Competing theories on the aetiology of eating disorders originate from a diverse set of disciplines. One such discipline is Evolutionary Psychology which assumes that the human mind has been shaped by natural and sexual selection. Most evolutionary theories on eating disorders limit themselves to the causation of anorexia nervosa only. The Sexual Competition Hypothesis (SCH), based on the Darwinian theory of sexual selection, provides an explanatory framework for the whole spectrum of eating disorders. It contends that intense female intrasexual competition (ISC) is the ultimate cause of eating disorders. The SCH explains the phenomenon of the pursuit of thinness as an adaptation to ISC in the modern environment. It argues that eating disorders are pathological phenomena that arise from the mismatch between the modern environment and the inherited female adaptations for ISC.

To test predictions from a novel evolutionary hypothesis for eating disorders.

1. i) To examine the relationship between disordered eating behaviour (DEB) and ISC in a sample of female undergraduates.

2. ii) To establish whether there is any relationship between DEB and Life History (LH) strategy.

A group of 206 female undergraduates were recruited. A structural equation model was constructed to analyse the data.

ISC for mates was significantly associated with DEB, as predicted by the SCH. DEB was found to be predicted by fast LH strategy, which was only partially mediated by the SCH.

The results of this study are supportive of the SCH and justify research on a clinical sample.

The eating disorders are serious psychological problems which particularly affect young women. In this context, and in view of epidemiological data are still scarce in Portugal, is of great interest to boost a current and ongoing research.

This study aims to identify and characterize, in Portuguese adolescents, behavioral and psychological dimensions associated with eating disorders Methods: Using quantitative methods, the study focused on a group of 458 adolescent students, aged between 15 and 20 years (average: 16.86), mostly female (58.70%), attending the tenth grade (37.80%) and without having to diet at the present time (74.70%). As measurement instruments were used anthropometric data and “Eating Disorders Inventory - EDI (Garner, Olmsted & Polivy, 1983).

The female adolescents tend to have higher results in the clinical subscales of EDI, suggesting a higher level of psychological distress. An analysis of age distribution of adolescents shows a peak for the characteristic signs of anorexia at 16 and a peak for the symptoms of bulimia at 20. Finally, adolescents who are currently dieting tend to score higher on all subscales of EDI, which suggests they tend to seek more leanness, feel greater body dissatisfaction, interpersonal distrust increased, fear of maturity and also a greater general feeling of powerlessness, insecurity, low self-esteem and loss of control over their lives.

After it performed this situation diagnosis, we intend to formulate a proposal of intervention in school environment, in the scope of Health Education, that can help these young it will carry out his healthier form life project.

Obesity is a serious health issue, associated with significant medical and psychosocial co-morbidity. Bariatric surgery is a promising treatment modality however, few studies have so far investigated its impact on patients’ sexuality.

The present study's aim was to determine bariatric surgery's effect on female patients’ Body Mass Index (BMI), psychological and sexual functioning.

59 obese female patients, scheduled to undergo weight loss operation, completed the study. Psychological functioning was measured by the Hospital Anxiety and Depression Scale (HADS), while sexual functioning was assessed by the Female Sexual Functioning Index (FSFI). All participants were evaluated in two consecutive time intervals, one week before surgery (T1) and one year after (T2).

Statistical analysis revealed a significant reduction in BMI (p < 0.001) and depression (p < 0.001) scores, a significant improvement in sexual desire (p = 0.005), arousal (p = 0.001), lubrication (p = 0.003), satisfaction (p = 0.012) and total sexual function (p = 0.003) and a decrease in the levels of pain during intercourse (p = 0.014) postoperatively.

Postoperative total sexual functioning was correlated with baseline BMI (p = 0.030) and BMI decrease (p = 0.037).

Bariatric surgery appears as an effective way to control weight and improve psychological and sexual functioning in female obese patients. Patients, who ceased to be obese postoperatively, reported the greatest level of sexual improvement, indicating that obesity treatment should focus on BMI normalization.

Anorexia nervosa (AN) is showing the highest mortality in psychiatric illness, especially because of its somatic consequences. A special program for refeeding patients with extreme severe underweight has been established in Munich.

