Search

Objective: The YBC-EDS is a semistructured interview assessing core preoccupations and rituals related to eating disorders., Method: We developed and conducted an examination of the reliability and validity of a self-report questionnaire (SRQ) version of the YBC-EDS. Convergent validity of YBC-EDS-SRQ with the YBC-EDS was examined for 112 eating disordered patients., Results: All subscales and total scores were significantly intercorrelated. Thirty-one additional patients completed YBC-EDS-SRQ at admission and again 1 week later. All correlations revealed significant test-retest reliability. Discriminant validity of the SRQ was evaluated for a smaller subset of participants who completed the Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI). There were no significant correlations between various symptom dimensions of the YBC-EDS-SRQ and the BDI and STAI., Discussion: Taken together, these findings indicate that the self-report form of the YBC-EDS is both valid and reliable. The SRQ can serve as a useful and efficient assessment of eating disorder patients for clinicians and researchers., (Copyright © 2012 Wiley Periodicals, Inc.)

Objective: To examine the moderating effect of trait affective lability on the relationship between past suicidal behavior and future nonsuicidal self-injury (NSSI)., Method: A total of 127 adult females diagnosed with bulimia nervosa took part in this study. We hypothesized that individuals with greater levels of self-reported trait affective lability and a greater number of past suicide attempts would engage in a greater number of NSSI episodes over the course of 2 weeks than would individuals lacking elevations in one or both of those variables, controlling for average level of negative affect and affective lability as measured through ecological momentary assessment (EMA)., Results: The two-way interaction of trait affective lability and past suicidal behavior predicted participants' number of NSSI episodes during the course of the study., Discussion: Interaction of self-reported trait affective lability and past suicidal behavior may exhibit clinical utility in the prediction of patients' imminent risk of engaging in NSSI., (Copyright © 2011 Wiley Periodicals, Inc.)

Context: Anecdotal reports suggest bariatric surgery may increase the risk of alcohol use disorder (AUD), but prospective data are lacking., Objective: To determine the prevalence of preoperative and postoperative AUD, and independent predictors of postoperative AUD., Design, Setting, and Participants: A prospective cohort study (Longitudinal Assessment of Bariatric Surgery-2) of adults who underwent bariatric surgery at 10 US hospitals. Of 2458 participants, 1945 (78.8% female; 87.0% white; median age, 47 years; median body mass index, 45.8) completed preoperative and postoperative (at 1 year and/or 2 years) assessments between 2006 and 2011., Main Outcome Measure: Past year AUD symptoms determined with the Alcohol Use Disorders Identification Test (indication of alcohol-related harm, alcohol dependence symptoms, or score ≥8)., Results: The prevalence of AUD symptoms did not significantly differ from 1 year before to 1 year after bariatric surgery (7.6% vs 7.3%; P = .98), but was significantly higher in the second postoperative year (9.6%; P = .01). The following preoperative variables were independently related to an increased odds of AUD after bariatric surgery: male sex (adjusted odds ratio [AOR], 2.14 [95% CI, 1.51-3.01]; P < .001), younger age (age per 10 years younger with preoperative AUD: AOR, 1.31 [95% CI, 1.03-1.68], P = .03; age per 10 years younger without preoperative AUD: AOR, 1.95 [95% CI, 1.65-2.30], P < .001), smoking (AOR, 2.58 [95% CI, 1.19-5.58]; P = .02), regular alcohol consumption (≥ 2 drinks/week: AOR, 6.37 [95% CI, 4.17-9.72]; P < .001), AUD (eg, at age 45, AOR, 11.14 [95% CI, 7.71-16.10]; P < .001), recreational drug use (AOR, 2.38 [95% CI, 1.37-4.14]; P = .01), lower sense of belonging (12-item Interpersonal Support Evaluation List score per 1 point lower: AOR, 1.09 [95% CI, 1.04-1.15]; P = .01), and undergoing a Roux-en-Y gastric bypass procedure (AOR, 2.07 [95% CI, 1.40-3.08]; P < .001; reference category: laparoscopic adjustable gastric band procedure)., Conclusion: In this cohort, the prevalence of AUD was greater in the second postoperative year than the year prior to surgery or in the first postoperative year and was associated with male sex and younger age, numerous preoperative variables (smoking, regular alcohol consumption, AUD, recreational drug use, and lower interpersonal support) and undergoing a Roux-en-Y gastric bypass procedure.

