Secondary amenorrhea, ovulatory disturbances, and luteal phase deficiency occur in normal-weight women with sub-clinical eating disorders. The purpose of this investigation was to examine the influence of Eating Attitudes Test (EAT-26) scores, energy intake, and frequency of activity on ovarian hormone status in normal-weight, college-age women. Fourteen normal-weight female students, ages 19 - 24, who were attempting weight loss and did not currently meet diagnostic criteria for an eating disorder, served as subjects. Food-intake, dieting behavior, and menstrual cycle function were recorded by subjects during a three month period. Biweekly blood samples were assayed for estradiol and progesterone for one menstrual cycle. Mean age, number of years dieting, and BMI were similar between subjects. Five subjects (36%) had progesterone levels indicative of luteal phase deficiency or anovulation. The EAT-26 score was not associated with menstrual cycle dysfunction. Frequency of exercise and serum progesterone concentration were significantly correlated. Subjects who exercised 7+ hours per week had significantly lower peak progesterone values (p<0.03) than subjects who exercised 1 -3 hours per week. Within the group of subjects scoring above 20 on the EAT-26, those who exercised 7+ hours per week had significantly lower peak progesterone values than subjects exercising 1 - 6 hours (p < 0.03). There was a positive correlation (r = 0.384, P = 0.21) between length of luteal phase and daily energy intake, however the relationship was non-significant. Normal-weight, premenopausal women dieting to lose weight experienced menstrual cycle dysfunction in the absence of significant weight loss or diagnosable eating disorder. / Master of Science

The purpose of this exploratory research was to analyze, through a qualitative in-depth approach, the attitudes and perceptions of food and portion sizes of a group of clients diagnosed with anorexia nervosa, bulimia nervosa or an eating disorder with bulimic features. To accomplish this, a set of two questionnaires and a food portion test were administered; one at the beginning of treatment and a second at a given interval after treatment began. These responses, along with observations made by the author during patient interviews, will be reported. All patients received either inpatient and/or outpatient treatment from a mental health professional, a dietitian and a medical physician. The exploratory nature of the study and small sample size (12) prohibit positing of causative connections. Observations were made however, that a distortion of nutrition attitudes exists in the sample studied that were responsive to improvements while receiving treatment from a multidisciplinary team. A tendency to over estimate portions was evident, and no improvement in the second administration supports the need for additional food portion training. These findings were discussed in terms of the study limitations, along with suggestions for future research. / Master of Science

In view of the findings of this study, it is concluded that of all the factors studied, only the education of the mother, the income of the family, and the behavior of the mother while feeding the child were associated significantly with the adequacy of the performance of the child during eating. / Master of Science

Although subclinical eating disorders are more common than clinical eating disorders, they have received significantly less empirical attention. Subclinical symptoms of eating disorders often surface during adolescence and young adulthood and are far more common among females than males. Despite knowledge that the larger sociocultural context may contribute to the development of eating disorders, few studies have examined feminist-informed factors that may serve as protective mechanisms for young women who are influenced by Western capitalist culture and exhibit some symptomology, but do not develop clinically disordered eating. Using the feminist-relational model (feminist-relational Model (Jordan, 1997; Maine and Bunnell, 2008; Surrey, 1991) as a guide, this study sought to fill this gap. Informed by feminist grounded theory methodology, this study qualitatively examined socio-relational and socio-political contexts as potential protective factors for young women ages 18-25 whose subclinical eating disorder symptoms had not yet developed into a clinical eating disorder. Using constructivist grounded theory methodology, an emerging model was developed which demonstrates how participants spoke of their eating disorder symptoms in an externalized way. This was termed the "eating disorder voice." Findings highlight how feminist-informed protective factors helped participants resolve the tension between their genuine voice and eating disorder voice, and act in accordance with their preferred values. Participants were then more likely to be open about their symptoms and invest in their relationships. The main protective factors that emerged included, support people who provide emotional and tangible support, support people who challenge the eating disorder, a personal sense of agency, and community activism and involvement. The present study adds to the feminist theory and the feminist-relational model by providing a conceptualization of the symbiotic relationship between feminist-informed protective factors, suggesting through supportive relationships, individuals experience increased empowerment and agency. Clinical findings indicate that protecting symptoms, misperceptions regarding subclinical symptoms, and stigma served as barriers to seeking treatment. Implications for future research and practice are discussed. / Ph. D.

