stimuli differed from pupil response to normal weight or overweight stimuli in both groups. Weight gain was associated with an increase in PSR, an improvement of ideal BMI and a decrease of body dissatisfaction, but no change in perceptual distortion. Conclusion: Our findings support the idea that pupillometry could be a useful tool to assess the physiological state of patients with AN. Key points: Standardised body silhouettes and subjects' own silhouettes trigger different pupil responses in both patients with anorexia nervosa (AN) and healthy controls.Pupil response to underweight silhouettes differs from pupil response to normal weight and overweight silhouettes.Weight gain is associated with an evolution of pupil reactivity in patients with AN. [ABSTRACT FROM AUTHOR]

Previous research has shown a gender difference in the incidence of eating disorders, with a far higher number of female sufferers. This study aimed to re-examine this gender difference, and also any difference in primary excessive exercise, based on Lerner et al.'s (1976) theoretical distinction between ‘body effectiveness’ and ‘body attractiveness’. It also considered the significance of parental styles to abnormal eating and exercising behaviour. As predicted, young adult females demonstrated significantly higher levels of disordered eating than young adult males while the reverse was the case for excessive exercise. The degree of these behavioural abnormalities was related to low body satisfaction and subjects' weight perceptions. For both sexes, mother and father overprotection was associated with low body satisfaction, and, for female subjects, disordered eating patterns. These results are discussed in relation to Lerner et al. 's (1976) theory and the models proposed by Eisler and Le Grange (1990). Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective: Eating disorders (EDs) are associated with a high prevalence of childhood maltreatment (CM). We aimed to experimentally assess if people with EDs and history of CM show altered biological, emotional and behavioural responses to the Trier Social Stress Test (TSST). Methods: According to Childhood Trauma Questionnaire cut‐off scores, 29 participants (14 with anorexia nervosa [AN] and 15 with bulimia nervosa [BN]) were classified as maltreated (Mal) ED participants while 19 participants (11 with AN and eight with BN) without CM were identified as no maltreated (noMal) ED participants. Cortisol, anxiety and hunger responses to TSST and post‐stress body dissatisfaction were measured. Results: Mal ED people showed heightened emotional reactivity, lower levels of hunger and more severe post‐stress body dissatisfaction in comparison with noMal ones. Higher cortisol production was observed in people with AN, regardless of CM history, and in those with BN and emotional CM. Emotional trauma was the main CM type contributing to the experimental differences observed in Mal ED people. Conclusions: This is the first study providing experimental and multi‐level support to the maltreated ecophenoptype hypothesis in people with EDs. These findings may promote new insights into the biological bases of EDs and provide novel therapeutic implications. Highlights: Childhood maltreatment affects psychological and biological responses to acute psychosocial stress in people with eating disorders (EDs)Emotional trauma is the main childhood maltreatment type contributing to the observed experimental differencesExperimental and multi‐level data support the identification of a maltreated ecophenoptype in people with EDs [ABSTRACT FROM AUTHOR]

Objective: This study provides a comprehensive assessment of own body representation and linguistic representation of bodies in general in women with typical and atypical anorexia nervosa (AN). Methods: In a series of desktop experiments, participants rated a set of adjectives according to their match with a series of computer generated bodies varying in body mass index, and generated prototypic body shapes for the same set of adjectives. We analysed how body mass index of the bodies was associated with positive or negative valence of the adjectives in the different groups. Further, body image and own body perception were assessed. Results: In a German‐Italian sample comprising 39 women with AN, 20 women with atypical AN and 40 age matched control participants, we observed effects indicative of weight stigmatization, but no significant differences between the groups. Generally, positive adjectives were associated with lean bodies, whereas negative adjectives were associated with obese bodies. Discussion: Our observations suggest that patients with both typical and atypical AN affectively and visually represent body descriptions not differently from healthy women. We conclude that overvaluation of low body weight and fear of weight gain cannot be explained by generally distorted perception or cognition, but require individual consideration. Highlights: Computerized tasks were used to assess the visual representation of linguistic body descriptions in patients with typical and atypical anorexia nervosa (AN) as compared with controlsPerformance suggested weight bias in all groups, but no differences between groupsIt is concluded that patients with AN apply double standards to their own and other bodies and that body image disturbance needs individual consideration [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to examine whether dissociation and attitudes towards change were associated with the psychopathology in patients with eating disorders (EDs) at 1‐year follow‐up. Method: The study included 110 females with anorexia nervosa and bulimia nervosa (48 and 62 respectively). At the beginning of the study and 1 year later, they were assessed by means of the following questionnaires: Dissociative Experiences Scale, Attitudes Towards Change (ACTA), State–Trait Anxiety Inventory, Rosenberg Self‐Esteem Scale, Beck Depression Inventory, Eating Attitude Test, Bulimic Investigatory Test Edinburgh and Body Shape Questionnaire (BSQ). Results: No statistically significant differences were found between both diagnostic groups regarding dissociation scores. The ACTA at baseline, specifically for patients in the contemplation stage, mediate the effect of dissociation on the psychopathological outcome. Discussion: These findings suggest that dissociation might be a transdiagnostic feature related to the EDs outcome. The psychotherapeutic framework must take it into account, particularly in patients in the contemplation stage. [ABSTRACT FROM AUTHOR]