Research suggests that loss of control (LOC) while eating (the sense that one cannot control what or how much one is eating) is a more salient feature of binge eating than the amount of food consumed. This study examined the unique contributions of LOC and episode size to negative affect surrounding eating episodes in binge eating disorder (BED) and obesity. Twenty-two obese adults with (n = 9) and without (n = 13) BED completed daily records of eating patterns and mood using ecological momentary assessment (EMA). Linear mixed modeling revealed that across groups, greater premeal self-reported LOC was associated with higher premeal negative affect independent of episode size. For individuals with BED, greater premeal self-reported LOC was associated with higher postmeal negative affect, regardless of the amount of food eaten, whereas for obese controls, the combination of LOC and consumption of large amounts of food was associated with lower postmeal negative affect. Results indicate that LOC, but not the quantity of food consumed, is associated with momentary distress related to aberrant eating in BED. Findings also highlight the need for further research investigating the emotional context surrounding aberrant eating in obese individuals without BED.

Objective: To develop and evaluate an instrument to assess severity in anorexia nervosa (AN), the Clinician Administered Staging Instrument for Anorexia Nervosa (CASIAN)., Method: Candidate items for the CASIAN were developed in three phases (domain, content, and item generation) followed by a pilot study. The psychometric properties of the resultant 34-item questionnaire were investigated in cross-sectional and longitudinal samples (N = 171) with DSM-IV AN and subthreshold AN., Results: Item and factor analysis procedures resulted in a refined 23-item CASIAN comprising of six factors ("Motivation," "Weight," "Illness Duration," "Obsessionality," "Bulimic Behaviors," and "Acute Issues"). The CASIAN had high internal consistency (.811), test-retest (.957), and interrater reliability (.973). Preliminary support for the convergent, discriminant, concurrent, and predictive validity of the CASIAN was found., Discussion: The CASIAN is a psychometrically sound instrument. Further studies are needed to confirm the factor structure and assess its clinical and research utility., (Copyright © 2011 Wiley Periodicals, Inc.)

Background: This study characterizes the walking limitations of bariatric surgery candidates by age and body mass index (BMI) and determines factors independently associated with walking capacity. The setting was multi-institutional at research university hospitals in the United States., Methods: Participants of the Longitudinal Assessment of Bariatric Surgery study (n=2458; age 18-78 yr, BMI 33-94 kg/m(2)) attended a preoperative research visit. Their walking capacity was measured by self-report and the 400 m Long Distance Corridor Walk (LDCW)., Results: Almost two thirds (64%) of subjects reported limitations with walking several blocks, 48% had an objectively defined mobility deficit, and 16% reported at least some walking aid use. In multivariate analysis, BMI, older age, lower income, and greater bodily pain were independently associated (P < .05) with walking aid use, physical discomfort during the LDCW, an inability to complete the LDCW, and a slower time to complete the LDCW. Female gender, Hispanic ethnicity (but not race), greater heart rate at rest, a history of smoking, several co-morbidities (history of stroke, ischemic heart disease, diabetes, asthma, sleep apnea, venous edema with ulcerations), and depressive symptoms were also independently related (P < .05) to at least one measure of reduced walking capacity., Conclusions: Walking limitations are common in bariatric surgery candidates, even among the least severely obese and youngest patients. Physical activity counseling must be tailored to individuals' abilities. Although several factors identified in the present study (eg, BMI, age, pain, co-morbidities) should be considered, directly assessing the patient's walking capacity will facilitate appropriate goal setting., (Copyright © 2012 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

