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1.  GABRG1 and GABRA2 as Independent Predictors for Alcoholism in Two Populations 
The chromosome 4 cluster of GABAA receptor genes is predominantly expressed in the brain reward circuitry and this chromosomal region has been implicated in linkage scans for alcoholism. Variation in one chromosome 4 gene, GABRA2, has been robustly associated with alcohol use disorders (AUD) although no functional locus has been identified. Since HapMap data reveals moderate long-distance linkage disequilibrium across GABRA2 and the adjacent gene, GABRG1, it is possible that the functional locus is in GABRG1. We genotyped 24 SNPs across GABRG1 and GABRA2 in two population isolates: 547 Finnish Caucasian men (266 alcoholics) and 311 community-derived Plains Indian men and women (181 alcoholics). In both the Plains Indians and the Caucasians: (a) the GABRG1 haplotype block(s) did not extend to GABRA2; (b) GABRG1 haplotypes and SNPs were significantly associated with AUD; (c) there was no association between GABRA2 haplotypes and AUD; (d) there were several common (≥ 0.05) haplotypes that spanned GABRG1 and GABRA2 (341 kb), three of which were present in both populations: one of these ancestral haplotypes was associated with AUD, the other two were more common in non-alcoholics; this association was determined by GABRG1; (e) in the Finns, three less common (< 0.05) extended haplotypes showed an association with AUD that was determined by GABRA2. Our results suggest that there are likely to be independent, complex contributions from both GABRG1 and GABRA2 to alcoholism vulnerability.
doi:10.1038/npp.2008.171
PMCID: PMC2656604  PMID: 18818659
Linkage disequilibrium; GABAA receptor; ancestral haplotypes; alcohol use disorders; anxiety; American Indians
2.  Long-term efficacy of psychological treatments for binge eating disorder 
The British Journal of Psychiatry  2012;200(3):232-237.
Background
The long-term efficacy of psychological treatments for binge eating disorder remains largely unknown.
Aims
To examine the long-term efficacy of out-patient group cognitive–behavioural therapy (CBT) and group interpersonal psychotherapy (IPT) for binge eating disorder and to analyse predictors of long-term non-response.
Method
Ninety people with binge eating disorder were assessed 4 years after treatment cessation within a randomised trial (trial registration: NCT01208272).
Results
Participants showed substantial long-term recovery, partial remission, clinically significant improvement and significant reductions in associated psychopathology, despite relapse tendencies in single secondary outcomes. Body mass index remained stable. While the IPT group demonstrated an improvement in eating disorder symptoms over the follow-up period, the CBT group reported a worsening of symptoms, but treatments did not differ at any time point.
Conclusions
The results document the long-term efficacy of out-patient CBT and IPT for binge eating disorder. Further research is warranted to elucidate the time course and mechanisms of change of these treatments for binge eating disorder.
doi:10.1192/bjp.bp.110.089664
PMCID: PMC3290797  PMID: 22282429
3.  Life Beyond the Eating Disorder: Education, Relationships, and Reproduction 
Objective
We investigated sociodemographic characteristics in women with and without lifetime eating disorders.
Method
Participants were from a multi-site international study of eating disorders (N = 2096). Education level, relationship status, and reproductive status were examined across eating disorder subtypes and compared with a healthy control group.
Results
Overall, women with eating disorders were less educated than controls, and duration of illness and age of onset were associated with educational attainment. Menstrual status was associated with both relationship and reproductive status, but eating disorder subtypes did not differ significantly from each other or from healthy controls on these dimensions.
Conclusion
Differences in educational attainment, relationships, and reproduction do exist in individuals with eating disorders and are differentially associated with various eating disorder symptoms and characteristics. These data could assist with educating patients and family members about long-term consequences of eating disorders.
doi:10.1002/eat.20804
PMCID: PMC2888627  PMID: 20143323
Children; relationship; education; anorexia nervosa; bulimia nervosa; amenorrhea
4.  Eating Disorders, Normative Eating Self-Efficacy and Body Image Self-Efficacy: Women in Recovery Homes 
Although eating disorders (EDs) and ED symptoms are common among individuals in recovery for substance abuse (SA), long-term SA treatment programmes rarely address these problems. The present study examined the prevalence of EDs among women residing in Oxford Houses—low-cost, self-governed recovery homes for SA. Further, among women both with and without an ED diagnosis, the association between duration of Oxford House residency and eating-related self-efficacy scores was examined as an indicator of potential treatment effects on ED symptoms. During a telephone assessment, participants were administered the Structured Clinical Interview for DSM-IV-TR Axis I Disorders and the Eating Disorder Recovery Self-Efficacy Questionnaire. Results indicated that 12 of the 31 women analysed met criteria for an ED (bulimia nervosa, 2; ED not otherwise specified, 10). Differential findings were evident for eating-related self-efficacy measures depending on ED diagnostic status and duration of residency. Potential interpretations, limitations and implications are discussed.
