Personality in men with eating disorders

advertisement
Journal of Psychosomatic Research 57 (2004) 273 – 278
Personality in men with eating disorders
D. Blake Woodside a,b,*, Cynthia M. Bulik c, Laura Thornton d, Kelly L. Klump e, Federica Tozzi f,
Manfred M. Fichter g, Katherine A. Halmi h, Allan S. Kaplan a,b, Michael Strober i, Bernie Devlin d,
Silviu-Alin Bacanu d, Kelly Ganjei j, Scott Crow k, James Mitchell l, Alessandro Rotondo m,
Mauro Mauri m, Giovanni Cassano n, Pamela Keel o, Wade H. Berrettini p, Walter H. Kaye d
a
Program for Eating Disorders, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada M5G 2C4
b
Department of Psychiatry, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada M5G 2C4
c
Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA 23298-0126, USA
d
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213-2593, USA
e
Department of Psychology, Michigan State University, East Lansing, MI 48824, USA
f
University of Rome Tor Vergata, Rome, Italy
g
Roseneck Hospital for Behavioural Medicine affiliated with the University of Munich, Prien, Germany
h
New York Presbyterian Hospital, Weill Medical College of Cornell University, White Plains, NY 10605, USA
i
Department of Psychiatry and Behavioral Science, University of California at Los Angeles, Los Angeles, CA 90024-1759, USA
j
Core Genotyping Facility, Advanced Technology Center, National Cancer Institute, Gaithersburg, MD 20877, USA
k
Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
l
Neuropsychiatric Research Institute, Fargo, ND, USA
m
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, Pisa, Italy
n
University of Pisa, Pisa, Italy
o
Department of Psychology, Harvard University, Cambridge, MA, USA
p
Center of Neurobiology and Behavior, University of Pennsylvania, Philadelphia, PA 19104, USA
Received 9 July 2003; accepted 3 February 2004
Abstract
Objective: This study compares personality variables of men
with eating disorders to women with eating disorders. Method:
Data were obtained from an international study of the genetics of
eating disorders. Forty-two male participants were age-band
matched at 1:2 ratio to females from the same study. Personality
features were compared between males and females controlling for
diagnostic subgroup. Results: Males with eating disorders appear
to be slightly less at risk for perfectionism, harm avoidance,
reward dependence, and cooperativeness than females. Few
differences were found when diagnostic subgroup was considered.
Conclusion: Observed differences in personality variables may
help explain the difference in incidence and prevalence of eating
disorders in men and women.
D 2004 Elsevier Inc. All rights reserved.
Keywords: Eating disorders; Men; Personality
Introduction
Eating disorders in males continue to be an area of
interest, primarily because of the marked difference in
* Corresponding authors. D.B. Woodside is to be contacted at Inpatient
Eating Disorders Program, Toronto General Hospital, 8EN-219, 200
Elizabeth Street, Toronto, Ontario, Canada M5G 2C4. Fax: +1-416-3404198. W.H. Kaye, Anorexia and Bulimia Nervosa Research Module,
Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Suite 600
Iroquois Building, Pittsburgh, PA 15213, USA. Fax: +1-412-647-3507.
E-mail addresses: b.woodside@utoronto.ca (D.B. Woodside), kayewh@
msx.upmc.edu (W.H. Kaye).
0022-3999/04/$ – see front matter D 2004 Elsevier Inc. All rights reserved.
doi:10.1016/j.jpsychores.2004.02.011
prevalence of both anorexia nervosa (AN) and bulimia
nervosa (BN) between the two genders [1,2]. Recent work
upholds the existence of this gender imbalance, although to
a lesser extent than previously believed [3].
In addition to examining prevalence, research in this area
has focused on the clinical characteristics, psychometric
profiles, and comorbidity patterns in men with eating disorders compared to women. In general, there are more similarities than differences across genders on these dimensions [4].