Body image disturbance, consisting of an affective (body dissatisfaction) and perceptual (body distortion) component, is not only found in eating disorders, but is also present in healthy individuals, affecting their psychological well‐being and everyday life. A higher body mass index is associated with higher body dissatisfaction, whereas results in relation to body distortion are mixed. Furthermore, body dissatisfaction is associated with a weight‐related attentional bias. This study aimed to investigate the mediating role of a weight‐related attentional bias in the relationship between body mass index and body image disturbance. Forty‐one college women took part in a virtual reality and eye tracking procedure, in which the illusion of owning a virtual avatar with their body measurements was induced. During this procedure, body‐related attentional bias was measured and afterwards body image disturbance was assessed. Mediation analysis revealed that weight‐related attentional bias mediated the relationship between body mass index and body dissatisfaction (but not distortion). These findings suggest that modifying weight‐related attentional bias would be a useful treatment target for improving body dissatisfaction. In addition, virtual reality technology could serve as an innovative method for modifying attentional bias in an ecologically valid way. Highlights: This Virtual Reality and Eye‐Tracking study expands our knowledge about the relation between body mass index, body‐related attention and body image disturbances.The results suggest that attentional bias towards weight‐related body parts mediates the relation between BMI and body dissatisfaction.On the contrary, the relation between BMI and body distortion was not significant. [ABSTRACT FROM AUTHOR]

Objective: This qualitative study examines the representations of young Chinese girls and women with eating disorders (EDs) about the role of women in China, because conflicting societal values for women may foster the development of EDs there. Method: Semistructured interviews were conducted with 11 adolescent girls or young women hospitalized for an ED and with eight of their parents. Interpretative phenomenological analysis was used to explore the data. Result: Three superordinate themes emerged from the participants' narratives: the thin ideal in Chinese society; the experience of gender‐related pressure; and independence and autonomization in a changing society. The ideal of thinness prevails, both in interpersonal relationships and in social roles. Highly codified representations persist, limiting women's opportunities. The participants and their parents show substantial ambivalence about independence; the young women have real difficulty in making decisions, thus failing to adopt roles that accord with their aspirations. Discussion Young girls' and women's representations of their gender could have implications in the development of EDs, mediated by their focus on thinness and their difficulties in constructing their identity, in developing autonomy and self‐esteem, as well as family conflict. These findings indicate that construction of femininity in China is unsettled by rapid societal changes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationships between weight/shape overvaluation, health‐related quality of life (HRQoL) and functional role impairment (days out of role [DOR]) in the general population over 11 years. Method: Five cross‐sectional surveys of men and women representative of the South Australian population were conducted in 2005, 2008, 2009, 2015, and 2016 (ntotal = 15,140). Data were collected on demographics, overvaluation, HRQoL, DOR, and eating disorder behaviours. Results: Between 2005 and 2016, the prevalence of moderate overvaluation increased from 18.1% to 40.0%, marked overvaluation from 7.5% to 23.7%, and extreme overvaluation from 3.1% to 9.2% (all p < 0.001). Overvaluation at any level was associated with more DOR in 2005 but not in 2016, and the association between HRQoL impairment and overvaluation weakened over time. Conclusion: Although the population prevalence of overvaluation has increased significantly in the past decade, the impairment associated with it appears to have reduced. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the characteristics and content of intrusive images in patients with different subtypes of eating disorders (EDs). Data were collected from 74 ED patients, 22 dieting, and 29 nondieting controls. Participants completed a set of self‐report questionnaires. Intrusive images of ED patients were significantly more repetitive, detailed, vivid, and distressing than intrusive images of dieting and/or nondieting controls. Most of the intrusive images were the same for the ED subtypes; however, patients with anorexia nervosa were more likely to report an observer vantage perspective than patients with bulimia nervosa, who were more likely to report a field vantage perspective. As expected, intrusive images' content was related to body checking (weight and shape) or negative self (evaluated by themselves or others). Finally, there were significant associations between intrusive images' vividness and weight and shape concerns. These findings indicate that intrusive images may be a core element of EDs and targeting intrusive images in therapy may be helpful. [ABSTRACT FROM AUTHOR]