doi:10.1002/erv.1116
PMCID: PMC3894607  PMID: 21751298
eating disorder; substance abuse; Oxford House; self-efficacy; recovery home
5.  Using Linkage Information to Weight a Genome-Wide Association of Bipolar Disorder 
Issues of multiple-testing and statistical significance in genome-wide association studies (GWAS) have prompted statistical methods utilizing prior data to increase the power of association results. Using prior findings from genome-wide linkage studies on bipolar disorder (BPD), we employed a weighted false discovery approach (wFDR; (Roeder et al. 2006)) to previously reported GWAS data drawn from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Using this method, association signals are up or down-weighted given the linkage score in that genomic region. Although no SNPs in our sample reached genome-wide significance through the wFDR approach, the strongest single SNP result from the original GWAS results (rs4939921 in myosin VB) is strongly up-weighted as it occurs on a linkage peak of chromosome 18. We also identify regions on chromosome 9, 17, and 18 where modestly associated SNP clusters coincide with strong linkage scores, implicating them as possible candidate regions for further analysis. Moving forward, we believe the application of prior linkage information will be increasingly useful to future GWAS studies that incorporate rarer variants into their analysis.
doi:10.1002/ajmg.b.31183
PMCID: PMC3082625  PMID: 21480485
6.  The relationship between anxiety, depression and illness perception in tberculosis patients in Pakistan 
Objective
As the rates of TB world over have increased during the past 10 years, there has been a growing awareness of depression and its role in the outcome of chronic disorders. Though depression is common in patients with TB no study as yet has examined the prevalence of depression in this group in Pakistan. We aimed to determine the presence of depression, anxiety and illness perceptions in patients suffering from Tuberculosis (TB) in Pakistan.
Methods
108 consecutive outpatients with tuberculosis completed the Hospital Anxiety and Depression scale (HADS) and the Illness Perception Questionnaire (IPQ).
Results
Out of 108 patients, 50 (46.3%) were depressed and 51 (47.2%) had anxiety. Raised depression and anxiety scores were associated with an increase in the number of symptoms reported (HADS Depression: r = 0.346, p = < 0.001), more serious perceived consequences (HADS Depression: r = 0.279, p = 0.004, HADS Anxiety: r = 0.234, p = 0.017) and less control over their illness (HADS Depression: r = 0.239, p = 0.014, HADS Anxiety: r = 0.271, p = 0.005).
Conclusion
We found that about a half of patients in our sample met the criteria for probable depression and anxiety based on HADS score. Negative illness perceptions were clearly related to reports of mood symptoms. As depression and lack of perceived control over illness in those suffering from tuberculosis are reported to be independent predictors of poor adherence further studies to investigate their relationship with medication adherence are required.
doi:10.1186/1745-0179-4-4
PMCID: PMC2288599  PMID: 18302758
7.  Prevalence of Disordered-Eating Behaviors in Undergraduate Female Collegiate Athletes and Nonathletes 
Journal of Athletic Training  2005;40(1):47-51.
Context: As the number of female college students participating in athletics has grown dramatically in the last few decades, sports medicine health care providers have become more aware of the unique health concerns of athletic women. These concerns include disordered eating, amenorrhea, and osteoporosis: the female athlete triad. Disordered eating appears to be central in the triad, and the literature has conflicting data regarding the influence of athletic participation on disordered-eating behaviors.
Objective: To compare disordered-eating symptoms between collegiate athletes (in lean and non-lean sports) and nonathletes.
Design: A volunteer, cross-sectional cohort study of female students during the 2002–2003 academic year.
Setting: A National Collegiate Athletic Association Division I institution.
Patients or Other Participants: Undergraduate females, including 84 collegiate athletes and 62 nonathletes.
Main Outcome Measure(s): Symptoms associated with disordered eating were assessed using the Eating Disorders Inventory-2, a self-report measure of 91 items, and self-reported weight and menstrual function.
Results: The athletes had significantly lower scores in body dissatisfaction (P = .01) and ineffectiveness (P = .002). No difference in mean body weight was noted between the 2 groups, but the nonathlete group had a significantly lower desired body weight (P = .004). Lean-sport athletes had a higher score on body dissatisfaction (P = .008) and lower actual (P = .024) and desired body weight (P = .002) than non–lean-sport athletes. A total of 7.1% of the collegiate athletes and 12.9% of the nonathletes were classified as having a high risk for disordered eating. Within the athlete sample, the high-risk group included 2.9% of the non–lean-sport athletes and 25% of the lean-sport athletes.
Conclusions: In our study, female athletes did not exhibit more disordered-eating symptoms than women who did not participate in collegiate sports. However, our data suggest that lean-sport athletes are at greater risk for disordered eating than athletes in non-lean sports.
PMCID: PMC1088345  PMID: 15902324
female athlete triad; nutrition; psychology
8.  Genome-Wide Association Analysis of Eating Disorder-Related Symptoms, Behaviors, and Personality Traits 
American Journal of Medical Genetics  2012;159B(7):803-811.
