The College Health Advisor and the College Age Adoptee

Abstract

Eating disorders are among the most common psychopathologies on college campuses. Research on ethnic differences in eating disorder symptoms and prevalence has resulted in conflicting conclusions. Some studies find that particular ethnic groups have a higher prevalence of a symptom; others find that members of that ethnic group have a lower prevalence of the same symptom. The authors explored the role of body mass index (BMI), one potential confound. They used a reliable measure of eating disorder symptoms to assess differences between Hispanic, Asian, and non-Hispanic White college women from two separate samples. After controlling for BMI, ethnic differences in eating disorder symptoms of concern about weight and shape disappeared, but differences in restrained eating remained. Inconsistent findings in the ethnic-difference literature on eating disorders may result from systematic group differences in BMI. Implications for college health programs, counseling, and case finding are discussed.     

Eating Disorders Among a Community-based Sample of Chilean Female Adolescents

The purpose of this study was to explore the prevalence and correlates of eating disorders among a community-based sample of female Chilean adolescents. Data were collected through structured interviews with 420 female adolescents residing in Santiago, Chile. Approximately 4% of the sample reported ever being diagnosed with an eating disorder. Multivariate logistic regression analyses revealed that those with higher symptoms of anxiety and who had tried cigarettes were significantly more likely to have been diagnosed with an eating disorder. Findings indicate that Chilean female adolescents are at risk of eating disorders and that eating disorders, albeit maladaptive, may be a means to cope with negative affect, specifically anxiety.     

Symptoms of Eating Disorders Among Females in Drug Addiction Treatment

The aim of this study is to measure and describe symptoms of eating disorders among females in treatment for drug addiction in Norway. Previous clinical and epidemiological studies have revealed coprevalence between eating disorders and substance use or abuse. However, few studies have measured eating disorders in drug-using samples and even fewer within the context of drug treatment. In this study, 29 females with drug use disorder in residential treatment were tested with the Eating Disorder Inventory–2. A subgroup of 9 females (31%) with significant symptoms of eating disorders was identified. The characteristics of this group and possible clinical consequences are discussed.     

Attention-deficit hyperactivity disorder symptomatology,binge eating disorder symptomatology,and body mass index among college students

Abstract

Objective: To explore the relationship between symptoms of attention-deficit hyperactivity disorder (ADHD), symptoms of binge eating disorder, and body mass index (BMI) among students at a southern university. Participants: Two hundred seventy-seven college students. Methods: Between January 31, 2013 and March 27, 2013, participants completed the Adult ADHD Self-Report Scale (ASRS) Screener and the Binge Eating Scale (BES) in addition to permitting researchers to measure their height and weight. Results: Higher ASRS scores, higher BMIs, and lower BES scores were observed among men. Among both men and women, BES scores were positively correlated with BMI and ASRS scores; however, the correlation between ASRS and BMI was not significant. Conclusion: Binge eating disorder symptomatology was associated with increased ADHD symptomatology and a higher BMI among both men and women. Among students presenting with obesity or ADHD, screening for binge eating may assist with the identification of problematic eating behaviors.     

Eating disorders and body image of undergraduate men

Eating disorders and body dissatisfaction among undergraduate men are less documented and researched than are eating disorders and body dissatisfaction among undergraduate women. OBJECTIVE AND PARTICIPANTS: In this study, the authors examined these issues in undergraduate men to identify similarities and differences between this population and undergraduate women. METHODS: In a random sample of undergraduates, the authors categorized respondents by gender and by presence or absence of an eating disorder. The authors compared undergraduate men with an eating disorder with (1) undergraduate women with an eating disorder and (2) undergraduate men without an eating disorder. RESULTS: The patterns of responses suggest that undergraduate men with an eating disorder are preoccupied with body shape and tone but not necessarily with losing weight. CONCLUSIONS: The authors discuss implications for future prevention as well as clinical and research efforts based on male symptoms within the diagnostic category of bulimia nervosa and eating disorder, not otherwise specified.     

Attention-deficit/hyperactivity disorder–specific stimulant misuse,mood, anxiety,and stress in college-age women at high risk for or with eating disorders

ABSTRACT

Objective: To examine the misuse of attention-deficit/hyperactivity disorder (ADHD)-specific stimulants in a college population at high risk for or with clinical or subclinical eating disorders. Participants: Four hundred forty-eight college-age women aged 18–25 at high risk for or with a clinical or subclinical eating disorder. Methods: Participants completed assessments of stimulant misuse and psychopathology from September 2009 to June 2010. Results: Greater eating disorder pathology, objective binge eating, purging, eating disorder–related clinical impairment, depressive symptoms, perceived stress, and trait anxiety were associated with an increased likelihood of stimulant misuse. Subjective binge eating, excessive exercise, and dietary restraint were not associated with stimulant misuse. Conclusions: ADHD-specific stimulant misuse is associated with eating disorder and comorbid pathology among individuals at high risk for or with clinical or subclinical eating disorders. Screening for stimulant misuse and eating disorder pathology may improve identification of college-age women who may be engaging in maladaptive behaviors and inform prevention efforts.     