Little research has been done in the area of personality
in men with eating disorders. Joiner et al. [5] compared
14 males to 97 females, showing that men chronically ill
D.B. Woodside et al. / Journal of Psychosomatic Research 57 (2004) 273–278
274
disorder diagnoses were confirmed by trained raters using the
Structured Interview for Anorexia Nervosa and Bulimic
disorders (SIAB) [13]. Informed consent was obtained from
all study participants, and all sites received approval from
their local Institutional Review Board.
For the AN study, probands were required to meet
modified (criterion D, amenorrhea, not required) lifetime
DSM-IV criteria for AN, and had never met criteria for BN.
Probands from the BN study were required to meet the
following criteria: (1) a DSM-IV lifetime diagnosis of BN
purging type (purging must have included regular vomiting,
with other means of purging also allowed, and bingeing and
vomiting must have occurred at least twice a week for a
duration of at least 6 months); and (2) age between 13 and
65 years. A current or lifetime history of AN was acceptable.
Exclusion criteria for all probands included mental retardation (IQ < 70); dementia; organic brain syndromes; psychotic disorders including schizophrenia, schizophreniform
disorder, delusional disorder, and schizoaffective disorder;
Turner’s syndrome; any medical condition that could affect
appetite, body weight, or eating (e.g., diabetes and thyroid
conditions were excluded if the onset of the disease preceded the onset of the ED). Bipolar I and bipolar II were
excluded only if symptoms of BN occurred exclusively
during manic or hypomanic episodes. Probands with neurological problems were excluded with the exception of those
diagnosed with a seizure disorder resulting from trauma
following the onset of the ED. Probands whose premorbid
weight exceeded the BMI for the 95th percentile for gender
and age on the Hebebrand index [14] or whose high lifetime
BMI was greater than 35 kg/m2 were also excluded.
Affected relatives were biologically related to the proband
(e.g., siblings, half siblings, cousins). Inclusion criteria for
affected relatives required they be 13 –65 years of age and
received at least one of the following lifetime eating disorder
diagnoses: (1) DSM-IV BN, purging type or nonpurging
type; (2) DSM-IV AN, restricting type or binge eating/
purging type; (3) EDNOS-1, defined as subthreshold AN
with the presence of two of three criteria A through C of
DSM-IV AN, no lifetime bingeing, and a lifetime BMI
< 125% of expected for height and weight; (4) EDNOS-2,
defined as subthreshold BN with the presence of criteria A,
B, D, and E of DSM-IV BN and the presence of binge eating
and purging, which must have occurred ‘‘more than just
experimentally’’ but may have occurred for less than 3
months or at a lower frequency than twice a week; (5)
with BN had higher levels of perfectionism and interpersonal distrust than the female comparison group. Research
into Axis II comorbidity has some relevance to this question, as the presence of personality disorders may reflect
underlying dimensional personality characteristics. StriegelMoore et al. [6] showed elevated rates of personality
disorders, substance use, and mood disorders in males with
ED in comparison to a sample of men without [7] ED.
Fassino et al. [7] compared a small group of male anorectic
patients to a control group of anorectic women and a sample
of nonclinical men and women using the Temperament and
Character Inventory (TCI) [8] and showed that male anorectics had lower scores on harm avoidance, reward dependence, and cooperativeness and higher scores on novelty
seeking compared to women with AN.
As we advance our understanding of the genetic underpinnings of AN and BN, it becomes increasingly important
to refine our phenotypic definitions. In a series of linkage
analyses, we have optimized our linkage information by
incorporating behavioral phenotypes into the genetic linkage analysis [9]. As the relative risk for AN appears to be
highest in female relatives of males with AN [10], male
eating disorders cases may be particularly valuable to
genetic studies. The purpose of this study is to examine
personality factors in a sample of males with ED derived
from a large-scale study of the genetics of ED, and compare
these factors to a matched sample of females with ED from
the same study.