The purpose of this study was to examine the relationship between caloric restriction (CR) and binge eating (BE) using ecological momentary assessment (EMA). Participants included 133 women with bulimia nervosa (BN) who completed an EMA protocol for 2 weeks. Logistic regression analyses tested whether CR increased the probability of BE episodes. The results revealed that the odds of BE increased on the day that restriction occurred as well as on the following day. In addition, both restriction and BE on one day predicted the likelihood of BE the subsequent day, but restriction for two days prior to the episode failed to add additional information for predicting BE. These findings support the cognitive behavioral therapy (CBT) model of BN, suggesting that self-reported dietary restriction is predictive of subsequent BE episodes, and that reducing dietary restriction in treatment may lead to improvements in bulimic symptoms., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the psychometric properties of a German version of the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire., Method: IWQOL-Lite scores were obtained from 351 overweight/obese individuals and 127 lean adult volunteers. In addition, a subgroup of 126 obese subjects completed also the German versions of the 36-item short-form health survey (SF-36), the Beck Depression Inventory (BDI), the Eating Disorder Examination-Questionnaire (EDE-Q), and the German validated version of the Three-Factor Eating Questionnaire (TFEQ)., Results: The German version of the IWQOL-Lite has psychometric properties comparable to those found for the original version and demonstrates high internal consistency and excellent construct validity. Furthermore, the German IWQOL-Lite clearly discriminates between groups based on BMI on all subscales and the total score., Conclusion: The results of the present study suggest that the German IWQOL-Lite is a psychometrically validated instrument with which to measure weight-specific health related quality of life., (© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York.)

Affective lability has been linked to several maladaptive behaviors (Anestis et al., 2009; Coccaro, 1991). Methodology for measuring affective lability varies and includes retrospective self-report and ecological momentary assessment (EMA). In this study, we sought to test these methodologies by examining which better predicted binge eating episodes and general eating disorder symptoms in a sample (n = 131) of women diagnosed with bulimia nervosa (BN). We hypothesized that, while the two forms of measurement would be correlated with one another and predict binge eating episodes, EMA affective lability would be the stronger predictor. Results supported several hypotheses. Specifically, both EMA affective lability and retrospective self-report affective lability significantly predicted global eating disorder symptoms, even when controlling for depression, age, body mass index, and level of education, EMA affective lability exhibited a significantly stronger correlation with binge eating episodes than did retrospective self-report affective lability, and EMA affective lability predicted number of binge eating episodes on any given day controlling for the same list of covariates. Limitations include the use of a clinical sample that may limit the generalizability of our findings. Findings highlight the importance of affect in such behavior., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Objective: This review attempted to examine the validity and clinical utility of the DSM-IV binge eating disorder (BED) diagnosis across a wide range of validating strategies., Method: Various electronic databases (Pub Med, Psych Info) were searched for terms relevant to the diagnosis of BED (e.g., binge eating disorder, binge eating) in order to identify papers. Additionally, published papers were reviewed in order to locate additional manuscripts and papers that were presented at meetings., Results: The validity and utility of BED varied substantially according to the validator chosen. There is reasonable evidence that BED can be differentiated from other existing eating disorders and is associated with significant impairment and clinical levels of eating disorder psychopathology. The relationship of BED to obesity is complex, and in spite of some positive findings, further research examining the predictive power of BED, beyond the simple presence of obesity and associated psychopathology, in relationship to clinically relevant outcomes is needed., Discussion: Binge eating disorder is being considered for inclusion in the DSM-V and various options regarding this decision are reviewed based upon the empirical findings in the paper.

Laboratory studies have shown considerable differences between the eating behavior, particularly binge eating behavior, of participants with and without binge eating disorder (BED). However, these findings were not replicated in two field experiments employing ecological momentary assessment (EMA) in which obese BED and obese non-BED participants reported comparable binge eating behavior. In the current study, we examined differences in binge eating with an innovative assessment scheme employing both EMA and a standardized computer-based dietary recall program to avoid some of the limitations of past laboratory and field research. Obese BED, obese non-BED, and non-obese control participants reported significant differences in eating patterns, loss of control, overeating, and binge eating behavior. Of particular importance was the finding that BED participants engaged in more overeating and more binge eating episodes than non-BED participants. These findings suggest that the use of EMA in combination with dietary recall may be a relatively objective and useful approach to assessing binge eating behavior. The findings further suggest that individuals with BED are observably different from those without the disorder, which may have implications for eating disorder diagnoses in DSM-V.