From 2000–2010 about 80 patients with any eating disorder were admitted. Data of 53 patients with AN were analysed. After admission most of the patients (n = 43) received a percutaneous gastric feeding tube. A high caloric solution (Fresubin energy) was administered adjusted to bodyweight aiming a weight gain of 700–1000 g per week. After reaching BMI 17 most patients were send for illness specific psychotherapy to a specialized clinic.

The sample consists of 50 (94.3%) females. Patients were diagnosed as having AN restrictive subtype in 25 cases (47.2%), AN binge/purge subtype in 24 cases (45,2%) and AN purging subtype in 4 cases (7.6%). Mean age at admission was 25.4 years (SD 7.0) and mean duration of illness until admission was 8.4 years (SD 5.7). Average length of stay in the intensive care unit was 135 days (SD 79.4). Mean BMI at admission was 12.3 (SD 1.6) and mean BMI at discharge 16.6 (SD 1.6). Thus, mean weight increase was 11.4 kg (SD 5.4).

This intensive care program was established to enable patients with extreme severe AN to participate in psychotherapeutic programs afterwards as it was reported that cognitive function changed in regard to bodyweight. Further evaluation has to consider the occurrence of a refeeding syndrome.

Psychiatrists play an important role as members of the bariatric surgery team. A preoperative psychiatric evaluation is considered as part of a mandatory workup before approving surgery.

This evaluation focuses on the identification of any pre-existing psychiatric disorders among candidates for TOGa[1], a new experimental technique of bariatric surgery, and their correlations with post surgical weight loss.

45 obese patients underwent a psychiatric interview and several psycho diagnostic questionnaires (SCL-90; HAM-D; HAM-A; EDI; TAS).

A follow-up was set each 3 months.

We found that 34.1% of surgery candidates had a current diagnosis of depression; the majority showed anxiety symptoms. We also documented dissatisfaction about body shape, desire of slimness, fear of maturity, perfectionism, bulimia and binge eating disorder. Other frequent psychiatric symptoms were somatization, sensitivity, obsession and compulsion. After 3 months from surgery we found that the best weight loss was associated to low score in HAM-A, high score in hanger-hostility item (SCL-90) and low score in sensitiveness item (SCL-90).

The diagnosis of a psychiatric pathology during the pre-surgical evaluation can be considered a predictive negative factor for the outcome of the surgery. The predictive positive factors are firstly the nonexistence of psychiatric symptoms, secondly the high score in sensitiveness-insight item (SCL-90) and the high score in the ability to express feelings. [1] (TransOral Gastroplasty)

Persistent Hyperphagia, Pica, and Severe Food Restriction are rare but potentially life threatening complications following acquired brain injury. These disorders are not formally coded in disease classification systems though do present with significant management challenges in both inpatient and outpatient settings.

To inform treatment and management strategies and service development for complex neuropsychiatric conditions

To study presentation and prevalence of organic eating disorders following acquired brain injury.

Systematic review of medical literature on Medline, PsychInfo, CINAHL, Embase, Cochrane database of systematic reviews, using terms eating disorders, organic eating disorders, binge eating, bulimia, anorexia nervosa, atypical eating disorders, food restriction, pica, head injury, acquired brain injury, traumatic brain injury.

Service consultations and identification of grey literature

Systematic review identified case reports, case series, and case studies relevant to these disorders. It also identified lack of research in this area and absence of well structured longitudinal studies that can identify true prevalence in a representative sample. Persistent Hyperphagia has been reported in 2–3% of adult cases requiring inpatient post acute rehabilitation. Pica has been reported in young children after acquired brain injury only. Two reports identified this condition in post neurosurgery period. Severe food restriction, at times also described as atypical anorexia, has been reported following acquired brain injury. However, it remains rather difficult to estimate prevalence in different patient populations.

Organic eating disorders present with significant levels of challenges in patient management and do carry identifiable mortality risk.

Drop-out from treatment for Eating Disorders is increasing (Campbell; 2007), and it is a risk factor for relapse and more chronic and severe course of the illness (Fassino et al.; 2009). Drop-out can be caused by interaction of concurrent, individual, familiar ad environmental factors (Sly; 2009).