Eating disorders (EDs) are common, complex psychiatric disorders thought to be caused by both genetic and environmental factors. They share many symptoms, behaviors, and personality traits, which may have overlapping heritability. The aim of the present study is to perform a genome-wide association scan (GWAS) of six ED phenotypes comprising three symptom traits from the Eating Disorders Inventory 2 [Drive for Thinness (DT), Body Dissatisfaction (BD), and Bulimia], Weight Fluctuation symptom, Breakfast Skipping behavior and Childhood Obsessive-Compulsive Personality Disorder trait (CHIRP). Investigated traits were derived from standardized self-report questionnaires completed by the TwinsUK population-based cohort. We tested 283,744 directly typed SNPs across six phenotypes of interest in the TwinsUK discovery dataset and followed-up signals from various strata using a two-stage replication strategy in two independent cohorts of European ancestry. We meta-analyzed a total of 2,698 individuals for DT, 2,680 for BD, 2,789 (821 cases/1,968 controls) for Bulimia, 1,360 (633 cases/727 controls) for Childhood Obsessive-Compulsive Personality Disorder trait, 2,773 (761 cases/2,012 controls) for Breakfast Skipping, and 2,967 (798 cases/2,169 controls) for Weight Fluctuation symptom. In this GWAS analysis of six ED-related phenotypes, we detected association of eight genetic variants with P < 10−5. Genetic variants that showed suggestive evidence of association were previously associated with several psychiatric disorders and ED-related phenotypes. Our study indicates that larger-scale collaborative studies will be needed to achieve the necessary power to detect loci underlying ED-related traits. © 2012 Wiley Periodicals, Inc.
doi:10.1002/ajmg.b.32087
PMCID: PMC3494378  PMID: 22911880
Drive for Thinness; Body Dissatisfaction; Childhood Obsessive Compulsive Personality Disorder; Weight Fluctuation; Breakfast Skipping
9.  Association Study of 182 Candidate Genes in Anorexia Nervosa 
We performed association studies with 5,151 SNPs that were judged as likely candidate genetic variations conferring susceptibility to anorexia nervosa (AN) based on location under reported linkage peaks, previous results in the literature (182 candidate genes), brain expression, biological plausibility, and estrogen responsivity. We employed a case–control design that tested each SNP individually as well as haplotypes derived from these SNPs in 1,085 case individuals with AN diagnoses and 677 control individuals. We also performed separate association analyses using three increasingly restrictive case definitions for AN: all individuals with any subtype of AN (All AN: n = 1,085); individuals with AN with no binge eating behavior (AN with No Binge Eating: n = 687); and individuals with the restricting subtype of AN (Restricting AN: n = 421). After accounting for multiple comparisons, there were no statistically significant associations for any individual SNP or haplotype block with any definition of illness. These results underscore the importance of large samples to yield appropriate power to detect genotypic differences in individuals with AN and also motivate complementary approaches involving Genome-Wide Association (GWA) studies, Copy Number Variation (CNV) analyses, sequencing-based rare variant discovery assays, and pathway-based analysis in order to make up for deficiencies in traditional candidate gene approaches to AN.
doi:10.1002/ajmg.b.31082
PMCID: PMC2963154  PMID: 20468064
single nucleotide polymorphisms; probands; anorexia nervosa; bulimia nervosa
10.  How should DSM-V classify eating disorder not otherwise specified (EDNOS) presentations in women with lifetime anorexia or bulimia nervosa? 
Psychological medicine  2010;40(10):1735-1744.
Objective
Anorexia nervosa (AN) and bulimia nervosa (BN) are marked by longitudinal symptom fluctuations. DSM-IV-TR does not address how to classify eating disorder (ED) presentations in individuals who no longer meet full criteria for these disorders. To consider this issue, we examined subthreshold presentations in women with initial diagnoses of AN and BN.
Method
A total of 246 women with AN or BN were followed for a median of 9 years; weekly symptom data were collected at frequent intervals using the Longitudinal Interval Follow-up Evaluation of Eating Disorders (LIFE-EAT-II). Outcomes were ED presentations that were subthreshold for ≥3 months, including those narrowly missing full criteria for AN or BN, along with binge eating disorder (BED) and purging disorder.
Results
During follow-up, most women (77.6%) experienced a subthreshold presentation. Subthreshold presentation was related to intake diagnosis (Wald χ2 = 8.065, df = 2, p = 0.018). Individuals with AN most often developed subthreshold presentations resembling AN; those with BN were more likely to develop subthreshold BN. Purging disorder was experienced by half of those with BN and one-quarter of those with AN binge/purge type (ANBP); BED occurred in 20% with BN. Transition from AN or BN to most subthreshold types was associated with improved psychosocial functioning (p < 0.001).