Eating disorders (EDs) and post‐traumatic stress disorder (PTSD) are highly comorbid. However, specific mechanisms by which PTSD‐ED comorbidity is maintained are unknown. The current study constructed two PTSD‐ED comorbidity networks (25 EDs and 17 PTSD symptoms) in two samples: a clinical (N = 158 individuals with an ED diagnosis) and a nonclinical sample (N = 300 college students). Glasso networks were constructed to identify (1) pathways between disorders (bridge symptoms) and (2) core symptoms. Three illness pathways emerged: between binge eating and irritability, between desire for a flat stomach and disturbing dreams, and between concentration problems and weight and shape‐related concentration problems. Our findings suggest that pathways between binge eating and irritability, body dissatisfaction and trauma reminders, and concentration difficulties may be the mechanisms by which comorbidity is maintained. Interventions disrupting these pathways and targeting core and bridge symptoms may be more efficient than traditional treatment approaches. [ABSTRACT FROM AUTHOR]

Background: Network analysis is increasingly applied to psychiatric populations to understand relationships among symptoms. Methods: Network analysis was applied on 955 patients with anorexia nervosa (AN; 631 restricting‐type [ANR] and 324 binge eating‐/purging‐type [ANBP]), assessed with Symptom Check‐List 90 (SCL‐90), Eating Disorder Inventory (EDI), and Tridimensional Personality Questionnaire. Results: Depression, anxiety, interpersonal sensitivity (SCL‐90), and ineffectiveness (EDI) had the highest centrality (strength from 1.19 to 1.35 in ANBP, and from 1.15 to 1.51 in ANR). Body mass index (BMI) had low centrality (0.14 ANBP and 0.41 ANR). Drive for thinness showed the strongest correlation with central nodes in ANBP (correlation around 0.44) and ANR (correlation range 0.38–0.47), and drive for thinness had higher centrality in ANR (1.15) than in ANBP (0.81), whereas body dissatisfaction in ANBP (0.73) than in ANR (0.61). Discussion: In addition to ED‐core symptoms, psychiatric comorbid symptoms should be the focus of specific treatments in patients with AN, independently from BMI. [ABSTRACT FROM AUTHOR]

