Eating-disorder clients show low motivation, poor follow-through, and inordinate premature dropout rates in treatment. To date, little research has been conducted that might provide clinicians with an understanding of the critical factors that may aid clients' recovery. Such factors may be used by clinicians to better motivate clients to collaborate in treatment. The purpose of this study was to identify some of the critical factors that women with eating disorders believed were crucial in prompting or facilitating their recovery. Identification of these factors was accomplished through a systematic content analysis of semistructured interviews with recovered or recovering bulimics and anorexics. This study may contribute significantly to future research into the development of motivational supplements to eating disorder therapy (e.g., psychoeducational materials or therapy orientation programs). Of interest were what personal, interpersonal, or environmental factors anorexic and bulimic clients reported increased their motivation to recover, and prompted them to begin the recovery process, maintain recovery, and cope with the threat ofrelapse. Also, factors that subjects reported hindered their progress in recovery were examined. The anorexic and bulimic subjects reported social support as a critical factor across three stages of recovery, including beginning recovery, maintaining recovery, and coping with relapse. Being "tired" of the disorder and therapy were indicated to be relevant to beginning recovery. Improved self-esteem was deemed significant in helping subjects both maintain recovery and cope with the threat of relapse. Establishing healthy eating habits and attitudes was a necessary factor required to maintain recovery. Subjects shared that developing healthy ways to deal with emotions enabled them to deal successfully with the threat of relapse. Anorexic subjects reported that people and societal expectations, fear of becoming fat, incentive to numb emotions, and poor eating habits and attitudes impeded their recovery. Bulimic subjects indicated that people and societal expectations, incentive to numb emotions, lack of understanding, and poor eating habits and attitudes hindered their recovery.

Eating disorders have a dramatic effect on the lives of people who struggle with them, including cardiovascular and gastrointestinal problems, and death. Individuals with these diagnoses are also often struggling with comorbid diagnoses such as depression, anxiety, and substance abuse/dependence. Building on a conceptualization of eating disorders as a means to dysfunctionally regulate negative affect and escape unwanted thoughts, psychological flexibility, the ability of a person to contact unwanted thoughts or feelings and behave without escape or avoidance, is investigated as a tool for treatment. Additionally, because quantitative analysis of the construct of psychological flexibility has often employed the use of college samples, this study employed a sample of participants drawn from a residential treatment facility dedicated to the treatment of eating disorders. Through regression and modeling, psychological flexibility demonstrates its utility in the treatment of eating disorders through its relationship with body dissatisfaction and quality of life.

Ziel: Das Ziel der explorativen Studie war es, erwachsene Patientinnen mit restriktiver bzw. bulimischer Anorexie oder Bulimie mit einer starken Inanspruchnahme von stationären Versorgungsleistungen, sogenannte Heavy User (HU), die eine vollstationäre Behandlung in der Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Universitätsklinikums Würzburg erhalten haben, zu beschreiben, soziodemographische sowie erkrankungsbezogene somatische und kognitive Charakteristika darzustellen und die Ergebnisse mit einer Kontrollgruppe aus Patientinnen mit dem gleichen Störungsbild, aber einer geringeren Inanspruchnahme medizinischer Versorgungsangebote, den Nicht-Heavy Usern (NHU), zu vergleichen. Teilnehmer und Methode: 23 anorektische bzw. bulimische Heavy User-Patientinnen, die sich im Zeitraum der Datenerhebung (1997-2008) zum mindestens dritten Mal in einer stationären Therapie aufgrund ihrer Essstörung befanden, und eine Vergleichsgruppe von 13 Nicht-Heavy User-Patientinnen mit höchstens einem stationären Voraufenthalt wurden in dieser Studie untersucht. Allgemein- und neurologischer Status sowie die Laborparameter zum Aufnahmezeitpunkt und die Auswertungen der kranialen CTs bzw. MRTs sowie der kognitiven Testverfahren zu Beginn der Therapie und vor der Entlassung wurden analysiert und miteinander verglichen. Ergebnisse und Schlußfolgerung: Die anorektischen und bulimischen Heavy User weisen viele auffällige somatische Befunde, von der Norm abweichende Laborparameter sowie im Falle der anorektischen Heavy User eine häufig bestehende Hirnatrophie auf. Darüber hinaus zeigen sie eine Reihe von kognitiven Defiziten in verschiedenen Bereichen. Am stärksten davon betroffen sind die restriktiv anorektischen Heavy User. Die Ausprägungen der untersuchten pathologischen Befunde unterscheiden sich jedoch nicht signifikant von denen der Nicht-Heavy User. Spezifische Eigenschaften der Heavy User, die es zulassen, sie von einem Nicht-Heavy User abzugrenzen, wurden nicht gefunden. Weitere Studien sind notwendig, um andere typische Merkmale der Heavy User zu eruieren, damit sie möglichst frühzeitig identifiziert und ihnen für sie geeignetere alternative Behandlungsmöglichkeiten angeboten werden können. / Objective: The objective of this explorative study was to describe female adult patients with restricting- respectively purging-type anorexia nervosa or bulimia nervosa with a high use of hospital services, so called heavy users, who received full inpatient treatment in the Clinics and Polyclinics for Psychiatry, Psychosomatics and Psychotherapy of the University Hospital of Würzburg, to show sociodemographic and disease-related somatic and cognitive characteristics and to compare the results with a control group of female patients with the same disorder, but a reduced demand of healthcare offerings, the non-heavy users. Patients and Methods: 23 anorectic respectively bulimic female heavy user patients, who were for at least the third time in inpatient treatment due to their eating disorder, and a comparison group of 13 female non-heavy user patients with a maximum of one inpatient prior stay were studied. General and neurological status, as well as the laboratory parameters at the time of exposure and the evaluation of the cranial CTs or MRTs plus the cognitive test methods at the beginning of the therapy and before discharge were analysed and compared with each other. Results and Conclusion: The anorectic and bulimic heavy users show a lot of noticeable somatic findings, laboratory parameters deviating from the norm and in case of the anorectic heavy users an often existing atrophy of the brain. Furthermore they present a series of cognitive deficits in various sectors. The most affected are the heavy users with restricting-type anorexia nervosa. The manifestations of the examined pathological findings are not significantly different from those of the non-heavy users. Specific characteristics of the heavy users which permit to differentiate them from a non-heavy user were not found. Further studies are necessary, to determine other typical features of heavy users, in order to identify them as early as possible and offer them more suitable alternative treatment options.