Conclusions
Subthreshold presentations in women with lifetime AN and BN were common, resembled the initial diagnosis, and were associated with modest improvements in psychosocial functioning. For most with lifetime AN and BN, subthreshold presentations seem to represent part of the course of illness and to fit within the original AN or BN diagnosis.
doi:10.1017/S0033291709992200
PMCID: PMC3740170  PMID: 20047706
Anorexia nervosa; bulimia nervosa; classification; eating disorder not otherwise specified; longitudinal
11.  Nocturnal Eating: Association with Binge Eating, Obesity, and Psychological Distress 
Objective
To examine clinical correlates of nocturnal eating, a core behavioral symptom of night eating syndrome.
Method
Data from 285 women who had participated in a two-stage screening for binge eating were utilized. Women (n = 41) who reported one or more nocturnal eating episodes in the past 28 days on the Eating Disorder Examination and women who did not report nocturnal eating (n =244) were compared on eating disorder symptomatology, Body Mass Index (BMI), and on measures of psychosocial adjustment.
Results
Nocturnal eaters were significantly more likely to report binge eating and differed significantly from non-nocturnal eaters (with responses indicating greater disturbance) on weight and shape concern, eating concern, self-esteem, depression, and functional impairment, but not on BMI or dietary restraint. Group differences remained significant in analyses adjusting for binge eating.
Conclusions
This study confirms the association between nocturnal eating and binge eating previously found in treatment seeking samples yet also suggests that the elevated eating disorder symptoms and decreased psychosocial adjustment observed in nocturnal eaters is not simply a function of binge eating.
doi:10.1002/eat.20735
PMCID: PMC2891279  PMID: 19708071
nocturnal eating; night eating syndrome; binge eating; obesity
12.  The Role of Ghrelin, Salivary Secretions, and Dental Care in Eating Disorders 
Nutrients  2012;4(8):967-989.
Eating disorders, including anorexia and bulimia nervosa, are potentially life-threatening syndromes characterized by severe disturbances in eating behavior. An effective treatment strategy for these conditions remains to be established, as patients with eating disorders tend to suffer from multiple relapses. Because ghrelin was originally discovered in the stomach mucosa, it has been widely studied over the past decade in an effort to uncover its potential roles; these studies have shed light on the mechanism by which ghrelin regulates food intake. Thus, studying ghrelin in the context of eating disorders could improve our understanding of the pathogenesis of eating disorders, possibly resulting in a promising new pharmacological treatment strategy for these patients. In addition, early detection and treatment of eating disorders are critical for ensuring recovery of young patients. Oral symptoms, including mucosal, dental, and saliva abnormalities, are typically observed in the early stages of eating disorders. Although oral care is not directly related to the treatment of eating disorders, knowledge of the oral manifestations of eating disorder patients may aid in early detection, resulting in earlier treatment; thus, oral care might contribute to overall patient management and prognosis. Moreover, ghrelin has also been found in saliva, which may be responsible for oral hygiene and digestion-related functions. This review discusses the pharmacological potential of ghrelin in regulating food-intake and the role of saliva and oral care in young patients with eating disorders.
doi:10.3390/nu4080967
PMCID: PMC3448082  PMID: 23016127
anorexia nervosa; bulimia nervosa; ghrelin; salivary secretions
13.  Neuropeptide S Receptor Induces Neuropeptide Expression and Associates with Intermediate Phenotypes of Functional Gastrointestinal Disorders 
Gastroenterology  2009;138(1):98-107.e4.
Background & Aims
NPSR1, the receptor for neuropeptide S (NPS), is expressed by gastrointestinal (GI) enteroendocrine (EE) cells, and is involved in inflammation, anxiety and nociception. NPSR1 polymorphisms are associated with asthma and inflammatory bowel disease. We aimed to determine whether NPS induces expression of GI neuropeptides; and to associate NPSR1 single nucleotide polymorphisms (SNPs) with symptom phenotype and GI functions in health and functional GI disorders (FGID).
Methods
The effect of NPS on mRNA expression of neuropeptides was assessed using real-time PCR in NPSR1-tranfected HEK293 cells. Seventeen NPSR1 SNPs were successfully genotyped in 699 subjects from a regional cohort of 466 FGID patients and 233 healthy controls. Associations were sought using sex-adjusted regression analysis and false discovery rate (FDR) correction.
Results
NPS-NPSR1 signaling induced increased expression of CCK, VIP, PYY, and somatostatin. There were no significant associations with phenotypes of FGID symptoms. There were several NPSR1 SNPs associated with individual motor or sensory functions; the associations of SNPs rs2609234, rs6972158 and rs1379928 with colonic transit rate remained significant after FDR correction. The rs1379928 polymorphism was also associated with pain, gas and urgency sensory ratings at 36 mm Hg distension, the level pre-specified for formal testing. Associations with rectal sensory ratings were not significant after FDR correction.