Increasing empirical evidence supports the validity of binge eating disorder (BED), a research diagnosis in the appendix of DSM-IV, and its inclusion as a distinct and formal diagnosis in the DSM-V. A pressing question regarding the specific criteria for BED diagnosis is whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape and weight. This study compared features of eating disorders in 436 treatment-seeking women comprising four groups: 195 BED participants who overvalue their shape/weight, 129 BED participants with subclinical levels of overvaluation, 61 BN participants, and 51 participants with sub-threshold BN. The BED clinical overvaluation group had significantly higher levels of specific eating disorder psychopathology than the three other groups which did not differ significantly from each other. Findings suggest that overvaluation of shape and weight should not be considered as a required criterion for BED because this would exclude a substantial proportion of BED patients with clinically significant problems. Rather, overvaluation of shape and weight warrants consideration either as a diagnostic specifier or as a dimensional severity rating as it provides important information about severity within BED.

Objective: The present study examined ecological momentary assessments of binge/vomit behavior, mood, and type and severity of stressors in a sample of 133 women with bulimia nervosa., Method: Participants completed an ecological momentary assessment protocol for a period of 2 weeks., Results: Mixed-effects and multilevel logistic models revealed significant variation across time of day and day of the week in the occurrence of binging, vomiting, positive and negative affect, and the severity and types of stressful events., Discussion: These findings explicate how momentary and daily experiences vary in the natural environments of women with bulimia nervosa, and document critical time periods for intervention.

Objective: To examine the caloric intake in women with anorexia nervosa (AN) and how it varies by day as a function of the presence or absence of binge eating and/or purging behaviors., Method: Female participants with AN (n = 84, mean age = 24.4, range 18-51) were recruited from three different sites. Data on food intake were obtained through the use of 24-h dietary recall using the Nutritional Data Systems for Research, and data on binge eating and purging behaviors were collected on palmtop computers using an ecological momentary assessment paradigm. Daily macronutrient intake was compared on days during which binge eating and/or purging behaviors did or did not occur., Results: On days during which binge eating and purging behaviors both occurred, participants reported significantly greater kilocalorie intake when compared with days when neither behavior occurred, or when only binge eating or purging occurred. Binge eating episodes were only modest in size on days when purging did not occur. Energy intake overall was higher than expected., Discussion: Intake on days where binge eating occurred varied dramatically based on whether or not purging occurred. Whether markedly increased binge eating intake was causally related to purging is unclear. Nonetheless eating episodes were at times quite large and equivalent to those reported by participants with bulimia nervosa in other research.

Objective: The aim of this article is to provide a narrative review of empirical studies related to health-related quality of life (HRQOL) and eating disorders and to report recent changes in the measurement of HRQOL in eating disorders., Method: Twenty-five articles of central importance to the topic were identified in a systematic search of six databases. All articles were selected based on a consensus relevancy rating process. Key themes were extracted from the articles and validated by all authors., Results: We identify six themes in the extant empirical literature., Discussion: We discuss these six themes and review them in light of the fact that they are identified in studies using only generic measures of HRQOL. Four recently developed disease-specific HRQOL measures specific to patients with eating disorder are discussed.

Objective: Negative affect has been purported to play an important role in the etiology and maintenance of bulimic behaviors. The objective of this study was to identify daily mood patterns in the natural environment exhibited by individuals with bulimia nervosa and to examine the relationship between these patterns and bulimic behaviors., Method: One hundred thirty-three women aged 18-55 meeting DSM-IV criteria for bulimia nervosa were recruited through clinical referrals and community advertisements. Ecological momentary assessment was used to collect multiple ratings of negative affect, binge eating and purging each day for a two-week period using palmtop computers. Latent growth mixture modeling was used to identify daily mood patterns., Results: Nine distinct daily mood patterns were identified. The highest rates of binge eating and purging episodes occurred on days characterized by stable high negative affect or increasing negative affect over the course of the day., Conclusions: These findings support the conclusion that negative mood states are intimately tied to bulimic behaviors and may in fact precipitate such behavior.