The purpose of this study was to examine the relationships between family differentiation, family recreation and symptoms of eating disorders. The Family Intrusiveness Scales, the Perceived Social Support from Family, the Family Leisure Activity Profile and the Eating Attitudes Test were used. Participants were students at two large universities, one in the East and one in the West. Data were analyzed using correlation and ANCOVA. Findings supported the hypothesis that a positive relationship exists between family leisure involvement and family differentiation. In addition, a negative relationship between family differentiation and symptoms of eating disorders for individuals whose parents are not in their first marriage was indicated by the results.

A questionnaire was mailed to a random sample of 771 undergraduate women at Virginia Tech. The research instrument was designed to accurately estimate the frequency of bulimia among university women. Bulimia was operationalized in specific behavioral terms that extend the DSM-III definition. The response rate for the mail survey was 87%, with 669 surveys used in the descriptive data analysis. One hundred and twelve subjects, 17% of the total sample, were classified as bulimic. The bulimic subjects were matched on height, weight, and age with 112 women without an eating disorder. This subset of 224 subjects was analyzed in order to assess the degree to which the respondent's family system, use of coping strategies, and weight preoccupation are predictive of bulimia. Multiple regression analysis indicated that 28% of the variance in bulimia can be explained by these three variables. The survey findings and implications for future research are discussed. / Ph. D.

Eating disorders fall within the top nine health ailments affecting young people today. These illnesses such as Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders Not Otherwise Specified affect a large number of people, particularly female adolescents. The disorders can further cause complications in one’s health, systemically and orally, sometimes resulting in death. The purpose of this paper is to closely examine published studies examining the link between eating disorders and oral health. Multiple studies have found that patients suffering from eating disorders are more likely to develop tooth erosion. Behaviors often found in eating disorder patients such as self-induced vomiting and ingestion of highly acidic diets can lead to such enamel loss, a condition that is irreversible. Other researchers disagree about whether eating disorders can lead to an increase in dental caries, with some finding amplification and others finding no significant results. Parotid gland swelling is another side effect of eating disorders but this complication often recedes once the unhealthy behavior is halted. Most studies have not yet found a link between these illnesses and increased periodontal disease. However, they do seem to lead to decreased unstimulated salivary flow rates. Furthermore, it also appears that the disorders lead to augmented levels of S. mutans and Lactobacilli. One’s oral mucosa can also be affected via angular cheilitis and oral candidiasis. Additionally, eating disorders may serve as a risk factor for bone and joint disorders such as osteoporosis and temporomandibular joint disorders, respectively. The illnesses may show effect outside the oral cavity through Russell’s sign on one’s knuckles and oral function may be impaired. With all these possible oral complications being some of the first to indicate the presence of an eating disorder, dentists may be integral to identifying and stopping the progression of the disease. However, it has been suggested that eating disorder patients may have greater dental anxiety keeping them from visiting the dentist in the first place, let alone divulging their disease to their dentist. Furthermore, oral health professionals may not be adequately prepared to notice the presence of an eating disorder. Dental schools must do more to teach future oral health professionals about eating disorders, especially in the clinic, as simple suggestions like avoiding brushing one’s teeth immediately after participating in self-induced vomiting may help to reduce the likelihood of enamel erosion. Through this analysis it was determined that while sufficient baseline research has been done, there is still a great deal more to learn about how eating disorders affect one’s oral health. There are multiple forms of diagnostic criteria that could possibly prevent patients from receiving the best treatment possible. Furthermore, more research needs to be done on disorders other than Anorexia Nervosa and Bulimia Nervosa as not every patient falls under these two categories. Since it has been shown that certain types of medication can decrease one’s salivary flow rate, future studies need to also consider any medication that patients may be on. In order to really aid those affected by eating disorders, men should be considered as future subjects too, since most studies have currently only focused on women. By completing more research on eating disorders and their consequences on oral health, health care professionals will be better able to serve those affected.