Aging male symptomatology and eating behavior

Objective: The literature on eating disorders in older males is still very limited. We assessed the relationship between aging male symptomatology and eating behavior in middle-aged and older men.

Method: We distributed anonymous questionnaires to men aged 40–75?years living in or near Innsbruck, Austria, covering demographic items, current eating disorder symptoms (as defined by DSM-5), and associated measures of eating pathology, body image, and sports activity (including exercise addiction). We also administered the Aging Males’ Symptoms scale (AMS), and classified respondents as “high-AMS” (AMS score ≥37; N?=?82) or “low-AMS” (AMS score <37; N?=?386).

Results: High-AMS men reported a significantly higher mean current BMI, a greater prevalence of eating disorder symptoms, higher scores on the Eating Disorder Examination Questionnaire, greater risk of exercise addiction, and more negative body image than low-AMS men.

Discussion: We found a marked association between aging-male symptomatology and eating-disorder symptomatology in aging men. Our findings suggest that clinicians should carefully inquire about eating disorder symptoms in men aged 40 and above reporting aging-male symptomatology. Importantly, several men in the study reported “purging” via excessive exercise (as opposed to the more common methods of vomiting or use of laxatives or diuretics), and therefore this should be a subject of inquiry in clinical evaluations. To pursue these findings, subsequent studies of eating disorders in older men should consider assessing endocrinological measures, particularly testosterone levels, and should use longitudinal designs.     

Eating Disorders and Body Image of Undergraduate Men

Eating disorders and body dissatisfaction among undergraduate men are less documented and researched than are eating disorders and body dissatisfaction among undergraduate women. Objective and Participants: In this study, the authors examined these issues in undergraduate men to identify similarities and differences between this population and undergraduate women. Methods: In a random sample of undergraduates, the authors categorized respondents by gender and by presence or absence of an eating disorder. The authors compared undergraduate men with an eating disorder with (1) undergraduate women with an eating disorder and (2) undergraduate men without an eating disorder. Results: The patterns of responses suggest that undergraduate men with an eating disorder are preoccupied with body shape and tone but not necessarily with losing weight. Conclusions: The authors discuss implications for future prevention as well as clinical and research efforts based on male symptoms within the diagnostic category of bulimia nervosa and eating disorder, not otherwise specified.     

Eating Disorders and Additional Psychopathology in Women

Eating disordered individuals are often found to exhibit additional psychopathology such as depression, anxiety, substance abuse, and "borderline symptoms" such as self-injury and suicidality. This pilot study examined 535 female subjects with eating disorders to determine the relationship between such additional psychopathology and a prior history of sexual abuse. While few differences were found on general psychiatric/psychological symptoms as measured by the SCL-90-R, subjects that reported a history of sexual abuse were found to have more prior suicide attempts and hospitalizations, and more frequent self-injury and alcohol problems. These findings suggest that symptoms seen in some eating disorder patients that are frequently described as "borderline" may be indicators for a history of sexual abuse.     

Rethinking a universal framework in the psychiatric symptom-disorder relationship

Research on disparities in health and services should include a critical examination of how social, cultural, and contextual factors affect the connection between symptoms and psychiatric disorders. Systematic differences in this connection by these factors will mean that clinicians using a universalist approach to disorders may make more diagnostic errors for certain patients (e.g., ethnic minorities, the poor). Based on the literature on normative clinical decision-making, this study tests for whether the effect of specific psychiatric disorders on key symptoms is the same for certain groups of the population. The data come from the National Comorbidity Survey. Conditional probabilities of disorders and symptoms, the elements feeding into clinical decision-making, are calculated and tested for equivalence across various racial/ethnic, educational, income, and gender groups. We find some significant differences in the relation of key symptoms to disorders across groups. These findings should encourage testing relativistic frameworks in diagnostic nosology as a step to improve clinical decision-making and reduce diagnostic and treatment disparities in mental health services.     