Objective: To examine associations between eating disorder (ED) risk and dietary habits. Also, to determine if ED risk changes after exposure to nutrition education and to investigate how the dietary habits in both at-risk (AR) and not-at-risk (NAR) college students compare the Dietary Guidelines (DG). Design: A longitudinal observational study over one academic year. Self-reported dietary intake was collected via seven-day food records. The Eating Attitudes Test 26 (EAT-26) was used to assess ED risk. Subjects underwent measurements of height, weight, skin fold, waist circumference and hip circumference. Subjects/Setting: Data from 507 students enrolled in one of two fall 2005 nutrition/health courses at a land grant university in southwest Virginia were analyzed. Main Outcome Measures: ED risk, mean daily intake of fruits, vegetables, fiber, whole grains, protein, total calories, and changes in ED risk over one academic year. BMI, weight change, percent body fat, and waist circumference were also evaluated. Statistical Analysis Performed: Associations between ED risk and mean daily intake of dietary variables were assessed using independent samples t-tests (p<0.05). Changes in mean EAT-26 scores were assessed using paired-t tests. Changes in the proportion of subjects categorized as AR and NAR were evaluated using Chi-square analysis. Results: This study was completed by 192 subjects. Those AR consumed significantly fewer calories than NAR subjects in both September. In April, AR subjects consumed significantly fewer fried vegetable servings than NAR subjects. Chi-square analysis in April revealed that the size of the NAR group increased thus reducing the size of the AR group. Overall, subjects' diets failed to meet the DG for fruits, vegetables, whole grains, and dietary fiber. Conclusion: Overall dietary intake did not vary significantly between AR and NAR subjects, excepting lower caloric intake and fewer fried vegetable servings in those AR. Both groups failed to meet the DG for fruits, vegetables, whole grains and dietary fiber. Application: Educational interventions emphasizing the DG may improve ED risk but warrant more specific targeting of poor dietary habits in order to increase the college population's compliance with the DG. / Master of Science

Although factors associated with eating disorders (ED) have been studied, no comprehensive source of research findings was identified in this review. The purpose of this study was to identify and synthesize research findings of factors associated with ED in women published from 1992-2006. These findings may be useful to nurses, other professionals, families, and the public to facilitate the prevention, detection, treatment, and rehabilitation of women with EDs. The factors identified as most pertinent through this review were depression, sexual abuse, substance abuse, anxiety disorders, early pubertal onset and the personality traits of perfectionism and impulsivity. No factor was identified as causative for EDs, but sexual abuse and anxiety disorders often preceded the ED. Findings varied among ED subtypes, with sexual abuse and substance abuse more common with binge/purge behaviors and bulimic symptomology, while depression and anxiety disorders were more common with both anorexia nervosa and bulimia nervosa. Perfectionism was most common in anorexics; in one study it was identified independent of stress and persisted after recovery. Limitations noted in the research reviewed include using self-report questionnaires, some small samples, exclusion of some ED subtypes, and a predominant use of cross-sectional and clinical samples. Recommendations for further research included large epidemiological samples containing multiple ED subtypes and males, as well as longitudinal studies and methods to determine causal relationships among EDs and the associated factors identified. Implications for nursing education, practice, and policy development focus on screening for ED during physical examinations and interviews, posing questions to facilitate disclosure, addressing emotions elicited, and suggestions for routine monitoring of patients in clinical settings.

It has only been in recent years that eating disorder researchers have begun focusing on sexual orientation as a variable that may affect prevalence rates. Heeding the call for studies that extend beyond identification of fixed eating disorder risk factors (e.g., gender), this study was designed to explore factors that contribute to the development of disordered eating among lesbians. In this study, a hypothesized Lesbian Model of Disordered Eating was tested using structural equation modeling. Lesbian Sexual Identity and Social Supports were hypothesized to positively influence Psychological Health. In addition, Internalization of U.S. Societal Norms of beauty and attractiveness was hypothesized to negatively affect Psychological Health. Psychological Health, in turn, was hypothesized to negatively influence Body Image Concerns. Body Image Concerns was then hypothesized to positively affect Disordered Eating. The fit of the model was evaluated and one of the hypothesized pathways, Internalization of Norms was moved to directly predict Body Image Concerns. After adjusting the model, the model accounted for 54% of the variance in disordered eating. Most notably, the results highlight the potential affects of adopting a positive lesbian identity on disordered eating and underscore the importance of including sexual identity as a demographic variable in studies of body image and disordered eating. Implications for counseling and directions for future research are discussed.