Bulimia is often viewed as an extreme expression of eating concerns and body image disturbances that afflicts many adolescent and adult women. The cognitive strategies employed by individuals to inhibit eating and facilitate bingeing and purging are thought to include disattending internal sensations of hunger and satiety while sustaining attention on food, distorted beliefs, and interoceptive experiences (e.g., Heatherton & Baumeister, 1991). To the extent that these attentional and perceptual shifts mediate bulimic symptomatology, individuals with bulimic tendencies should exhibit certain cognitive attributes. Because hypnotizability, dissociation, and absorption have each been invoked (either directly or indirectly) as explanatory constructs for clinical and subclinical bulimia, the present study evaluated the absolute and relative effects of these factors on bulimic symptomatology in a large sample of undergraduate women (N = 309) using structural equation modeling. Following 2 assessments of hypnotic susceptibility (Harvard Group Scale of Hypnotic Susceptibility, Form A [Shor & Orne, 1962] & Group Stanford Hypnotic Susceptibility Scale, Form C [Crawford & Allen, 1982]), participants completed measures of eating disorder symptomatology (Eating Disorders Inventory-2 [Garner, 1991]; Three Factor Eating Questionnaire [Stunkard & Messick, 1985]), dissociation (Dissociative Experiences Scale [Carlson & Putnam, 1986]; Dissociation Questionnaire [Vanderlinden et al., 1993]), and absorption (Tellegen Absorption Scale [Tellegen & Atkinson, 1974]; Differential Attentional Processes Inventory [Crawford, Brown, & Moon, 1993; Grumbles & Crawford, 1981]). A final model including the latent constructs Hypnotizability, Dissociation, Absorption, and Bulimic Symptomatology provided a very good fit to the data (X 2 (58, N = 309) = 31.09, NFI = .932, CFI = .967, & RMSEA = .053). As hypothesized, dissociation was found to a have moderate effect (Standardized coefficient = .32, p < .01) on Bulimic Symptomatology when controlling for Hypnotizability and Absorption. Moreover, contrary to past research, the path between Hypnotizability and Bulimic Symptomatology and the path between Absorption and Bulimic Symptomatology were not significant. Based on these finding, we can now speak with increased confidence of a meaningful link between dissociation and the continuum of bulimic symptomatology. A pathological dissociative style appears to contribute to the development of bulimia. / Ph. D.

The eating disorders, encompassing both bulimia and anorexia nervosa, have become a matter of increasing concern for mental health professionals. The presence of bulimic symptoms within the syndrome of anorexia nervosa has been associated with greater individual and family psychopathology as well as with poorer prognosis when compared to restricter type anorectics. This study hypothesizes that when compared with a normal control group, non-anorectic bulimics would show higher levels of individual psychopathology and family dysfunction, and more disordered eating attitudes and behaviors. This study further hypothesizes that an anorectic group would exhibit a similar pattern on these variables due to the presence of bulimic symptoms in many anorectics. These hypotheses were confirmed and support was generated for the proposition that bulimia even in normal weight persons is associated with significant pathology comparable to that documented in the bulimic subtype of anorexia nervosa.

The research of Stice et al. (1994) and Stice and Shaw (1994) proposed several mechanisms that may mediate the adverse effects of media exposure to the thin ideal including internalization of the thin-ideal, negative affect, and body dissatisfaction. The purpose of this study was to extend initial research of Stice and Shaw (1994) by incorporating two forms of media (e.g., TV and Magazines) to assess the effects of exposure to the media portrayal of ideal body shape on women's mood, body satisfaction, and internalization of societal values concerning attractiveness. The relation of these variables to bulimic symptomatology was examined. The current study improved upon Stice and Shaw's study (1994) by matching participants' scores on BMI, level of negative affect, and level of body satisfaction before random assignment to the experimental conditions. Female undergraduates aged 18 to 25 years participated in premeasure (N = 198) and post measure (N = 164) conditions. Results from repeated mulitvariate analysis indicated media exposure to ideal-body images demonstrated no significant changes in women's affect, body satisfaction or endorsement of the thin ideal. Indirect support for the sociocultural theory of eating disorders was provided by multiple regression analyses that demonstrated lower levels of satisfaction with size and shape of body and higher levels of negative affect predicted bulimic symptomatology in women. Future research should determine which females are at greater risk than others for the development of body dissatisfaction, negative mood, and internalization of U.S. values of attractiveness in response to media related messages communicating a thin ideal.

The incidence of bulimia seems to be increasing dramatically as actors, models, dancers, and college populations are seeking help for this eating disorder. In this study, the Adjective Checklist was administered to 21 bulimic women and 17 normal women to compare personality characteristics on the following scales: abasement, affiliation, autonomy, achievement, aggression, personal adjustment, succorance, and self-control. Results showed bulimic women scored higher on abasement and succorance. A multiple regression was performed which elucidated the scales responsible for the greatest amount of variance. These were aggression, autonomy, and self-control. Further studies of personality measures may aid in describing this population more fully.