Conclusions
Expression of several neuropeptides is induced upon NPS-NPSR1 signaling; NPSR1 variants are associated with colonic transit in FGID. The role of the NPS system in FGID deserves further study.
doi:10.1053/j.gastro.2009.08.051
PMCID: PMC2813358  PMID: 19732772
14.  Survey of Eating Disorder Symptoms among Women in Treatment for Substance Abuse 
A strong association between substance use disorders (SUD) and eating disorders (ED) in women has been established. Yet, little is known about the rates and impact of ED symptoms in women presenting to addiction treatment. The current investigation assessed the prevalence of ED symptoms and their effect on treatment outcomes in a sample of substance abusing women with co-occurring posttraumatic stress disorder (PTSD) enrolled in outpatient substance use programs. Participants were 122 women who participated in a multi-site clinical trial comparing two behavioral treatments for co-occurring SUD and PTSD. The Eating Disorder Examination-self report (EDE-Q), and measures of PTSD and SUD symptoms were administered at baseline, during treatment and at four follow-up points. Two subgroups emerged; those reporting binge eating in the 28 days prior to baseline (Binge group; n = 35) and those who reported no binge eating episodes (No Binge group; n = 87). Women in the Binge group endorsed significantly higher ED, PTSD and depression symptoms at baseline than those in the No Binge group. Though all participants showed significant reductions in PTSD symptoms and improvements in abstinence rates during the study period, the improvements for the Binge group were significantly lower. These findings suggest that a sub-group of women with co-occurring PTSD and SUDs who endorsed binge ED symptoms responded differently to SUD/PTSD group treatment. Identification of eating disorder symptoms among treatment-seeking women with SUDs may be an important element in tailoring interventions and enhancing treatment outcomes.
doi:10.1111/j.1521-0391.2010.00038.x
PMCID: PMC2882625  PMID: 20525031
15.  Variation in NGFB is Associated with Primary Affective Disorders in Women 
Affective disorders (AFDs) are highly comorbid with substance dependence (SD) and both are genetically influenced. However, the specific etiology of the comorbidity is not well understood. We genotyped an array of 1,350 single nucleotide polymorphisms (SNPs) in or near 130 genes in 868 European-Americans (EAs), including 182 individuals with primary AFDs (PAFDs), 214 with SD comorbid with AFD (CAFD), and 472 screened controls. NGFB, which encodes nerve growth factor β and was represented in the array by 15 SNPs, showed the strongest evidence of association, but only among women with PAFDs. Six of the SNPs showed a nominally significant association with PAFDs in women (Ps = 0.0007–0.01); three (rs2856813, rs4332358, and rs10776799) were empirically significant based on 1,000,000 permutations (Ps = 0.008–0.015). Seven haplotypes were significantly associated with PAFDs in women (Ps = 0.0014–0.01), of which six were significant based on empirical permutation analysis (minimal P = 0.0045). Four diplotypes were significantly associated with PAFDs in women (global Ps = 0.001–0.01). The specific diplotype GG-TC, reconstructed from rs2856813 and rs6678788, showed the strongest evidence of association with PAFDs in women (OR = 4.07, P = 4.2E-05). No SNPs or haplotypes were associated with PAFDs in men or with CAFDs in either sex. We conclude that variation in NGFB is a risk factor for PAFDs in women, but not for CAFD.
doi:10.1002/ajmg.b.31175
PMCID: PMC3108453  PMID: 21294249
nerve growth factor β; NGFB; affective disorder; substance dependence; association study; sex-specific
16.  Genome-wide association study identifies two novel loci containing FLNB and SBF2 genes underlying stature variation 
Human Molecular Genetics  2008;18(9):1661-1669.
Human stature, as an important physical index in clinical practice and a usual covariate in gene mapping of complex disorders, is a highly heritable complex trait. To identify specific genes underlying stature, a genome-wide association study was performed in 1000 unrelated homogeneous Caucasian subjects using Affymetrix 500K arrays. A group of seven contiguous markers in the region of SBF2 gene (Set-binding factor 2) are associated with stature, significantly so at the genome-wide level after false discovery rate (FDR) correction (FDR q = 0.034–0.042). Three SNPs in another SNP group in the Filamin B (FLNB) gene were also associated with stature, significantly so with FDR q = 0.042–0.048. In follow-up independent replication studies, rs10734652 in the SBF2 gene was significantly (P = 0.036) and suggestively (P = 0.07) associated with stature in Caucasian families and 1306 unrelated Caucasian subjects, respectively, and rs9834312 in the FLNB gene was also associated with stature in such two independent Caucasian populations (P = 0.008 in unrelated sample and P = 0.049 in family sample). Particularly, additional significant replication association signals were detected in Chinese, an ethnic population different from Caucasian, between rs9834312 and stature in 619 unrelated northern Chinese subjects (P = 0.017), as well as between rs10734652 and stature in 2953 unrelated southern Chinese subjects (P = 0.048). This study also provides additional replication evidence for some of the already published stature loci. These results, together with the known functional relevance of the SBF2 and FLNB genes to skeletal linear growth and bone formation, support that two regions containing FLNB and SBF2 genes are two novel loci underlying stature variation.
doi:10.1093/hmg/ddn405
PMCID: PMC2667283  PMID: 19039035
17.  Temporal Sequence of Comorbid Alcohol Use Disorder and Anorexia Nervosa 
Addictive behaviors  2012;38(3):1704-1709.