To examine possible risk factors of drop-out from inpatient treatment for eating disorders.

The sample included 41 patients who voluntarily left the treatment before completion (’droppers’) and 88 patients who completed it (’completers’), in the period between 1st January 2006 and 31st December 2009 at Villa Maria Luigia Hospital (Monticelli Terme, PR, Italy). Patients were administered 2 self-report questionnaires and 3 psychometric tests: Eating Disorders Questionnaire, Predisposing, bringing on and maintaining risk factors for eating disorders, EDI-II, BUT, SCL-90.

Droppers appear to be more aggressive (p = 0.022), get worse scholastic results (p = 0.016) and have less friendships and less social interaction (p = 0.021). Parental break-up (p = 0.015), moving house (p = 0.006), father's death (p = 0.005), abortition (p = 0.040), father's alcohol abuse (p = 0.011) and a mother who suffers of eating disorder (p = 0.008) are more frequent in droppers than completers. Catholic religion seems to be a protective factor from drop-out (p = 0.005).

Drop-out is a multifactor phenomenon; identification of risk factors can improve treatment strategies and outcome.

To estimate the prevalence of eating disorders (EDs) and associated risk factors in a sample of undergraduate students.

This is a cross-sectional study. We used a questionnaire consisting of the following sections: demographics, SCOFF questionnaire for screening EDs, the Achievement Anxiety Test (AAT) and the Depression, Anxiety and Stress Scale (DASS). Our sample was selected randomly. Sample size was 535 students (44% men, 56% women), and 33% of students were between 18 and 20 years old (age range 16–28).

SCOFF's reliability measured by Cronbach's alpha was 0.542; AAT's alpha for its facilitating scale was 0.682 and debilitating scale 0.821; finally, DASS's depression, anxiety and stress sections’ alpha were 0.923, 0.896 and 0.876 respectively. The prevalence of EDs was 42.2%. The associated factors with the presence of EDs was gender (62% women, 38% men; X2 = 5.007, p = 0.025) and personal family status (X2 = 18.862, p = 0.002), while having divorced parents was a borderline association (OR = 1.53, 95% CI 0.97–2.42). Mann-Whitney’s U test showed that there was a significant difference in the scale of stress between those with an ED and those without (p = 0.026) but not for depression and anxiety. According to multiple logistic regression, risk factors for having an eating disorder were depression, stress, female gender, being married and searching for a romantic relationship (overall model fit p < 0.0001).

This is the first study on EDs from Greece. Depression and stress were significant predictors of EDs, which shows the importance of these two factors in the pathogenesis of EDs.

Greenwald et al. (1998) developed The implicit Association Test (IAT) to measure automatic concept-attribute associations. Several evidences showed that Eating Disorders (EDs) were charactterized by a low explicit self-esteem.

The first aim was the evaluation of implicit self-esteem in a sample of patients with EDs. Second aim was to verify the correlation between implicit and explicit self-esteem, hypothesizing that they could represent two independent constructs.

A IAT modeled to assess self-esteem (Self-esteem IAT) has been administered to 17 Anorexia Nervosa (AN), 14 Bulimia Nervosa (BN), 17 Binge Eating (BED) patients and 32 healthy controls (HC). In IAT, the target categories were represented by the words «SELF / OTHER» and «agreeable / disagreeable». A positive IAT effect suggest a negative implicit self esteem, instead a negative IAT effect suggest a positive implicit self-esteem. Traditional self reports were used to evaluate explicit self-esteem to all participants.

Results showed a significant difference between HC and clinical groups in implicit self-esteem. HC and BED showed positive IAT effect, instead AN and BN shows a negative IAT effect. No correlations between implicit and explicit self-esteem were found.

Results showed that HC has a much more positively implicit self-esteem compared to clinical samples. An interesting result concerns the absence of any significant correlation between the implicit and explicit self-esteem, that could suggests that the implicit self-esteem is an independent construct respect to the explicit one.