Methods and materials
Participants
All participants were from the multisite Price Foundation
Genetic Study of AN [11] or the Price Foundation Genetic
Study of BN [12], both of which used similar methodologies.
Males and females affected with AN, BN or eating disorder
not otherwise specified (ED-NOS) were recruited from 11
sites in North America and Europe including Pittsburgh, New
York, Los Angeles, Toronto, London, Munich, Philadelphia,
Pisa, Fargo, Minneapolis, and Boston.
Details of sample ascertainment and recruitment strategies
are described elsewhere (Ref.[11]; Kaye et al., submitted) and
will only be described briefly here. Full assessments were
completed on the proband and affected relative(s). Eating
Table 1
Age and weight-related variables for males and female comparison group
AN
Age (years)
BMI (kg/m2)
Lowest past BMI
Highest past BMI
ANBN, BN, EDNOS
Males (n = 21)
Females (n = 40)
HR
v2
P
Males (n = 21)
Females (n = 40)
HR
v2
29.43
20.37
15.98
22.28
28.20
19.00
14.88
21.04
0.88
1.42
1.28
1.15
0.43
4.36
2.71
1.60
.51
.04
.10
.21
28.52
22.31
19.66
24.24
26.23
20.41
17.50
23.48
1.45
1.42
1.28
1.15
3.60
4.36
2.71
1.60
(9.3)
(2.5)
(1.8)
(3.1)
Values represent means (S.D.). HR = hazard ratio.
(6.2)
(1.9)
(2.2)
(2.7)
(11.6)
(2.6)
(2.8)
(3.2)
(9.6)
(2.8)
(2.6)
(3.1)
D.B. Woodside et al. / Journal of Psychosomatic Research 57 (2004) 273–278
EDNOS-3, defined as the presence of purging or other
clearly excessive compensatory behaviors, in the absence
of objective binge eating, in individuals of normal weight
who have either an intense fear of gaining weight or
becoming fat or an undue influence of body weight or shape
on self evaluation. Exclusion criteria for affected relatives
included all exclusion criteria listed for the probands, with
the following additional criteria: (1) monozygotic twin of the
proband; (2) biological parent with an ED, unless there was
another affected family member with whom the parent could
be paired; (3) a diagnosis of binge eating disorder as the only
lifetime eating disorder diagnosis.
All males (n = 42) with an ED were included in this
study. Each male was matched to two females by ED
diagnosis, 5-year age band (age at the time of interview),
and proband status (proband or affected relative). In addition, the females included in the comparison group were not
related to any of the males. Two of the males were only able
to be matched to one female on the basis of our matching
criteria and we were unable to identify an appropriate match
for one male (total number of females = 80).
Assessment instruments
All participants were assessed with the SIAB [13], the
Yale –Brown – Cornell Eating Disorder Scale (YBC-EDS)
[15], and the Yale –Brown Obsessive Compulsive Scale
(Y-BOCS) [16]. Participants completed self-report questionnaires including the TCI [8], Multidimensional Perfectionism Scale (MPS) [17], and State-Trait Anxiety Inventory
(STAI) [18].
SIAB
A modified version of the SIAB was used to assess the
lifetime histories and phenotype diagnoses of eating disorders of the subjects in both studies.
YBC-EDS
The YBC-EDS was used to assess the severity and types of
core obsessions and compulsions specific to eating disorders.
Y-BOCS
Y-BOCS is a semistructured interview designed to rate
the presence and severity of obsessive thoughts and compulsive behaviors typically found among individuals with
obsessive – compulsive disorder.
MPS
The MPS assesses six specific dimensions of perfectionism, including concern over mistakes, personal standards,
perceived parental expectations, perceived parental criticism, doubts about actions, and organization.
TCI
The TCI measures seven dimensions of personality,
including novelty seeking, harm avoidance, reward depen-
275
dence, persistence, self-directedness, cooperativeness, and
self-transcendence.