Women with eating disorders have a significantly higher prevalence of substance use disorders than the general population. The goal of the current study was to assess the temporal pattern of comorbid anorexia nervosa (AN) and alcohol use disorder (AUD) and the impact this ordering has on symptomatology and associated features. Women were placed into one of three groups based on the presence or absence of comorbid AUD and the order of AN and AUD onset in those with both disorders: (1) AN Only, (2) AN First, and (3) AUD First. The groups were compared on psychological symptoms and personality characteristics often associated with AN, AUD, or both using general linear models. Twenty-one percent of women (n = 161) with AN reported a history of AUD with 115 reporting AN onset first and 35 reporting AUD onset first. Women with binge-eating and/or purging type AN were significantly more likely to have AUD. In general, differences were found only between women with AN Only and women with AN and AUD regardless of order of emergence. Women with AN and AUD had higher impulsivity scores and higher prevalence of depression and borderline personality disorder than women with AN Only. Women with AN First scored higher on traits commonly associated with AN, whereas women with comorbid AN and AUD displayed elevations in traits more commonly associated with AUD. Results do not indicate a distinct pattern of symptomatology in comorbid AN and AUD based on the temporal sequence of the disorders.
doi:10.1016/j.addbeh.2012.10.005
PMCID: PMC3558554  PMID: 23254222
anorexia nervosa; alcohol use disorder; comorbidity; age of onset
18.  Eating Disorder Symptoms and Weight and Shape Concerns in a Large Web-Based Convenience Sample of Women Ages 50 and Above: Results of the Gender and Body Image Study (GABI) 
Objective
Limited research exists on eating disorder symptoms and attitudes and weight and shape concerns in women in mid-life to older adulthood. We conducted an online survey to characterize these behaviors and concerns in women ages 50 and above.
Method
Participants (n = 1,849) were recruited via the Internet and convenience sampling.
Results
Eating disorder symptoms, dieting and body checking behaviors, and weight and shape concerns were widely endorsed. Younger age and higher body mass index (BMI) were associated with greater endorsement of eating disorder symptoms, behaviors, and concerns.
Discussion
Weight and shape concerns and disordered eating behaviors occur in women over 50 and vary by age and BMI. Focused research on disordered eating patterns in this age group is necessary to develop age-appropriate interventions and to meet the developmental needs of an important, growing, and underserved population.
doi:10.1002/eat.22030
PMCID: PMC3459309  PMID: 22729743
eating disorder symptoms; binge eating; body dissatisfaction; mid-life; older adult; women
19.  Eating disordered patients: personality, alexithymia, and implications for primary care. 
BACKGROUND: Eating disorders are becoming more apparent in primary care. Descriptions of character traits related to people with eating disorders are rarely reported in the primary care literature and there is little awareness of the implications of alexithymia--a concept that defines the inability to identify or express emotion. We hypothesised that many individuals with active eating disorders have alexithymic traits and a tendency to somatize their distress. AIM: To analyse the character traits and degree of alexithymia of a selected group of women with active eating disorders and in recovery, and to recommend responses by members of the primary care team that might meet the needs of such individuals. METHOD: Letters were sent to 200 female members of the Eating Disorders Association who had agreed to participate in research. Seventy-nine women volunteered to complete four postal questionnaires. This gave a response rate of 38.5%. Responders were categorised into three groups--anorexic, bulimic, and recovered--using the criteria of the Eating Disorders Inventory (EDI-2). The results of the 16PF5 Personality Inventory (16PF5) and the Toronto Alexithymia Scale (TAS-20) were analysed using one-way analysis of variance (ANOVA) and correlated using Pearson's correlation. A biographical questionnaire was also completed. RESULTS: In all three subgroups, high scores were achieved on the 16PF5 on 'apprehension and social sensitivity', while there were significant differences in the scores for 'privateness': a scale that measures the ability to talk about feelings and confide in others. On the TAS-20, 65% of the anorexic and 83% of the bulimic group scored in the alexithymic range compared with 33% of the recovered group. There was a significant negative correlation between alexithymia and social skills such as 'social and emotional expressivity' on the 16PF5. CONCLUSION: The results of this study emphasise the difference between those with active eating disorders who achieved high scores for privacy, introversion, and alexithymia, and those who have recovered. These character traits give potential helpers an important indication of the areas that can both block and facilitate recovery, and they act as a reminder that the presenting symptoms in eating disorders and other psychosomatic conditions are the outward presentation of internal conflict. It is suggested that effective screening and needs assessment will facilitate a more appropriate and prompt therapeutic response. This may be provided in the primary care setting where appropriate training has occurred.