Anorexia nervosa (AN) is an eating disorder characterised by severe emaciation due deliberate restriction of food intake and an intense fear of gaining weight. Theoretical accounts of AN have to date focused predominately on cognitive elements of the disorder, yet resulting treatments have been inadequate and outcome for AN remains poor. Understanding the processes that maintain the disorder is an important step in developing effective strategies to augment existing treatments. With this in mind, the question arises: what processes drive AN? Novel frameworks for AN suggest that particular information processing configurations or “modes” may underpin many symptoms of AN, such as preoccupation with control of eating, weight and shape. More specifically, it is proposed that a ruminative mode of processing may function as an avoidance strategy in AN, enabling individuals to neglect salient and rewarding stimuli, such as food, and thus uphold restrictive eating practices. Whilst empirical studies have examined processes such as rumination, avoidance and reward in depression, they have seldom been studied in AN. The aim of this thesis is therefore to understand the role of rumination and reward processes in AN. Chapter 1 reviews the literature on AN, rumination and reward processing. Chapter 2 presents data demonstrating to what extent the content of rumination in AN differs from rumination in depression and the effect that rumination may have on ED symptoms. The study conducted in Chapter 3 examines whether individuals with AN can be switched out of rumination around meal times and what effect this has on AN psychopathology. Chapter 4 presents neuroimaging data which elucidates the brain regions involved in processing rewarding and aversive food stimuli after recovery from AN. The study reported in Chapter 5 teases apart hedonic (liking) versus motivational (wanting) aspects of food reward in AN. The final study (Chapter 6) provides further evidence using neuroimaging that rumination may be an important process in AN which may override appetitive responses to rewarding stimuli, such as food. The studies reported support the notion that rumination and aberrant reward processing may be involved in the maintenance of AN.

This study examined two theoretical factors proposed to explain the relationship between sexual abuse experiences and disturbed eating patterns. Over 300 women completed questionnaires designed to assess sexual abuse histories, bodily shame, body disparagement, and disordered eating behaviors. Multivariate analyses indicated that bodily shame, body image dysphoria, and bodily dissatisfaction were significantly higher in participants with previous sexual violations. In addition, disordered eating symptoms and behaviors were related to reported severity of sexual abuse experiences. However, the relationship between the severity of disturbed eating patterns and sexual abuse histories appears to be more meaningful in relation to the presence of bodily shame and body dissatisfaction, as proposed in previous research. Future research implications are discussed.

This study investigates the impact of sociocultural mediators in relation to eating disorders among male undergraduates. Literature on eating disorders has demonstrated that a thin body shape ideal depicted in the media directly contributes to eating pathology among females, but little research has investigated the direct effects of ideal body shape images among men. The focus of the present investigation was to assess the direct effects of exposure to the ideal male body shape on men’s affect, self esteem, body satisfaction, and endorsement of U. S. societal ideals of attractiveness. In addition, the relation of these variables to bulimic symptomatology was examined. Modeling a study conducted on women (Stice & Shaw, 1994), male undergraduates between the ages of 18 to 25 participated in premeasure (N = 169) and post measure (N = 95) conditions. Participants in the post measure were randomly exposed to pictures from magazines containing either male models depicting the ideal body shape, an average body or pictures of clothing without models. Results from repeated mulitvariate analysis indicated that exposure to the ideal body shape condition did not demonstrate significant negative changes in men’s affect, self esteem, body satisfaction or endorsement of U. S. societal ideals of attractiveness. Indirect support for the sociocultural theory of eating disorders was provided by multiple regression analyses which demonstrated that increased body mass, self esteem, stress and anxiety predicted bulimic symptomatology in men. Future research should direct itself toward investigating possible sociocultural influences of eating disorders on certain male subenvironments, such as athletes or homosexual males that place a greater emphasis on maintaining lower body mass and an ideal body shape.