Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-19T04:17:14.637Z Has data issue: false hasContentIssue false
  • English
  • Français

Co-morbidity and disorder-related distress and impairment in purging disorder

Published online by Cambridge University Press:  10 September 2007

P. K. Keel ,
B. E. Wolfe ,
J. A. Gravener  and
D. C. Jimerson
P. K. Keel*
Affiliation:
Department of Psychology, The University of Iowa, Iowa City, IA, USA
B. E. Wolfe
Affiliation:
Psychiatric/Mental Health Department, Connell School of Nursing, Boston College, Boston, MA, USA
J. A. Gravener
Affiliation:
Department of Psychology, The University of Iowa, Iowa City, IA, USA
D. C. Jimerson
Affiliation:
Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: P. K. Keel, Ph.D., E11 Seashore Hall, Iowa City, IA 52246, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Recent studies suggest that purging disorder (PD) may be a common eating disorder that is associated with clinically significant levels of distress and high levels of psychiatric co-morbidity. However, no study has established evidence of disorder-related impairment or whether distress is specifically related to PD rather than to co-morbid disorders.

Method

Three groups of normal-weight women [non-eating disorder controls (n=38), with PD (n=24), and with bulimia nervosa (BN)-purging subtype (n=57)] completed structured clinical interviews and self-report assessments.

Results

Both PD and BN were associated with significant co-morbidity and elevations on indicators of distress and impairment compared to controls. Compared to BN, PD was associated with lower rates of current and lifetime mood disorders but higher rates of current anxiety disorders. Elevated distress and impairment were maintained in PD and BN after controlling for Axis I and Axis II disorders.

Conclusions

PD is associated with elevated distress and impairment and should be considered for inclusion as a provisional disorder in nosological schemes such as the Diagnostic and Statistical Manual to facilitate much-needed research on this clinically significant syndrome.