STAI
Subjects completed the STAI (Form Y-1), a 40-item
instrument used to assess states of anxiety both ‘‘at this
moment’’ and how the individual ‘‘generally feels’’.
Statistical analysis
Our goal was to identify characteristics that differentiate
males and females with eating disorder diagnoses. The data
set was designed as a case – control study, with each male
being matched with two females, except in the cases noted
above. To account for the double representation of the males
and to take advantage of the increased sample size of the
females, conditional logistic regression was conducted using
SAS (SAS Institute, 1996). This type of statistical analysis is
used to investigate the relationship between the outcome
Table 2
Predicting the likelihood of being male from symptom and personality
variables, combined eating disorders diagnoses
P value
Scale/Variable
Hazard ratio
CI
YBC-EDS
Current motivation to change
Current period preoccupation
Current rituals
Current period total score
Worst motivation to change
Worst period of preoccupation
Worst period ritual score
Worst period total score
1.17
0.57
0.86
0.71
0.67
0.53
0.62
0.54
(0.79,
(0.35,
(0.58,
(0.46,
(0.45,
(0.32,
(0.38,
(0.32,
1.71)
0.93)
1.27)
1.10)
1.00)
0.88)
1.01)
0.92)
.434
.026
.441
.124
.052
.014
.056
.022
TCI
Harm avoidance
Novelty seeking
Persistence
Reward dependence
Self-directedness
Cooperativeness
Self-transcendence
0.58
1.37
0.91
0.34
1.04
0.54
1.03
(0.37,
(0.91,
(0.61,
(0.19,
(0.67,
(0.35,
(0.71,
0.92)
2.08)
1.36)
0.61)
1.61)
0.84)
1.50)
.021
.133
.633
.0004
.867
.006
.870
MPS
Concern over mistakes
Doubts about actions
Organization
Parental criticism
Parental expectations
Personal standards
Overall
0.55
0.85
0.41
1.15
1.17
0.72
0.77
(0.35,
(0.58,
(0.24,
(0.77,
(0.80,
(0.46,
(0.51,
0.87)
1.25)
0.70)
1.71)
1.72)
1.12)
1.16)
.010
.402
.001
.500
.410
.148
.211
STAI
State anxiety
Trait anxiety
0.88
0.86
(0.59, 0.32)
(0.57, 1.28)
.540
.447
Y-BOCS
Compulsions
Obsessions
Total
0.84
1.09
0.96
(0.56, 1.27)
(0.73, 1.62)
(0.64, 1.43)
.407
.676
.822
276
D.B. Woodside et al. / Journal of Psychosomatic Research 57 (2004) 273–278
(whether the subject is a case or a control, in this study, a
male or a female) and one or more predictive factors.
Significant findings suggest that males and females differ
for those factors with hazard ratios greater than 1 indicating
that males have higher scores on the variable of interest, and
hazard ratios less than 1 indicating that females have higher
scores. Analysis was performed first on the whole sample
and then on two different diagnostic groups [group 1 = AN;
group 2 = ANBN (lifetime diagnosis of both AN and BN),
BN and EDNOS (a residual diagnostic group composed
primarily of partial syndrome eating disorders: all three types
of EDNOS were combined for this analysis)]. As the study is
exploratory, and there is very limited other literature, P = .05
was set as the significance level for this report.
Results
As indicated in Table 1, there were no significant differences between males and females on age, or highest past or
lowest past BMI. Males did report higher current BMI as
would be expected based on gender.
Table 2 presents hazard ratios, confidence intervals,
and P values. If the hazard ratio of a personality trait is
greater than 1, an increment in the trait increases the
hazard rate for males. If the hazard ratio is less than 1, an
increment in the trait decreases the hazard rate. The
hazard ratios were also significantly lower for males for
the following eating disorder symptoms as measured by
the YBC-EDS such as preoccupation with weight and
shape (HR 0.57, CI 0.35– 0.93, P = .026), level of preoccupation with eating disorder symptoms overall (HR 0.53,
CI 0.32– 0.88, P = .014), and overall score at the period
of worst symptoms (HR 0.54, CI 0.32– 0.92, P = .022).