The Prevalence and Course of Pathological Gambling in the Mood Disorders

The objective of the current investigation was to examine the prevalence of pathological gambling (PG) in a psychiatric sample with a history of mood disorder, and the concurrent and longitudinal association of PG and mood disorder symptoms according to retrospective report. A total of 275 (100 male, 175 female) psychiatric outpatients in Ontario, Canada, with a lifetime diagnosis of a depressive (n = 138) or bipolar disorder (n = 137), completed the Canadian Problem Gambling Index, South Oaks Gambling Screen and Longitudinal Interval Follow-up Evaluation. Correlational and cross-lagged panel analyses evaluated the relation between PG and mood disorder symptom course. The prevalence of PG was elevated within patients with a mood disorder; there was no difference across diagnosis. Concurrent PG and mood disorder symptoms were positively correlated; however, longitudinal analyses revealed no evidence for an association between PG and mood disorder symptoms when symptom stability was taken into account. Despite the elevated prevalence of PG within mood disorders, and the concurrent association between PG and mood disorder symptoms, no direct association was found between these types of pathology. Prospective designs and intervening variables are required to advance understanding of the etiological associations between these disorders.     

Female Collegiate Athletes: Prevalence of Eating Disorders and Disordered Eating Behaviors

Objective: The authors assessed the prevalence of pathogenic eating and weight-control behaviors among female college athletes, using a psychometrically valid measure. Participants: Participants were 204 college athletes (M age = 20.16 years, SD = 1.31 years) from 17 sports at 3 universities. On average, they participated in their sport for 10.88 years (SD = 16.68 years) and on their college team for 2.10 years (SD = 1.03 years). Methods: Participants completed a demographic and weight background questionnaire, Questionnaire for Eating Disorder Diagnoses, and the Bulimia Test-Revised. Results: The authors classified participants as eating disordered (n = 4, 2.0%), symptomatic (n = 52, 25.5%), and asymptomatic (n = 148, 72.5%). Few participants engaged in binge eating; most used exercise, as opposed to vomiting, dieting, laxatives, or diuretics, to control their weight. Conclusions: Female athletes suffer from eating disorders, and most experience symptom levels that are subclinical but problematic.     

Ethnicity and child sexual abuse experiences of female college students

This research examines the understudied issue of race/ethnicity in relation to child sexual abuse experiences (CSA) in a cross-sectional convenience sample of 461 female college students completing a survey. Comparisons of students' abuse experiences revealed ethnic differences in sexual abuse prevalence, severity of abuse, the victim- offender relationship and post-abuse coping. Black students reported more sexual abuse than other ethnic groups, followed by Hispanics, Whites, and Asians. Although timing and extent of disclosure of sexual abuse did not vary by ethnicity, negative social reactions to disclosure were more common for certain ethnic groups than others. No ethnic differences emerged for depressive or PTSD symptoms. Implications are drawn for future research on the issue of ethnic differences in the aftermath of CSA experiences.     

A Population-Wide Screening and Tailored Intervention Platform for Eating Disorders on College Campuses: The Healthy Body Image Program

Abstract

Objectives: This article presents a new approach to intervention for eating disorders and body image concerns on college campuses, using a model of integrated eating disorder screening and intervention. Formative data on implementation feasibility are presented. Participants: College students enrolled at 2 universities between 2011 and 2012. Methods: The Healthy Body Image program is an evidence-based screening and intervention platform, enacted via community and online resources. An online screen was used to identify students at varying levels of risk or eating disorder symptom status; responses were used to direct students to universal or targeted online interventions or further evaluation. Universal prevention programs to improve healthy weight regulation and body image culture were offered to all students. Results: Formative data from 1,551 students illustrates the application of this model. Conclusions: The Healthy Body Image program is feasible to deliver and provides a comprehensive system of screening, evidence-based intervention, and community culture change.     

Keynote Address

Abstract

Because of the increasing prevalence of eating disorders in college populations, it is increasingly important for student health services to identify affected individuals. Therefore, the authors analyzed the student health forms of member schools of the New York State College Health Association for the presence of items that would identify an eating disorder. Directors of health services that include specific questions about eating disorders on health forms were then surveyed for their opinions about this practice.

Specific items about eating disorders (anorexia nervosa, bulimia, vomiting to lose weight, laxative use to lose weight) were included on 5 of 111 forms. Less specific items including dissatisfaction with weight, being on a diet, or binge eating appeared on 10% of forms.

Approximately one-third of the students known by health service staffs to have an eating disorder reported this on their health form, when provided a specific opportunity to do so. Even though underreporting by students is potentially a problem in such circumstances, the health service directors all recommended the inclusion of items relating to eating disorders on student health forms.

“Human Papillomavirus Type 16 and Early Cervical Neoplasia,” CHRISTOPHER P. CRUM, et al. Flat warts (condylomata) of the uterine cervix are sometimes cytologically atypical and have abnormal mitotic figures; they are thought to be possible precursors of cancer of the cervix. Flat warts are caused by any of a number of types of human papillomaviruses (HPVs), one of which (HPV 16) has been previously associated with invasive cancer of the cervix. To determine whether HPV 16 is also associated with flat warts with abnormal mitoses, we analyzed 23 flat warts by DNA-hybridization techniques for the presence of HPV 16 and other HPV types, and correlated the results with the histology. Of 10 lesions with abnormal mitotic figures, 7 contained HPV 16, and 1 contained another type of HPV. Of 13 lesions without abnormal mitotic figures, only 1 contained HPV 16, and 7 contained other types of HPV.