Bulimia nervosa and non-suicidal self-injury (NSSI) co-occur at high rates, and both have been conceptualized as maladaptive emotion regulation strategies. Treatments focusing on emotion regulation have been designed for both problem behaviors, yet, there exists very little research examining the temporal emotional states surrounding acts of NSSI. Using ecological momentary assessment (EMA) methodology, the current study examined the temporal association between positive and negative emotional states prior to and consequent to acts of NSSI within a subset of bulimia nervosa patients. Results indicate significant increases in negative affect, and decreases in positive affect, prior to an NSSI act. Post-NSSI, positive affect significantly increased while negative affect remained unchanged. The findings offer partial support for an emotion regulation paradigm to understanding NSSI within bulimic populations and implications for treatment are discussed.

Uniform diagnostic criteria for the night eating syndrome (NES), a disorder characterized by a delay in the circadian pattern of eating, have not been established. Proposed criteria for NES were evaluated using item response theory (IRT) analysis. Six studies yielded 1,481 Night Eating Questionnaires which were coded to reflect the presence/absence of five night eating symptoms. Symptoms were evaluated based on the clinical usefulness of their diagnostic information and on the assumptions of IRT analysis (unidimensionality, monotonicity, local item independence, correct model specification), using a two parameter logistic (2PL) IRT model. Reports of (1) nocturnal eating and/or evening hyperphagia, (2) initial insomnia, and (3) night awakenings showed high precision in discriminating those with night eating problems, while morning anorexia and delayed morning meal provided little additional information. IRT is a useful tool for evaluating the diagnostic criteria of psychiatric disorders and can be used to evaluate potential diagnostic criteria of NES empirically. Behavioral factors were identified as useful discriminators of NES. Future work should also examine psychological factors in conjunction with those identified here.

Objective: Two studies sought to examine predictions of the Integrative Cognitive-Affective Therapy (ICAT) model, which views bulimic symptoms in terms of inter-relations between self-concept discrepancies, negative affect, and self-directed coping styles. The present results examine assessment-related predictions of this model., Method: Individuals with bulimic symptoms were compared to noneating disorder control participants in two studies involving central constructs of the ICAT model., Results: In both studies, bulimic individuals displayed higher levels of self-discrepancy and negative self-directed styles, supporting predictions of the model. Also predicted by the model, negative mood states mediated relations between bulimic status and negative self-directed coping styles in Study 2., Conclusion: Assessment-related predictions of the ICAT model of bulimic symptoms were supported in two studies. These initial results support further tests of the model in longitudinal designs, contrasts of different clinical populations, and treatment-evaluation studies., ((c) 2008 by Wiley Periodicals, Inc.)

Background: The aim of this study was to examine the differences between male and female bariatric surgery candidates with respect to health-related quality of life (HRQOL), health, sociodemographic variables, and interactions among these variables in a bariatric surgery practice in the United States. Women seek bariatric surgery 5 times more often than men. Research on gender differences in HRQOL is limited, and the results are conflicting., Methods: A total of 794 surgery candidates (mean age 42.2 y; body mass index 46.9 kg/m2; 84.8% women) completed both a weight-related (Impact of Weight on Quality of Life-Lite questionnaire) and a generic (Medical Outcomes Study Short-Form-36) measure of HRQOL. Health was evaluated by questionnaire and clinical interviews., Results: Compared to men, women reported reduced HRQOL on 3 of the 5 scales assessing obesity-specific HRQOL and also the physical aspects of general HRQOL. Women also had double the rate of depression (48.5% versus 22.5%), and men had double the rate of sleep apnea (80.3% versus 40.2%). Women were younger, less obese, and were less likely to be married. No gender differences were found in the association between HRQOL and co-morbidities. However, an increasing number of co-morbidities was associated with decreasing physical and mental HRQOL. Additionally, depression was associated with decreased mental HRQOL, and coronary heart disease was associated with decreased physical HRQOL., Conclusion: Women's reduced HRQOL, particularly in self-esteem, sexual life, and physical functioning, and their greater rates of depression, might play a role in their decision to seek bariatric surgery. Although we could not determine causality, this study is a first step toward understanding why women seek surgery 5 times more often than men.