On the TCI, men reported lower reward dependence (HR
0.34, CI 0.19– 0.61, P = .0004), cooperativeness (HR 0.54,
CI 0.35 –0.84, P = .006), and harm avoidance (HR 0.58, CI
0.37 – 0.92, P = .021) as compared to females. On the MPS,
men reported lower organization (HR 0.41, CI 0.24 – 0.70,
P = .001) and fewer concerns about mistakes (HR 0.55, CI
Table 3
Predicting the likelihood of being male from symptom and personality variables by eating disorders subgroup
AN
BN, ANBN, NOS1, NOS2, NOS3
P value
Hazard ratio
CI
2.16)
1.21)
1.67)
1.45)
1.40)
1.26)
1.44)
1.34)
.763
.122
.645
.293
.487
.192
.377
.255
1.20
0.61
0.86
0.74
0.50
0.43
0.50
0.42
(0.75,
(0.34,
(0.53,
(0.44,
(0.26,
(0.20,
(0.23,
(0.18,
1.91)
1.10)
1.39)
1.24)
0.97)
0.96)
1.08)
0.96)
.456
.099
.536
.250
.042
.033
.076
.040
(0.29,
(0.71,
(0.47,
(0.08,
(0.57,
(0.24,
(0.68,
1.06)
2.18)
1.42)
0.66)
2.16)
0.96)
1.67)
.072
.439
.478
.006
.753
.038
.790
0.61
1.54
1.03
0.44
0.98
0.59
0.96
(0.32,
(0.83,
(0.56,
(0.02,
(0.55,
(0.34,
(0.50,
1.18)
2.86)
1.88)
0.90)
1.76)
1.05)
1.87)
.144
.174
.934
.025
.953
.071
.920
0.47
0.74
0.49
0.74
0.83
0.61
0.55
(0.22,
(0.41,
(0.24,
(0.41,
(0.48,
(0.30,
(0.27,
0.98)
1.36)
1.02)
1.35)
1.42)
1.23)
1.11)
.045
.337
.056
.327
.486
.166
.093
0.61
0.93
0.34
1.98
1.90
0.82
1.00
(0.34,
(0.56,
(0.15,
(0.98,
(0.98,
(0.45,
(0.56,
1.10)
1.54)
0.78)
4.02)
3.67)
1.48)
1.80)
.100
.785
.011
.058
.057
.505
.990
STAI
State anxiety
Trait anxiety
0.87
0.71
(0.48, 1.57)
(0.40, 1.27)
.635
.252
0.89
1.03
(0.51, 1.56)
(0.58, 1.81)
.694
.926
YBOCS
Compulsions
Obsessions
Total YBOCS
0.60
0.75
0.65
(0.32, 1.13)
(0.40, 1.38)
(0.35, 1.22)
.113
.349
.180
1.22
1.49
1.37
(0.66, 2.25)
(0.85, 2.62)
(0.77, 2.45)
.522
.169
.285
Variable
Hazard ratio
CI
YBC-EDS
Current motivation to change
Current preoccupations
Current rituals
Current period total score
Worst period motivation to change
Worst period preoccupations
Worst period rituals
Worst period total
1.11
0.48
0.85
0.65
0.83
0.63
0.74
0.67
(0.57,
(0.19,
(0.44,
(0.29,
(0.49,
(0.32,
(0.38,
(0.34,
TCI
Harm avoidance
Novelty seeking
Persistence
Reward dependence
Self-directedness
Cooperativeness
Self-transcendence
0.55
1.25
0.82
0.23
1.11
0.48
1.06
MPS
Concern over mistakes
Doubts about actions
Organization
Parental criticism
Parental expectations
Personal standards
MPS overall
P value
D.B. Woodside et al. / Journal of Psychosomatic Research 57 (2004) 273–278
0.35 –0.87, P = .010) compared to the female sample. Men
did not differ from women on measures of anxiety-related
symptoms from the STAI and Y-BOCS.