We conclude that the presence of HPV 16 correlates with the presence of abnormal mitotic figures in flat warts of the cervix, and that this type of flat wart is a precursor of invasive cancer of the cervix. (New England Journal of Medicine 1984;310:880–3.)     

A Description of Disordered Eating Behaviors in Latino Males

Abstract

Objective: To explore disordered eating and eating disorders (EDs) in Latino males. Participants: Participants are 722 male college students from a larger prevalence study conducted in the University of Puerto Rico system. Methods: Participants were selected from a list of sections of required courses for first-year students on each campus. Self-report instruments were used to explore ED symptoms (the Eating Attitudes Test [EAT-26] and the Bulimia Test–Revised [BULIT-26-R] and the Beck Depression Inventory depression (BDI). Results: Overall, 2.26% scored above the cut-off point on the BULIT-R and 5.08% score above the cut-off point on the EAT-26. Of the males, 4.43% reported sufficient frequency and severity to approximate DSM-IV criteria for bulimia nervosa. Depression symptomatology was found in those who scored above the cut-off point on both instruments of EDs. Conclusion: College health practitioners should be aware of disordered eating in Latino males and include them in efforts to detect disordered eating behaviors in college students.     

Body mass index, disordered eating behavior, and acquisition of health information: examining ethnicity and weight-related issues in a college population

OBJECTIVE AND PARTICIPANTS: To investigate ethnic differences related to weight, the authors assessed body mass index, dysfunctional eating, receipt of health information, and perceived obstacles to healthy lifestyles of 210 ethnically diverse college women. METHODS: The authors used the Eating Attitudes Test to assess dieting, food preoccupation, and bulimic behaviors. RESULTS: The authors found no ethnic differences in body mass index or disordered eating, but African Americans were more likely than were European Americans and Latina Americans to receive nutrition information from professionals and less likely than European Americans to perceive time as an obstacle. Overall, receipt of health information from a professional was related to fewer disordered eating behaviors; however, the specific eating behavior that was reduced varied by ethnicity. CONCLUSIONS: Health professionals should reconsider traditional assumptions of disordered eating behavior as a European American problem and consider cultural appropriateness in the development of effective health programs.     

Ethnic Differences in Symptom Presentation of Sexually Abused Girls

ABSTRACT

Although researchers have begun to examine the issue of ethnic and cultural factors in childhood sexual abuse (CSA), relatively little has been done to look at possible ethnic and cultural differences in psychological symptoms related to CSA. This study investigated the relationship between ethnicity and symptom presentation among Hispanic, African American, and Caucasian sexually abused girls. The study examined the relationship between ethnicity and depression, ethnicity and post-trauma intrusive symptoms, and ethnicity and post-trauma avoidance symptoms. Results indicated that African American girls had significantly higher levels of post-trauma avoidance symptoms than Hispanic girls, but not Caucasian girls. No significant differences were found between ethnic groups for depression or intrusive symptoms.     

The eating disorders NOS diagnostic profile among college women

The authors examined a proposed profile of eating-related behaviors, associated features, developmental issues, and help-seeking behavior among college women, using an eating disorder response program. The most common symptom scenario was a pattern of regular binge eating, together with daily exercise and occasional purging. The most common associated features were distressing or dysfunctional overconcern about body image and self-esteem, usually with day-to-day stress and intermittent depression. The women who fit this pattern also presented developmental issues of perfectionism, conflictual relationships with parents, and struggles for independence; and they tended to be ambivalent about seeking services. Implications for practice, including the need to develop a framework for eating disorder responses on campus that includes preventive programs and developmental interventions to target emerging and moderate concerns are discussed; limitations and the preliminary nature of the findings are explicated.     

The Eating Disorders NOS Diagnostic Profile Among College Women

Abstract

The authors examined a proposed profile of eating-related behaviors, associated features, developmental issues, and help-seeking behavior among college women, using an eating disorder response program. The most common symptom scenario was a pattern of regular binge eating, together with daily exercise and occasional purging. The most common associated features were distressing or dysfunctional overconcern about body image and self-esteem, usually with day-to-day stress and intermittent depression. The women who fit this pattern also presented developmental issues of perfectionism, conflictual relationships with parents, and struggles for independence; and they tended to be ambivalent about seeking services. Implications for practice, including the need to develop a framework for eating disorder responses on campus that includes preventive programs and developmental interventions to target emerging and moderate concerns are discussed; limitations and the preliminary nature of the findings are explicated.