Keywords

Co-morbiditydistressimpairmentnosologypurging
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 10 , October 2008 , pp. 1435 - 1442
Copyright
Copyright © 2007 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision (DSM-IV-TR). American Psychiatric Association: Washington, DC.Google Scholar
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.CrossRefGoogle ScholarPubMed
Berkson, J (1946). Limitations of application of fourfold table analysis to hospital data. Biometrics 2, 47–53.CrossRefGoogle ScholarPubMed
Binford, RB, le Grange, D (2005). Adolescents with bulimia nervosa and eating disorder not otherwise specified-purging only. International Journal of Eating Disorders 38, 157–161.CrossRefGoogle Scholar
Bohn, K, Fairburn, CG (in press). The Clinical Impairment Assessment questionnaire (CIA). In Cognitive Behavior Therapy for Eating Disorders (ed. Fairburn, C. G.). Guilford Press: New York.Google Scholar
Cohen, J (1977). Statistical Power Analysis for the Behavioral Sciences – Revised. Academic Press: New York.Google Scholar
Fairburn, C, Cooper, Z (1993). The Eating Disorder Examination. In Binge Eating: Nature, Assessment and Treatment (ed. Fairburn, C. and Wilson, G. T.), pp. 317–331. Guilford Press: New York.Google Scholar
Fairburn, CG, Bohn, K (2005). Eating disorder NOS (EDNOS): an example of the troublesome ‘not otherwise specified’ (NOS) category in DSM-IV. Behaviour Research and Therapy 43, 691–701.CrossRefGoogle ScholarPubMed
Favaro, A, Ferrara, S, Santonastaso, P (2003). The spectrum of eating disorders in young women: a prevalence study in a general population sample. Psychosomatic Medicine 65, 701–708.CrossRefGoogle Scholar
First, M, Gibbons, M, Spitzer, RL, Williams, JBW, Benjamin, LS (1997). Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). American Psychiatric Press: Washington DC.Google Scholar
First, M, Spitzer, RL, Gibbon, M, Williams, JBW(1995). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition (SCID/P). Biometrics Research Department: New York State Psychiatric Institute.Google Scholar
Fossati, A, Maffei, C, Bagnato, M, Donati, D, Donini, M, Fiorilli, M, Novella, L, Ansoldi, M (1998). Brief communication: criterion validity of the personality diagnostic questionnaire – 4+(PDQ-4+) in a mixed psychiatric sample. Journal of Personality Disorders 12, 172–178.CrossRefGoogle Scholar
Grilo, CM, Devlin, MJ, Cachelin, FM, Yanovski, SZ (1997). Report of the National Institutes of Health (NIH) Workshop on the Development of Research Priorities in Eating Disorders. Psychopharmacology Bulletin 33, 321–333.Google ScholarPubMed
Halmi, KA, Agras, WS, Crow, S, Mitchell, J, Wilson, GT, Bryson, SW, Kraemer, HC (2005). Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Archives of General Psychiatry 62, 776–781.CrossRefGoogle ScholarPubMed
Hudson, JI, Hiripi, E, Pope, HG Jr., Kessler, RC (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry 61, 348–358.CrossRefGoogle ScholarPubMed
Keel, PK (in press). Purging disorder: full-threshold eating disorder or subthreshold variant? International Journal of Eating Disorders.Google Scholar
Keel, PK, Haedt, A, Edler, C (2005). Purging disorder: an ominous variant of bulimia nervosa? International Journal of Eating Disorders 38, 191–199.CrossRefGoogle ScholarPubMed
Keel, PK, Heatherton, TF, Dorer, DJ, Joiner, TE, Zalta, AK (2006). Point prevalence of bulimia nervosa in 1982, 1992, and 2002. Psychological Medicine 36, 119–127.CrossRefGoogle ScholarPubMed
Keel, PK, Mayer, SA, Harnden-Fischer, JH (2001). Importance of size in defining binge eating episodes in bulimia nervosa. International Journal of Eating Disorders 29, 294–301.CrossRefGoogle ScholarPubMed
Keel, PK, Wolfe, BE, Liddle, RA, De Young, KP, Jimerson, DC in press). Clinical features and physiological response to a test meal in purging disorder and bulimia nervosa. Archives of General Psychiatry.Google Scholar
Leitenberg, H, Gross, J, Peterson, J, Rosen, JL (1984). Analysis of an anxiety model and the process of change during exposure plus response prevention treatment of bulimia nervosa. Behaviour Therapy 15, 3–20.CrossRefGoogle Scholar
McWilliams, LA, Cox, BJ, Enns, MW (2003). Psychometric properties of an index of emotional distress in the U.S. National Comorbidity Survey. Social Psychiatry & Psychiatric Epidemiology 38, 256–261.CrossRefGoogle ScholarPubMed
Mond, J, Hay, P, Rodgers, B, Owen, C, Crosby, R, Mitchell, J (2006). Use of extreme weight control behaviors with and without binge eating in a community sample: implications for the classification of bulimic-type eating disorders. International Journal of Eating Disorders 39, 294–302.CrossRefGoogle Scholar
Oei, TP, Evans, L, Crook, GM (1990). Utility and validity of the STAI with anxiety disorder patients. British Journal of Clinical Psychology 29, 429–432.CrossRefGoogle ScholarPubMed
Ormel, J, Oldehinkel, AJ, Nolen, WA, Vollebergh, W (2004). Psychosocial disability before, during, and after a major depressive episode: A 3-wave population-based study of state, scar, and trait effects. Archives of General Psychiatry 61, 387–392.CrossRefGoogle Scholar
Patton, JH, Stanford, MS, Barratt, ES (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology 51, 768–774.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
Polivy, J, Herman, CP (2002). Causes of eating disorders. Annual Review of Psychology 53, 187–213.CrossRefGoogle ScholarPubMed
Pomeroy, C (2001). Medical evaluation and medical management. In The Outpatient Treatment of Eating Disorders (ed. Mitchell, J. E.), pp. 306–348. University of Minnesota Press: Minneapolis.Google Scholar
Rorty, M, Yager, J, Buckwalter, JG, Rossotto, E (1999). Social support, social adjustment, and recovery status in bulimia nervosa. International Journal of Eating Disorders 26, 1–12.3.0.CO;2-I>CrossRefGoogle ScholarPubMed
Rosen, J, Vara, L, Wendt, S, Leitenberg, H (1990). Validity studies of the Eating Disorders Examination. International Journal of Eating Disorders 9, 519–528.3.0.CO;2-K>CrossRefGoogle Scholar
Spielberger, C, Gorsuch, RL, Lushene, R, Vagg, PR, Jacobs, GA (1983). The State-Trait Anxiety Inventory. Consulting Psychologists Press: Palo Alto, CA.Google Scholar
Spielberger, C, Vagg, PR, Barker, LR, Donham, GW, Westberry, LG (1980). The factor structure of the State-Trait Anxiety Inventory. In Stress and Anxiety (ed. Sarason, I. and Spielberger, C. D.). Hemisphere: Washington, DC.Google Scholar
Spielberger, CD, Vagg, PR (1984). Psychometric properties of the STAI: a reply to Ramanaiah, Franzen, and Schill. Journal of Personality Assessment 48, 95–97.CrossRefGoogle Scholar
Striegel-Moore, RH, Franko, DL, Thompson, D, Barton, B, Schreiber, GB, Daniels, SR (2005). An empirical study of the typology of bulimia nervosa and its spectrum variants. Psychological Medicine 35, 1563–1572.CrossRefGoogle ScholarPubMed
Stunkard, AJ, Messick, S (1985). The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. Journal of Psychosomatic Research 29, 71–83.CrossRefGoogle ScholarPubMed
Wade, TD (2007). A retrospective comparison of purging type disorders: Eating disorder not otherwise specified and bulimia nervosa. International Journal of Eating Disorders 40, 1–6.CrossRefGoogle Scholar
Wade, TD, Bergin, JL, Tiggemann, M, Bulik, CM, Fairburn, CG (2006). Prevalence and long-term course of lifetime eating disorders in an adult Australian twin cohort. Australian & New Zealand Journal of Psychiatry 40, 121–128.CrossRefGoogle Scholar
Walsh, BT, Kahn, CB (1997). Diagtic criteria for eating disorders: current concerns and future directions. Psychopharmacology Bulletin 33, 369–372.Google ScholarPubMed
Weissman, MM, Bothwell, S (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry 33, 1111–1115.CrossRefGoogle ScholarPubMed
Wilson, G, Smith, D (1989). Assessment of bulimia nervosa: an evaluation of the Eating Disorders Examination. International Journal of Eating Disorders 8, 173–179.3.0.CO;2-V>CrossRefGoogle Scholar