This study uses novel biometric figure rating scales (FRS) spanning body mass index (BMI) 13.8 to 32.2 kg/m2 and BMI 18 to 42 kg/m2. The aims of the study were (i) to compare FRS body weight dissatisfaction and perceptual distortion of women with anorexia nervosa (AN) to a community sample; (ii) how FRS parameters are associated with questionnaire body dissatisfaction, eating disorder symptoms and appearance comparison habits; and (iii) whether the weight spectrum of the FRS matters. Women with AN ( n = 24) and a community sample of women ( n = 104) selected their current and ideal body on the FRS and completed additional questionnaires. Women with AN accurately picked the body that aligned best with their actual weight in both FRS. Controls underestimated their BMI in the FRS 14-32 and were accurate in the FRS 18-42. In both FRS, women with AN desired a body close to their actual BMI and controls desired a thinner body. Our observations suggest that body image disturbance in AN is unlikely to be characterized by a visual perceptual disturbance, but rather by an idealization of underweight in conjunction with high body dissatisfaction. The weight spectrum of FRS can influence the accuracy of BMI estimation. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Previous research has indicated that exposure to pro-eating disorder websites might increase eating pathology; however, the magnitude of this effect is unknown. This study aimed to conduct a systematic review and meta-analysis to examine the effect of exposure to pro-eating disorder websites on body image and eating pathology. Studies examining the relationship between exposure to pro-eating disorder websites and eating pathology-related outcomes were included. The systematic review identified nine studies. Findings revealed significant effect sizes of exposure to pro-eating disorder websites on body image dissatisfaction (five studies), d = .41, p = .003; dieting (six studies), d = .68, p < .001, and negative affect (three studies), d = 1.00, p < .001. No effect emerged for bulimic symptoms (four studies), d = .22, p = .73. Findings confirmed the effect of pro-eating disorder websites on body image and eating pathology, highlighting the need for enforceable regulation of these websites. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

High levels of body dissatisfaction have already been reported in the trans population; however, the root of this dissatisfaction, and its association with eating disordered behaviours, has not been studied in-depth. This study aims to assess eating disorder risk by comparing 200 trans people, 200 people with eating disorders and 200 control participants' scores on three subscales of the Eating Disorders Inventory-2 (EDI-2) and to further explore dissatisfaction in the trans participants using the Hamburg Body Drawing Scale (HBDS). The results showed that overall participants with eating disorders scored higher than trans or control groups on all EDI-2 measures, but that trans individuals had greater body dissatisfaction than control participants and, importantly, trans males had comparable body dissatisfaction scores to eating disordered males. Drive for thinness was greater in females (cis and trans) compared with males. In relation to HBDS body dissatisfaction, both trans males and trans females reported greatest dissatisfaction not only for gender-identifying body parts but also for body shape and weight. Overall, trans males may be at particular risk for eating disordered psychopathology and other body image-related behaviours. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

This study examined the associations between conscientious perfectionism (high standards), self-evaluative perfectionism (self-criticism) and eating psychopathology among dancers. A sample of 244 female dancers, with a mean age of 20.11 years (standard deviation = 1.97) completed the Perfectionism Inventory and Eating Disorder Examination Questionnaire. Self-evaluative perfectionism predicted eating psychopathology (eating restraint, eating concern, weight concern and shape concern). This relationship was not moderated by conscientious perfectionism. The mediation analyses showed that although conscientious perfectionism predicted eating psychopathology, this relationship was fully mediated by self-evaluative perfectionism. These findings demonstrate the greater influence of self-evaluative perfectionism, rather than conscientious perfectionism, on eating psychopathology in dancers. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Although there is evidence that childhood perfectionistic traits predate the onset of eating disorders, few studies to date have examined the prevalence and clinical correlates of these traits in patients with anorexia nervosa (AN) and their unaffected sisters. The aim of this work was to study the prevalence of childhood obsessive-compulsive traits in patients with lifetime AN, their unaffected sisters and healthy women. A total of 116 AN patients, 32 healthy sisters and 119 controls were assessed by the EATATE Interview to assess traits such as perfectionism, inflexibility, rule-bound traits, drive for order and symmetry, and excessive doubt and cautiousness. Both self-report and maternal reports were collected. AN patients reported more childhood obsessive-compulsive traits than their healthy sisters and controls. In contrast, no differences between healthy controls and unaffected sisters emerged. In patients with AN, a dose-response relationship was found between the number of childhood obsessive-compulsive traits and psychopathology, including body image distortion, thus indicating that these traits are an important feature to be considered in assessing and treating eating disorders. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective To determine the efficacy of 10 session body image therapy (BAT-10) in the treatment of anorexia nervosa with adherence to the methodological guidance for complex interventions. Method Fifty-five adult inpatients with anorexia nervosa at two national centres received the group-based manualised body-image therapy (BAT-10). BAT-10 was refined, developed and manualised over two decades, by using the mindfulness-based cognitive behavioural therapy, including mirror exposure. Outcomes were evaluated using Body Checking Questionnaire, Body Image Avoidance Questionnaire, Physical Appearance State and Trait Anxiety Scale, Eating Disorders Examination Questionnaire and Quality of Life in Eating Disorders. Participant experience was evaluated qualitatively by an interpretative phenomenological analysis. Results Ten session body image therapy achieved highly statistically significant changes in body checking, body avoidance and anxiety, as well as shape-concern and weight-concern, without the between-therapist effects. The quality of life improved globally but not in relation to the psychological subcategory. Discussion Ten session body image therapy delivers behavioural and cognitive improvements in body image in the short-term, suggesting an effective, feasible and acceptable manual-based therapy. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