Table 3 presents data examining hazard ratios by gender
for specific diagnostic subgroups. For AN, men are distinguished from women by lower levels of reward dependence
on the TCI (HR 0.23, CI 0.08 – 0.66, P = .006), lower body
image disturbance as measured by the SIAB (HR = 0.30, CI
0.11 –0.080, P = .016), and lower cooperativeness as measured by the TCI (HR = 0.48, CI 0.24 – 0.96, P = .038) and
concern over mistakes as measured by the MPS (HR = 0.47,
CI 0.22 –0.98, P = .045).
For EDNOS, males were significantly distinguishable
from women by reporting lesser influence of weight and
shape on self-esteem (HR = 0.41, CI 0.19 – 0.85, P = .017),
less motivation to change (HR = 0.50, CI 0.26 – 0.97,
P = .042), fewer preoccupations about wei ght and shape
(HR = 0.43, CI 0.20– 0.96, P = .033), lower reward dependence (HR = 0.44, CI 0.02 – 0.90, P = .025), and lower
organization (HR = 0.34, CI0.15 – 0.78, P = .011).
Discussion
This study represents one of a very few attempts to
systematically compare personality factors in men and
women with eating disorders. The measures used in this
study assess a reasonable cross section of personality factors
that have been thought to be important in ED, including
perfectionism, obsessionality, obsessive –compulsive disorder, harm avoidance, novelty seeking, and anxiety [19,20].
The primary findings of the study suggest that men with
ED are less perfectionistic as measured by the MPS than
women with ED, and their personality profile as measured
by the TCI is also marked by lower harm avoidance, reward
dependence, and cooperativeness. There is relatively little
literature comparing men and women on the MPS and the
TCI. Cloninger et al.’s initial report on the TCI [8] showed
women to have higher levels of cooperativeness and spiritual acceptance, while a 1994 paper [21] showed lower
scores by men on cooperativeness. We are not aware of any
literature comparing men and women on the MPS. Frost
et al.’s original research characterizing the measure was
performed entirely on women [17].
Our results are compatible with but extend the only other
comparable study, that of Fassino et al. [7]. The limitations
in comparing the two papers are that our sample included
men with a variety of eating disorder subtypes, and that not
all of our samples were acutely ill at the time of assessment.
However, both studies showed less risk for harm avoidance,
reward dependence, and cooperativeness in anorexic males
compared to anorexic females. While Fassino’s group were
all acutely ill, only a minority of our AN subjects were
underweight at the time of assessment, suggesting that these
observed differences are not entirely state dependent, and
may in fact represent trait abnormalities. Fassino et al.’s
277
comparisons to nonclinical males showed a reduced risk for
reward dependence and cooperativeness, possibly identifying these two variables as especially interesting as potential
trait markers for eating disorders.
There are relatively few differences between men and
women when diagnostic subgroup is considered. This may be
at least partially due to the way in which cases were
ascertained, specifically that probands with BN could have
a lifetime history of AN. Cooperativeness, reward dependence, and concern over mistakes were less characteristic of
males than females with AN. Likewise, motivation to change,
reward dependence, and organization were less characteristic
of males with EDNOS and BN than females with the same
diagnoses. Although there are few studies of treatment
response in men compared to women [22], it might be of
interest to evaluate the impact of reduced motivation to
change, and lower cooperativeness and reward dependence
on treatment outcome. Reduced levels of motivation to
change in the EDNOS group might partially explain the
findings of Woodside et al. [3] showing a relatively high
prevalence of EDNOS in males in the community that was
not reflected in terms of those attending treatment
These findings diverge from those of Joiner et al. [5] that
showed higher rates of perfectionism in late adolescent
males with BN compared to late adolescent females with
BN. This difference could be a result of the age differences
between the samples, with our sample being older. Alternately, the inclusion of ANBN and EDNOS diagnoses in
this part of the analysis may have obscured a difference that
would otherwise have been present. There may also be some
complex interaction between genetic loading and underlying
personality that could result in the established gender
difference in the prevalence of eating disorders. Further
work on the genetics of eating disorders may allow for more
precise examinations of the contribution of underlying
personality to the development of the illnesses.