The purpose of this study was to evaluate the Night Eating Questionnaire (NEQ) as a measure of severity of the Night Eating Syndrome (NES). The 14-item NEQ assesses the behavioral and psychological symptoms of NES. The NEQ was evaluated in three samples: 1980 persons who completed the NEQ on the Internet; 81 persons diagnosed with NES; and 194 bariatric surgery candidates. Study 1, using principal components analysis, generated four factors (nocturnal ingestions, evening hyperphagia, morning anorexia, and mood/sleep) and an acceptable alpha (.70). Confirmatory factor analysis suggested that 99% of covariation among factors is accounted for by a higher-order construct. Study 2 found convergent validity of the NEQ with additional measures of night eating, disordered eating, sleep, mood, and stress. Study 3 compared scores from obese bariatric surgery candidates with and without NES and found appropriate discriminant validity of the NEQ. The NEQ appears to be an efficient, valid measure of severity for NES.

The relation of mood and stress to binge eating and vomiting in the natural environments of patients with bulimia nervosa (BN) was examined using real-time data collection. Women (n = 131; mean age = 25.3 years) with BN carried a palmtop computer for 2 weeks and completed ratings of positive affect (PA), negative affect (NA), anger/hostility (AH), and stress (STRS); they also indicated binge or vomit episodes (BN-events) 6 times each day. Mixed models were used to compare mood and STRS between and within days when BN-events occurred. Between-days analyses indicated that binge and vomit days both showed less PA, higher NA, higher AH, and greater STRS than days with no BN-events. Within-day, decreasing PA, and increasing NA and AH, reliably preceded BN-events. Conversely, PA increased, and NA and AH decreased following BN-events. Demonstration of the temporal sequencing of affect, STRS, and BN-events with a large BN sample may help advance theory and clinical practice, and supports the view that binge and purge events hold negatively reinforcing properties for women with BN.

The present study examined whether personality-based subgroups of bulimic individuals differed in eating disorder behavior, comorbid psychopathology, treatment history, and momentary assessments of mood and behavior. Participants completed an Ecological Momentary Assessment (EMA) protocol for a period of 2 weeks. Latent profile analysis on the Dimensional Assessment of Personality Pathology revealed 3 groupings of bulimic participants: Interpersonal-emotional, Stimulus seeking-hostile, and Low personality pathology. The personality-based groups differed in histories of mood, anxiety, substance use disorders, features of borderline personality disorder, treatment history, and several momentary measures. These findings suggest that personality variation within the bulimia nervosa diagnostic construct may be associated with meaningful conceptual and clinical differences, including daily experiences in the natural environment.

Objective: Night eating syndrome (NES) was first described in 1955 by Albert Stunkard and colleagues. NES consists of either overeating at night or waking up during the night and eating., Method: In the current study we used ecological momentary assessment (EMA) to describe 14 self-defined night-eaters. The participants in the current study completed an EMA protocol of approximately two weeks., Results: We found that ratings of hunger appeared to be higher during night awakenings than in the evening. Also, both affect and arousal generally decreased throughout the day and were lowest during awakening episodes., Conclusion: The current study adds interesting data in describing the experience of night-eating behavior with ecological momentary assessments from self-described night-eaters.

Past research has suggested that negative affect may be a causal factor for eating disordered behaviors. More specifically, research has shown that anger appears to be one aspect of negative affect that is particularly relevant in bulimic patients. Previous studies have also shown that the relationship between negative affect and eating disordered behaviors may partially depend upon personality variables such as impulsivity. The present study examined whether the relationship between anger and eating disordered behaviors is moderated by impulsivity. Subjects completed an ecological momentary assessment (EMA) protocol for an average of 2 weeks. Findings revealed that overall antecedent anger level and the variability of antecedent anger predicted binge-eating episodes and that these relationships were moderated by participants' level of impulsivity. These findings suggest that personality variables impact the way that anger and eating behaviors relate. They also suggest that the variability of antecedent anger may be a fruitful avenue for future research for those interested in causal variables associated with bulimia nervosa.