The characteristics of the cognitive processing of food, body and emotional information in patients with anorexia nervosa (AN) are debatable. We reviewed functional magnetic resonance imaging studies to assess whether there were consistent neural basis and networks in the studies to date. Searching PubMed, Ovid, Web of Science, The Cochrane Library and Google Scholar between January 1980 and May 2012, we identified 17 relevant studies. Activation likelihood estimation was used to perform a quantitative meta-analysis of functional magnetic resonance imaging studies. For both food stimuli and body stimuli, AN patients showed increased hemodynamic response in the emotion-related regions (frontal, caudate, uncus, insula and temporal) and decreased activation in the parietal region. Although no robust brain activation has been found in response to emotional stimuli, emotion-related neural networks are involved in the processing of food and body stimuli among AN. It suggests that negative emotional arousal is related to cognitive processing bias of food and body stimuli in AN. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective Studies have established a link between shame and eating disorder symptoms but have generally been cross-sectional or failed to differentiate between general shame and bodily shame. The present study addressed both these issues. Design This study used a longitudinal panel design. Method Fifty-five women with a past or current eating disorder participated. They completed measures of eating pathology, depression, general shame (internal and external) and bodily shame (current feelings of bodily shame as well as bodily shame that is anticipated were the individual to gain weight) and were followed up over 2.5 years. Results Bodily shame uniquely predicted an increase in anorexic (but not bulimic) symptoms. Current bodily shame predicted an increase in the degree of underweight and the misperception of body size. Anticipated bodily shame predicted an increase in fear of weight gain. Discussion Current versus anticipated bodily shame predicts different anorexic symptoms. Both therefore should be considered in developing interventions and aetiological models of anorexia nervosa. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to examine symptoms of eating disorders (ED), drive for muscularity and physical activity in a Norwegian adolescent population. Methods A total of 722 adolescents aged 12-18 years (response rate: 83%) filled out a questionnaire containing the Drive for Muscularity Scale, Eating Disorders Inventory subscales Drive for Thinness (EDI-DT), Body Dissatisfaction (EDI-BD) and Bulimia (EDI-B), and questions about amount of and motives for physical activity. Results Eating Disorders Inventory subscale scores were higher, and Drive for Muscularity Scale Score (DMS) scores were lower among girls compared with boys. EDI and DMS were correlated with motives for, but not amount of, physical activity. EDI and DMS were associated in boys, not girls. Discussion The associations between EDI and DMS among boys call for a wider approach when examining ED among boys. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective To determine if male and female eating disorders differ in clinics, psychopathology and personality traits when compared with a healthy group. Methods Sixty male and 60 female eating disorder individuals (16% anorexia nervosa, 42% bulimia nervosa and 42% eating disorder not otherwise specified), matched for age and diagnostic, were compared with 120 healthy-eating participants (60 male and 60 female participants). All were diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Assessment measures included Eating Disorder Inventory-2, Symptom Checklist-Revised and Temperament and Character Inventory-Revised, as well as other clinical and psychopathological indices. Results Male eating disorder participants reported significant lower laxative abuse ( p = 0.020) and significant higher vomiting episodes ( p = 0.019) than female eating disorder participants. Differences on drive for thinness, body dissatisfaction and some Symptom Checklist-Revised scales were found across genders in eating disorder participants. Male eating disorder participants scored significantly lower than female participants with eating disorders on harm avoidance, reward dependence and cooperativeness. Conclusions Although eating disorder clinical features were similar across genders, male eating disorder participants had less body image concern and general psychopathology than female eating disorder participants. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