The constellation of differences reported on the TCI and
MPS may be a reflection of an underlying personality
structure associated with a higher risk of personality disorder, as reported by other investigators [6]. It is possible that
there is a protective effect of this constellation of personality
variables that accounts for some of the reduction in incidence of these illnesses in men compared to women. The
presence of increased levels of perfectionism and reward
dependence in women compared to men may be a mediating
factor that sensitizes women preferentially to the societal
pressures to be thin and to be excessively aware of body
shape. If men experience reduced levels of perfectionism,
they may as a group be less prone to develop the weight and
shape concerns that appear to be a pathway into the illness
in Western society. Alternately, given that all the subjects in
this study had an ED, these personality features may
represent gender-specific mediating pathways in the development of eating disorders.
The strengths of this study lie in its sophisticated and
comprehensive assessment protocols, and the inclusion of a
278
D.B. Woodside et al. / Journal of Psychosomatic Research 57 (2004) 273–278
fairly large sample of men with ED. The limitations include
the small numbers of men in the various diagnostic subgroups, making subgroup analysis tentative. As well, the
lack of control data makes it difficult to conclude that any
findings are specific to the illness rather than being a feature
of gender per se. The similarity of some of the TCI findings
to those of Fassino et al. [7] is, however, encouraging. This
study does not shed much light on the gender imbalance in
the prevalence of the conditions in men compared to
women, nor does it add anything to our body of information
about the treatment of the conditions.
Further research would include a larger sample of men
in the various subgroups of eating disorder diagnoses to
allow for a more precise identification of possible vulnerability and protective factors in this subset of the eating
disorder population.
[10]
[11]
[12]
[13]
[14]
References
[1] Lucas AR, Beard CM, O’Fallon WM, Kurland LT. 50-Year trends in
the incidence of anorexia nervosa in Rochester, Minnesota: a population-based study. Am J Psychiatry 1991;148:917 – 22.
[2] Soundy T, Lucas A, Suman V, Melton L. Bulimia nervosa in Rochester, Minnesota from 1980 to 1990. Psychol Med 1995;25:1065 – 71.
[3] Woodside DB, Garfinkel PE, Lin E, Goering P, Kaplan AS, Goldbloom DS, Kennedy SH. Men with full and partial syndrome eating
disorders: community comparisons with non-eating disordered men
and eating disordered women. Am J Psychiatry 2001;158:582 – 6.
[4] Braun DL, Sunday SR, Huang A, Halmi KA. More males seek treatment for eating disorders. Int J Eat Disord 1999;25(4):415 – 24.
[5] Joiner TE, Katz J, Heatherton TF. Personality features differentiate
late adolescent females and males with chronic bulimic symptoms. Int
J Eat Disord 2000;27:191 – 7.
[6] Striegel-Moore RH, Garvin V, Dohm FA, Rosenbeck RA. Psychiatric
comorbidity of eating disorders in men: a national study of hospitalized veterans. Int J Eat Disord 1999;25:399 – 404.
[7] Fassino S, Abbate-Daga G, Leombruni P, Amianto F, Rovera G,
Rovera GG. Temperament and character in Italian men with anorexia
nervosa: a controlled study with the temperament and character inventory. J Nerv Ment Disease 2001;189(11):788 – 94.