PMCID: PMC1313605  PMID: 10695062
20.  Relationship of Fruit, Vegetable, and Fat Consumption to Binge Eating Symptoms in African American and Hispanic or Latina Women 
Eating Behaviors  2012;13(2):179-182.
African American (AA) and Hispanic or Latina (HL) women have the highest rates of overweight and obesity of any gender and ethnic groups. Binge eating disorder (BED) is the most common eating disorder in the United States and is linked to overweight and obesity. Traditional treatments for BED may not be appropriate or viable for AA and HL women, because they are less likely than whites to seek treatment for psychological conditions and may have less access to healthcare. Improving dietary habits in those with BED or subthreshold BED may reduce binge eating symptoms. The current study investigated the association of fruit, vegetable, and fat consumption to binge eating symptoms in AA and HL women. AA and HL women in the Health Is Power (HIP) study (N=283) reported fruit and vegetable intake, fat intake, and binge eating symptoms. Women were middle aged (M=45.8 years, SD=9.2) and obese (M BMI=34.5 kg/m2, SD=7.5). Greater fat consumption was correlated with lower fruit and vegetable consumption (rs=−.159, p<.01). Higher BMI (rs=.209, p<.01), and greater fat consumption (rs=.227, p<.05) were correlated with increased binge eating symptoms. Multiple regression analysis demonstrated that HL women (β =.130, p=.024), higher BMI (β =.148, p=.012), and greater fat consumption (β=.196, p=.001) were associated with increased binge eating symptoms (R2=.086, F(3,278)=8.715, p<001). Findings suggest there may be a relationship between fat consumption and binge eating symptoms, warranting further study to determine whether improving dietary habits may serve as a treatment for BED in AA and HL women.
doi:10.1016/j.eatbeh.2012.01.007
PMCID: PMC3304303  PMID: 22365808
Binge Eating Disorder; African American; Hispanic; Dietary Habits; Binge Eating
21.  ESPECTRA: Searching the Bipolar Spectrum in Eating Disorder patients 
BMC Psychiatry  2011;11:59.
Background
Bipolar Disorder (BD) is a chronic, recurrent and highly prevalent illness. Despite the need for correct diagnosis to allow proper treatment, studies have shown that reaching a diagnosis can take up to ten years due to the lack of recognition of the broader presentations of BD. Frequent comorbidities with other psychiatric disorders are a major cause of misdiagnosis and warrant thorough evaluation.
Methods/Design
ESPECTRA (Occurrence of Bipolar Spectrum Disorders in Eating Disorder Patients) is a single-site cross-sectional study involving a comparison group, designed to evaluate the prevalence of bipolar spectrum in an eating disorder sample. Women aged 18-45 years will be evaluated using the SCID-P and Zurich criteria for diagnosis and the HAM-D, YOUNG, SCI-MOODS, HCL-32, BIS-11, BSQ, WHOQoL and EAS instruments for rating symptoms and measuring clinical correlates.
Discussion
The classificatory systems in psychiatry are based on categorical models that have been criticized for simplifying the diagnosis and leading to an increase in comorbidities. Some dimensional approaches have been proposed aimed at improving the validity and reliability of psychiatric disorder assessments, especially in conditions with high rates of comorbidity such as BD and Eating Disorder (ED). The Bipolar Spectrum (BS) remains under-recognized in clinical practice and its definition is not well established in current diagnostic guidelines. Broader evaluation of psychiatric disorders combining categorical and dimensional views could contribute to a more realistic understanding of comorbidities and help toward establishing a prognosis.
doi:10.1186/1471-244X-11-59
PMCID: PMC3094285  PMID: 21489298
22.  Longitudinal Replication Studies of GWAS Risk SNPs Influencing Body Mass Index over the Course of Childhood and Adulthood 
PLoS ONE  2012;7(2):e31470.
Genome-wide association studies (GWAS) have identified multiple common variants associated with body mass index (BMI). In this study, we tested 23 genotyped GWAS-significant SNPs (p-value<5*10-8) for longitudinal associations with BMI during childhood (3–17 years) and adulthood (18–45 years) for 658 subjects. We also proposed a heuristic forward search for the best joint effect model to explain the longitudinal BMI variation. After using false discovery rate (FDR) to adjust for multiple tests, childhood and adulthood BMI were found to be significantly associated with six SNPs each (q-value<0.05), with one SNP associated with both BMI measurements: KCTD15 rs29941 (q-value<7.6*10-4). These 12 SNPs are located at or near genes either expressed in the brain (BDNF, KCTD15, TMEM18, MTCH2, and FTO) or implicated in cell apoptosis and proliferation (FAIM2, MAP2K5, and TFAP2B). The longitudinal effects of FAIM2 rs7138803 on childhood BMI and MAP2K5 rs2241423 on adulthood BMI decreased as age increased (q-value<0.05). The FTO candidate SNPs, rs6499640 at the 5 ′-end and rs1121980 and rs8050136 downstream, were associated with childhood and adulthood BMI, respectively, and the risk effects of rs6499640 and rs1121980 increased as birth weight decreased. The best joint effect model for childhood and adulthood BMI contained 14 and 15 SNPs each, with 11 in common, and the percentage of explained variance increased from 0.17% and 9.0*10−6% to 2.22% and 2.71%, respectively. In summary, this study evidenced the presence of long-term major effects of genes on obesity development, implicated in pathways related to neural development and cell metabolism, and different sets of genes associated with childhood and adulthood BMI, respectively. The gene effects can vary with age and be modified by prenatal development. The best joint effect model indicated that multiple variants with effects that are weak or absent alone can nevertheless jointly exert a large longitudinal effect on BMI.