A cross-cultural comparison of a cognitive-behavioural, Internet-based, 8-week prevention programme for eating disorders (StudentBodies™) evaluated in the USA and in Germany was performed. Six US and four German randomized controlled trials with a total ( N) of 990 female high school and college students were included in the review. Two of the US and two of the German trials explicitly addressed high risk samples in a selective prevention approach. Effect sizes for main outcomes (disordered eating, weight and shape concerns) were calculated at postintervention and at follow-up. The intervention was associated with moderate improvements in eating disorder-related attitudes, especially reductions of negative body image and the desire to be thin. The reported effects remained significant at follow-up. No clear differences between US and German samples could be found on any of the outcome measures at postintervention. In conclusion, StudentBodies™ seems equally suitable and effective for American and German students. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective To assess the relationship between childhood sexual and physical abuse, and key attitudinal and behavioural aspects of eating disorders (ED). Method Participants included 708 female undergraduates in a Spanish public university, aged from 18 to 30. Abuse was measured by the Traumatic Life Events Questionnaire, and ED by the Eating Disorders Examination Questionnaire (EDE-Q). Results 14.3% of the sample had suffered childhood sexual abuse (CSA) and 3.8% childhood physical abuse (CPA). With respect to ED attitudinal features, we observed an increased Weight Concern score among CSA survivors. No association was found between this kind of abuse and disordered eating behaviours, after adjusting for depression, anxiety, self-esteem, body mass index, age and socioeconomic status. An inverse relationship was found between CPA and ED attitudes measured by EDE-Q (Restraint, Weight Concern, Shape Concern and the Overall Score), whereas no association was found with the behavioural aspects of eating disturbances. Discussion After controlling for different risk factors, CSA appears to be related to an increased Weight Concern, whilst other ED attitudinal features and behaviours do not seem to be related to childhood abuse. The inverse relationship found is discussed. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

The present study investigated the contribution of a contextual body image perspective to understanding disordered eating in high performance women athletes. Because existing questionnaires were not suitable for measuring body image in the contexts of sport and daily life, we developed the 'Contextual Body Image Questionnaire for Athletes' (CBIQA) in which body image is divided into 'appearance', 'muscularity', 'thin-fat self-evaluations' and 'thin-fat perceived opinions of others', in both contexts. In Study 1, the internal validity and reliability of this questionnaire was established in a general, heterogeneous sample of female sport participants and exercisers. In Study 2, the external validity was determined in a sample of 52 high performance women athletes who mainly participated in aesthetic or endurance sports, 19 of which were classified with and 33 without disordered eating. The results of Study 2 showed that both 'thin-fat self' and 'thin-fat opinions of others' in sport made significant unique contributions to explaining eating disorder variance, indicating the important role of athletic body image. In conclusion, the contextual body image approach seems to be a promising framework for a better understanding of athletes' disordered eating. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the association between disordered eating behaviours/attitudes and mass media exposure in a cross-sectional national survey of 1165 Spanish secondary students (age between 14 and 16 years). A battery of questionnaires were used to investigate mass media influence, body dissatisfaction, physical appearance, sociocultural attitudes and self-esteem. Likewise, the EAT-26 questionnaire was used to assess disordered eating behaviours/attitudes, identifying that 6.6% (n = 32) of the male and 13.6% (n = 68) of the female students reached a cut-off point of 20 or above. The main finding was that female and male adolescents with disordered eating showed an increased exposure to TV and magazine sections related to body image, specifically regarding music video channels, in comparison with those without eating disordered, gender-matched counterparts. However, findings indicate that media exposure was different to some degree between males and females with disordered eating behaviour. Males with disordered eating behaviours and attitudes were associated with higher TV and magazine exposure to health sections and also greater body dissatisfaction, internalisation of the thin-ideal and social and appearance comparison. In females, disordered eating was associated with higher TV and magazine exposure to dieting, fashion and sport sections, greater body dissatisfaction, internalisation and awareness of the thin-ideal and lower self-esteem. Understanding the mechanism involved in the media exposure's influence on adolescents is critical in preventing disordered eating. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