A study of bulimic women examined the relationship between histories of childhood trauma and psychiatric disorders, as well as daily measures of mood and behavior. One hundred twenty-three women with bulimia nervosa were assessed with interviews and completed an Ecological Momentary Assessment (EMA) protocol in which they carried a palmtop computer for 2 weeks. Sexual abuse was associated with a history of mood and anxiety disorders, and emotional abuse with eating disorder psychopathology. In the EMA assessment, sexual abuse was associated with daily purging frequency and self-destructive behavior. Emotional abuse was associated with average daily mood and mood lability. These findings support the idea that child maltreatment may be associated with various aspects of bulimia-related psychopathology.

It is theoretically plausible to assume that attention plays a role in eating disordered attitudes. Indeed, studies examining relations between eating disorders and attention to body and/or shape related stimuli have found such associations. Although this research is invaluable in characterizing relations between attentional processes and eating disordered attitudes, such work remains correlational in nature. In the present investigation, 73 undergraduate women were randomly assigned to one of two attentional training conditions. One condition trained attention away from body/shape words, whereas the other trained attention toward body/shape words. Following this training participants reported on their eating-related attitudes. Women trained to avoid body/shape words subsequently reported more concerns about eating and body shape. These results suggest that attentional avoidance of body/shape concerns increases such concerns. The results point to the potential causal effects of attention on eating disordered attitudes, in turn suggesting a basis for possible treatment.

Objective: Health-related quality of life (HRQOL) has been used increasingly as an outcome measure in clinical research. Although the generic quality of life instruments has been used in previous research, disease-specific instruments offer greater sensitivity and responsiveness to change than generic instruments. No such disease-specific instrument is currently available that applies to eating-disordered samples., Method: The current article reports on the development and validation of the Eating Disorders Quality of Life (EDQOL) instrument, a disease-specific HRQOL self-report questionnaire designed for disordered eating patients., Results: The EDQOL demonstrates excellent psychometric properties., Conclusion: The application of the EDQOL as an outcome measure in eating disorder research is considered., (2005 by Wiley Periodicals, Inc.)

Objective: The purpose of the current study was to demonstrate the feasibility of studying subjects with anorexia nervosa (AN) using ecologic momentary assessment (EMA). A second goal of the current study was to conduct a preliminary investigation of a proposed model of anorexic behavior., Method: Ten female participants with AN carried Palm top computers for an average of 2 weeks per participant. Each day, participants were signaled six times by the Palm top and answered questions about mood, behavior, stressful events, and self-appraisal., Results: AN subjects displayed excellent compliance with the protocol. Participants completed more than 90% of the signaled recordings. The results also generally support the model of AN behavior proposed., Conclusion: EMA appears to be a feasible and productive means of assessment in studying AN., (Copyright 2005 by Wiley Periodicals, Inc.)

Objective: A primary objective of the current article is to investigate the relationship between impulsivity and compulsivity in patients with bulimia nervosa (BN). A second goal is to explore the relationship between impulsivity and compulsivity and related psychiatric problems., Method: Two-hundred four females with BN completed several measures of impulsivity and compulsivity as well as measures of personality, substance use, eating pathology, and depression., Results: Participants reported considerable variability on measures of impulsivity and compulsivity and these scores were positively correlated with each other. Impulsive-compulsive groups differed in personality, substance use, eating, and depression., Conclusion: These findings suggest that impulsivity and compulsivity can coexist in BN patients and that both traits may provide useful information about comorbid problems in women with BN.

Objective: The present study sought to investigate the relationship between a number of areas of elite student-athletes' lives and disordered eating., Method: We surveyed 1445 elite Division I athletes at 11 different institutions and in 11 different sports. Hierarchical regression was used to indicate specific areas of the participants' collegiate experience that may be associated with disordered eating attitudes and symptomatology., Results: Results demonstrate that the variables entered into each model predicted between 40.5% and 46.4% of the variance for the restriction of food, body dissatisfaction, and drive for thinness. Categories of variables that generally predicted the most variance for each dependent measure were demographics, athletic involvement, and personality. Of the 11 sports included in the analysis, wrestling and gymnastics demonstrated elevated levels of drive for thinness, food restriction, and purging behavior compared to other athletes., Discussion: Findings suggest that in elite athletes gender, ethnicity, sport, and self-esteem are associated with several behaviors and attitudes indicative of disordered eating.