doi:10.1371/journal.pone.0031470
PMCID: PMC3280302  PMID: 22355368
23.  Impact of Substance Use Disorders on Recovery From Episodes of Depression in Bipolar Disorder Patients: Prospective Data From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) 
The American journal of psychiatry  2009;167(3):289-297.
Objective
Bipolar disorder is highly comorbid with substance use disorders, and this comorbidity may be associated with a more severe course of illness, but the impact of comorbid substance abuse on recovery from major depressive episodes in these patients has not been adequately examined. The authors hypothesized that comorbid drug and alcohol use disorders would be associated with longer time to recovery in patients with bipolar disorder.
Method
Subjects (N=3,750) with bipolar I or bipolar II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were followed prospectively for up to 2 years. Prospectively observed depressive episodes were identified for this analysis. Subjects with a past or current drug or alcohol use disorder were compared with those with no history of drug or alcohol use disorders on time to recovery from depression and time until switch to a manic, hypomanic, or mixed episode.
Results
During follow up, 2,154 subjects developed a new-onset major depressive episode; of these, 457 subjects switched to a manic, hypomanic, or mixed episode prior to recovery. Past or current substance use disorder did not predict time to recovery from a depressive episode relative to no substance use comorbidity. However, those with current or past substance use disorder were more likely to experience switch from depression directly to a manic, hypomanic, or mixed state.
Conclusions
Current or past substance use disorders were not associated with longer time to recovery from depression but may contribute to greater risk of switch into manic, mixed, or hypomanic states. The mechanism conferring this increased risk merits further study.
doi:10.1176/appi.ajp.2009.09020299
PMCID: PMC2918249  PMID: 20008948
24.  Entomophagy and Coprophagy in Undifferentiated Schizophrenia 
Coprophagia or the ingestion of feces, considered to be a variant of pica, has been associated with medical disorders like seizure disorders, cerebral atrophy, and tumors and with psychiatric disorders like mental retardation, alcoholism, depression, obsessive compulsive disorder, schizophrenia, schizoaffective disorder, fetishes, delirium, and dementia. But entomophagy or the practice of eating live or dead insects as food by humans has only been reported as part of eating habits by some cultures in the world and not in association with any medical or neuropsychiatric disorders. Till date, there is no report in medical literature of entomophagy as an association with any neuropsychiatric or medical illnesses. Coprophagy and entomophagy has not been together reported as well. We describe the first ever case report of a 19-year- old male patient diagnosed with undifferentiated schizophrenia and associated with both entomophagy and coprophagy. His schizophrenic symptoms, the entomophagic, coprophagic behaviors improved with olanzapine therapy. Entomophagy and coprophagy, two very unusual human behaviors, can be seen in association with schizophrenia.
doi:10.4103/0253-7176.53318
PMCID: PMC3168083  PMID: 21938094
Coprophagia; pica; schizophrenia
25.  The Role of Negative Urgency and Expectancies in Problem Drinking and Disordered Eating: Testing a Model of Comorbidity in Pathological and At-Risk Samples 
The aim of this study was to test hypotheses derived from a model that explains both the comorbidity of problem drinking and eating disorder symptoms and the difference in risk process between the two disorders. In Study One, the authors examined four personality constructs typically associated with rash action (sensation seeking, lack of planning, lack of persistence, and negative urgency) and disorder-specific expectancies in samples of women with eating disorders, substance dependence disorders, comorbid conditions, and no symptoms (N = 104). Negative urgency, the tendency to act rashly when distressed, differentiated the disordered groups from the control group. In contrast, learned expectancies differentiated among clinical groups. Women with eating disorders endorsed high levels of eating and dieting expectancies and women with substance use disorders endorsed high levels of alcohol expectancies, while comorbid women endorsed high levels of both. In Study Two, this pattern of findings was replicated in a sample of fifth grade girls (N = 905). Girls who had engaged in binge eating, alcohol use, or both had higher levels of negative urgency than asymptomatic girls, and the pattern of outcome expectancy endorsement was disorder specific. Negative urgency may represent a general, personality influence on both eating disordered behaviors and symptoms of alcohol dependence, which, when combined with learned, behavior-specific expectancies, leads to specific addictive behavior patterns.
doi:10.1037/a0023460
PMCID: PMC3954822  PMID: 21604832
alcohol; bulimia; impulsivity; urgency

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