This review had two aims. The first aim was to describe the existing literature regarding body dissatisfaction across cultures. Previous studies were organized and presented according to three general patterns found in the existing literature, patterns that were to some extent based on the differing degrees of affluence and type of lifestyles in the cultures examined. The review's second aim was to illuminate some of the specific problems that studies of body dissatisfaction across cultures deal with and to provide suggestions for improvement. The suggestions concern how future research may achieve a more inclusive and detailed picture of body dissatisfaction across cultures, for instance by using diversified measurements, providing detailed information about the cultural groups that are examined, investigating how different risk factors may influence the level of body dissatisfaction in different cultures and widening the research geographically. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

The author talks about the assumption that anorexia nervosa (AN) is a disorder of body image. The embarrassment and humiliation of body image therapies experienced by the author is described. The author suggests that AN is more powerfully related to identity than to body image. He believes that AN predominates in Western society because life in general there is more complicated than in developing countries.

This study examined the nature of extreme weight loss behaviours among overweight and normal weight adolescents. Body mass index (BMI), body dissatisfaction, body importance, pubertal timing, negative affect, bulimic symptoms, food supplements and exercise dependence were evaluated at Time 1 and 16 months later at Time 2 among 788 adolescents. There were a large number of differences in the strategies adopted by overweight adolescents, and these remained relatively stable over time. In addition, girls engaged in more bulimic symptoms than boys; particularly overweight girls. Negative affect was also a major predictor of health risk behaviours for overweight adolescent boys and girls. Implications of these findings for the treatment of extreme weight loss behaviours among overweight adolescents are discussed. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective To explore metacognition in women with anorexia nervosa (AN), dieting and non-dieting women. Method A cross-sectional study between groups design compared women with AN (n = 15), normal dieters (n = 17) and non-dieters (n = 18). A semi-structured interview was used to explore presence and content of explicit metacognitions and use of metacognitive control strategies. Results Explicit metacognitions and metacognitive control strategies were present in all three groups of women. There were group differences in amount and function of metacognitive activity and trends in the qualitative data suggested participants with AN believed that their thoughts were abnormal and uncontrollable. They used six metacognitive strategies more than control groups and were less successful at using thought re-appraisal and attending to body and others. Half of participants with AN reported using these strategies to deliberately make themselves feel worse. Discussion It is suggested that metacognitive activity may play a role in the maintenance of AN, particularly in reinforcing negative self-evaluations. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to explore the subjective accounts of weight-recovered female patients, who met DSMIV criteria for anorexia nervosa (AN), regarding their views of their illness following weight restoration. Method Qualitative semi-structured interviews were administered to 15 participants to ascertain their perspective of the factors that either contributed to their maintaining a healthy weight, or the factors involved in their having relapsed over the follow-up period. Results Qualitative analyses revealed six core categories: internal motivation to change, recovery as a work in progress, the perceived value of the treatment experience, developing supportive relationships, awareness and tolerance of negative emotion and self-validation. Discussion This study provides valuable information about the way in which AN patients experience their illness and highlight the factors that help or hinder recovery. These findings may help enhance relapse prevention programs and potentially enhance our ability to identify and target those individuals at the greatest risk of relapsing. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