[8] Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological
model of temperament and character. Arch Gen Psychiatry 1993;
50:975 – 90.
[9] Devlin B, Bacanu SA, Klump KL, Bulik CM, Fichter MM, Halmi
[15]
[16]
[17]
[18]
[19]
[20]
[21]
[22]
KA, Kaplan AS, Strober M, Treasure J, Woodside DB, Berrettini
WH, Kaye WH. Linkage analysis of anorexia nervosa incorporating
behavioral covariates. Hum Mol Genet 2002;11:689 – 96.
Strober M, Freeman R, Lampert C, Diamond J, Kaye W. Males with
anorexia nervosa: a controlled study of eating disorders in first-degree
relatives. Int J Eat Disord 2001;29:263 – 9.
Kaye WH, Lilenfeld LR, Berrettini WH, Strober M, Devlin B,
Klump KL, Goldman D, Bulik CM, Halmi KA, Fichter MM,
Kaplan A, Woodside DB, Treasure J, Plotnicov KH, Pollice C,
Rao R, McConaha CW. A genome-wide search for susceptibility
loci in anorexia nervosa: methods and sample description. Biol
Psychiatry 2000;47:794 – 803.
Kaye WH, Devlin B, Barbarich N, Bulik CM, Thornton L, Bacanu
SA, Fichter MM, Halmi KA, Kaplan AS, Strober M, Woodside DB,
Bergen AW, Crow S, Mitchell J, Rotondo A, Mauri M, Cassano G,
Keel P, Plotnicov K, Pollice C, Klump KL, Lilenfeld LR, Ganjei JK,
Quadflieg R, Berrettini WH. Genetic analysis of bulimia nervosa:
methods and sample description. Int J Eat Disord (In press)
Fichter MM, Herpertz S, Quadflieg N, Herpertz-Dahlmann B. Structured interview for anorexic and bulimic disorders for DSM-IV and
ICD-10: update (third) revision. Int J Eat Disord 1998;24:227 – 57.
Hebebrand J, Remschmidt H. Anorexia nervosa viewed as an extreme
weight condition: genetic implications. Hum Genet 1995;95(1):1 – 11.
Sunday SR, Halmi KA, Einhorn A. The Yale – Brown – Cornell Eating Disorder Scale: a new scale to assess eating disorder symptomatology. Int J Eat Disord 1995;18:237 – 45.
Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL,
Hill CL, Heninger GR, Chamey DS. The Yale – Brown Obsessive –
Compulsive Scale (Y-BOCS): 1. Development, use and reliability.
Arch Gen Psychiatry 1989;46:1006 – 11.
Frost RO, Marten P, Lahart C, Rosenblate R. The dimensions of
perfectionism. Cogn Ther Res 1990;14:449 – 68.
Spielberg CD, Gorsuch RL, Lushene RE. STAI manual for the
State Trait Anxiety Inventory. Palo Alto: Consulting Psychologists
Press, 1970.
Sutandar-Pinnock K, Woodside DB, Carter J, Olmsted MP, Kaplan
AS. Perfectionism in anorexia nervosa: a 6 – 24 month follow-up
study. Int J Eat Disord 2002;31:290 – 9.
Lilenfeld L, Kaye W, Greeno C, Merikangas K, Plotnikov K, Pollice
C, Rao R, Strober M, Bulik CM, Nagy L. A controlled family study
of restricting anorexia and bulimia nervosa: comorbidity in probands
and disorders in first-degree relatives. Arch Gen Psychiatry 1998;55:
603 – 10.
Cloninger CR, Przybeck TR, Svrakic DM, Wetzel RD. The Temperament and Character Inventory (TCI): a guide to its development
and use. St. Louis (MO): Center for Psychobiology of Personality,
Washington University, 1994.
Woodside DB, Kaplan AS. Day hospital treatment in males with
eating disorders—response and comparison to females. J Psychosom
Res 1994;38(5):471 – 5.
Download