Objective: To compare the impact of weight regain and weight loss on health-related quality of life., Research Methods and Procedures: Subjects were 122 (106 women, 16 men) overweight and obese participants in a weight reduction program (phentermine-fenfluramine and dietary counseling) who had initially lost at least 5% of their total body weight and then regained at least 5% of their weight during the follow-up period. Follow-up periods ranged from 10 to 41 months (mean, 28 months). Participants completed the Impact of Weight on Quality of Life-Lite, an obesity-specific health-related quality of life (HRQOL) measure, at 3-month intervals., Results: Mean BMI at baseline was 40.9 +/- 6.6 kg/m(2) (range, 29.2 to 63.7 kg/m(2)). Average weight loss from entry was 18.8 +/- 6.7% (range, 6.0% to 43.7%), and average regain was 10.1 +/-4.4% of baseline weight (range, 5.0% to 30.6%). The effects of weight regain on HRQOL mirrored the effects of weight loss-rates of HRQOL change were similar in magnitude but different in direction for comparable weight loss and regain. Those with more severe initial impairments in HRQOL experienced greater improvements in HRQOL during weight loss as well as greater deterioration during weight regain than those with less severe impairments., Discussion: Weight loss and regain produced mirror image changes in HRQOL. The initial severity of HRQOL impairment had a greater impact on the magnitude of HRQOL change than the direction of weight change. Findings underscore the importance of maintaining weight loss for the purposes of retaining obesity-specific HRQOL benefits.

The susceptibility of membranes to interaction with ethanol is an important consideration in the further understanding of the ethanol-membrane interaction. Interaction of membrane vesicles, including passive diffusion of ethanol across membranes, leakage of internal molecules out of membranes and membrane-membrane interaction, were examined systematically using two populations of fluorescent probe-encapsulated phospholipid bilayer vesicles, each prepared with 1,2-dimyristoyl phosphatidylcholine, cholesterol and a fluorescent probe. Fluorescence quenching experiments with these vesicles were performed in a medium containing a wide range of ethanol concentrations (0.30-3.5 M). In the presence of a lower concentration of ethanol in the external medium, passive diffusion of ethanol across membrane vesicles occurred. This was demonstrated by an interaction of ethanol with the encapsulated fluorescence probe molecules inside the vesicles, resulting in an increase in the fluorescence intensity and a shift of the fluorescence emission spectrum to a shorter wavelength. While, in the presence of a higher concentration of ethanol in the external medium, a strong perturbation of lipid bilayers by ethanol was found, leading to an over expansion of membranes and consequently causing the membrane leakage. As a result of this, the initially encapsulated probe molecules leaked out of the vesicles so as to interact with the other probe molecules in the external medium. Consequently, fluorescence quenching was observed. Moreover, studies of the mixture of two populations of fluorescence probe-encapsulated membrane vesicles revealed that ethanol acted on individual membranes and did not promote membrane-membrane interactions. The implication of the present results to the alcohol-mediated expansion of membranes is discussed.

In humans a higher incidence of renal toxicity is seen in old than in young patients undergoing gentamicin therapy. To investigate whether the sensitivity of the old kidney to gentamicin is a function of age, separate from the adverse effects arising from declining renal excretory function, the nephrotoxicity of 12 daily injections of this antibiotic was measured in rats. Young (7-10 months) and old (25-28 months) rats, selected for minimal age-related nephropathy, received an initial dose of 30 or 50 mg of gentamycin/kg. Based on the plasma half-lives, subsequent doses for the high dose group were reduced as needed to equalize renal exposure to gentamicin. Urinary excretion of beta-galactosidase peaked by the second or third day of injections, while proteinuria was highest in the second week. The amount of microscopic renal tubular damage was dose-related and was greater in the old rats of each dose group. The increased sensitivity of old kidneys toward gentamycin toxicity, although small, thus appears to be in addition to any age-related decrease in renal elimination of the drug from plasma.