This study used interviews and qualitative analyses to investigate the nature of the messages that preschool children receive from mothers and teachers about their bodies, general appearance, exercise and eating practices. Participants were 10 female teachers and 53 mothers. The behaviours of the 53 children (24 boys, 29 girls) were also observed to determine the nature of their eating and exercise behaviours. The results demonstrated that both mothers and teachers expressed concerns about their own bodies. Mothers also communicated messages to their daughters about losing weight and messages to their sons about increasing their muscles. Both girls and boys were concerned about their appearance, particularly their clothes and hair. Girls also demonstrated some concerns about losing weight, and boys with increasing muscles. Implications of these results are discussed in terms of designing education programs for mothers, teachers and children to prevent the development of body image concerns and disordered eating among children. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Body image disturbance is both a risk factor for the development of disturbed eating and a central feature of clinical eating disorders. This review examines empirically tested interventions for people with high levels of body image disturbance. The most commonly used therapies with the most empirical support are cognitive-behavioural. The specificity of the body image interventions and the importance of individual components have not yet been established. Prevention programmes to address body image disturbance appear promising, although further research evidence is required. It is concluded that treatments for addressing body image disturbance are hindered by the lack of a clearly specified theoretical model of the maintenance of body image disturbance and that such an analysis is needed to increase the effectiveness of current interventions. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Background Changes of perceptual body size distortion and body dissatisfaction during inpatient psychosomatic treatment were assessed. Differences between patients with anorexia and bulimia nervosa were compared. Methods Forty-one female patients with anorexia and 37 with bulimia nervosa were examined at beginning and end of an inpatient psychosomatic treatment. Body images were assessed by the somatomorph matrix and by the Eating Disorder Inventory (EDI-2). Results Both groups showed a distorted body size perception at the beginning of treatment. This decreased with the bulimia patients, with anorexia patients it largely remained in spite of a successful increase in weight. With bulimia patients body satisfaction improved, whereas it hardly changed with anorexia patients. Conclusion Bulimia patients were able to positively modify their body images. Treatment might have enabled patients with anorexia to maintain their level of body satisfaction and to tolerate a bigger perceived body image while they significantly gained weight. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective To critically review the literature examining the impact of acculturation, socio-economic status, family functioning and psychological control in relation to eating and body image disturbances across cultures. Method A review of the literature on eating disorders, eating and body image disturbances, psychological control, body composition, socio-economic status and family functioning on different cultural groups. Results Of the empirical studies undertaken, few investigated a cultural group's eating pathology in both its country of origin and a Western country using the same methodology. To date, the research findings are mixed and it is still unclear if the presentation of an eating disorder differs across cultures. Acculturation has not been consistently taken into consideration and psychological control has not been examined in relation to eating disturbances in non-Western groups. Discussion This review focuses on some of the methodological limitations of previous research and attempts to delineate the salient issues which warrant further scientific enquiry. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

The overestimation of body size has been suggested to play an important role in the maintenance of anorexia nervosa. It has been assessed in a variety of ways and the aim of this review is to present a comprehensive and critical appraisal of body size estimation in eating disorders. The review starts by classifying the different methods used to assess the estimation of body size, and considers factors that have been shown to influence it. The signal detection approach to body size estimation is examined and the impact of body size estimation on treatment outcome is reviewed. It is concluded that the significance of body size estimation research in the understanding and treatment of eating disorders can only be determined by combining ecologically valid assessment methods with state-of-the-art interventions. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

This study compared the factorial structure of the self-report inventory SATAQ (Sociocultural Attitudes Towards Appearance Questionnnaire) (Heinberg, Thompson, & Stormer, 1995) when administered to two samples of girls, one in Italy and a second in Australia. The measure was translated into Italian and its back-translation carefully checked to ensure equivalence of meaning. Participants were 172 Australian and 171 Italian female undergraduate students. Their responses were scored according to the authors' instructions. Following Heinberg et al. (1995), a principal components factor analysis with promax oblique rotation was conducted. A two-factor solution that essentially replicates that of Heinberg et al. was produced for the Australian data. However, a more clearly interpretable solution for the Italian responses involved three factors. We discuss the significance of the findings in terms of the utility of the instrument for research and for clinical intervention. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

My original article on bulimia nervosa appeared in the August 1979 issue of Psychological Medicine. It is timely to examine whether the description of this new disorder and the formulated diagnostic criteria have stood the test of time. A similar question is whether it was right to describe the new syndrome as an ominous variant of anorexia nervosa. The answers to these questions should really be given by other investigators. My own view is that the main clinical description and the diagnostic criteria of bulimia nervosa have proved reasonably robust, as has its close relationship to anorexia nervosa. On the other hand, my view about the ominous nature of bulimia nervosa was unduly pessimistic. The original description of bulimia nervosa had a significant impact on the clinical and scientific literature, which showed an accelerated growth during the 1980s, largely due to articles on bulimia and bulimia nervosa. The historical question ‘Is bulimia nervosa a new disorder?’ has hitherto been neglected. The evidence for answering this question in the affirmative is very strong and is derived from searches of the older psychiatric literature as well as more recent cohort studies which throw light on when the new syndrome burst from the blue upon modern society. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]