Greenwald and co-workers developed The implicit Association Test (IAT) to measure implicit automatic concept-attribute associations. Evidences have suggested that Anorexia Nervosa (AN) and Bulimia Nervosa (BN) were characterized by “Ideal Thin” construct.

The aim of this study was the evaluation, at an implicit level, of Ideal Thin construct in a sample of Eating Disorders (ED) patients.

An “Ideal thin” Implicit Association Tests (Ideal thin IAT) has been modeled, to evaluate the implicit ideal thin in ED patients compared with an healthy control group. IAT test has been administered to a sample composed by 17 AN patients, 14 BN patients, 17 Binge Eating patients (BED) and 32 healthy controls (HC). The target categories, were “OVERWEIGHT / UNDERWEIGHT” and “POSITIVE / NEGATIVE”. Stimuli included pictures of overweight and normal weight models and positive/negative words. A positive IAT effect underlines an implicit tendency to associate the category “UNDERWEIGHT” with negative attributes, instead a negative IAT effect suggest an implicit tendency to associate the same category with positive attributes.

Results showed no significant difference between HC and clinical groups in implicit “Ideal Thin construct”. All groups showed positive IAT effect. No correlations between implicit attitude and clinical variables were found.

Results show a common implicit tendency generalized in the sample to positively judge underweight. This implicit tendency was stronger in patients with Anorexia Nervosa (0,30), than patents with Bulimia Nervosa (0,41), than Healthy Control (0,42), followed by patients with BED (0,56).

Greenwald et al. (1998) developed The implicit Association Test (IAT) to measure automatic concept-attribute associations. The assumption of the test is that strongly associated (compatible) attribute-concept pairs should be easier to classify together than are weakly associated or opposed (incompatible) attribute concepts. Ease of classifying is measured by the response times and errors in performing such categorizations.

The aim of this study was the evaluation, at an implicit level, of the attitude concerning fat people in a sample of Eating Disorders (ED).

A IAT modeled to assess self-esteem the attitude concerning fat and slim persons has been administered to 17 Anorexia Nervosa (AN), 14 Bulimia Nervosa (BN), 17 Binge Eating (BED) patients and 32 healthy controls (HC). In IAT, the target categories were represented by the words «FAT-SLIM» and «good / bad». Stimuli were images of faces of overweight and normal weight people and positive/negative word. A positive IAT effect underline an implicit tendency to associate the category «FAT» with positive attributes, instead a negative IAT effect suggest an implicit tendency to associate the same category with negative attributes.

Results showed a significant difference between HC and clinical groups in implicit attitude concerning overweight persons. HC showed positive IAT effect, instead AN, BN and BED showed a negative IAT effect. No correlations between implicit attitude and clinical variables were found.

These results suggest a common implicit tendency in ED’s groups, compared with controls, to negatively judge overweight persons.

Several research studies have investigated Personality Disorder (PD) comorbidity in adult with Eating Disorders (ED), which showed an association between the two types of disorder.

The aim of this study is to examine the relationships between ED and PD in a sample of adolescents between 14 to 18 years of age.

Sixty-seven adolescents with ED treated in an outpatients setting [23 Anorexia Nervosa (AN), 17 Bulimia Nervosa (BN) and 27 Eating Disorder Not Otherwise Specified (EDNOS)] were assessed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), the Beck Depression Inventory (BDI) and the Eating Attitudes Test (EAT).

Overall, 13 (19.4%) of ED patients had one or more PD. Cluster C PDs were the most common specific PDs. No significant difference was found between AN and BN based on the general presence of PDs. EDNOS patients had a lower prevalence of PDs compared to AN and BN patients. ED patients with a PD had an higher BDI rates compared to ED patients without PDs. No significant difference was observed in EAT rates between ED patients with and without PDs.

Cluster C PDs were the most frequent PDs found in ED adolescent patients. The prevalence of PDs is similar in AN and BN patients, whilst EDNOS patients have a lower prevalence of PDs compared to AN and BN patients. ED adolescent patients with current PD comorbidity show higher depression scores.

People with eating disorders (ED) are at high risk for suicidal behavior. Among different ED, anorexia nervosa (AN) has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN). Attempted suicide is a key predictor of completed suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an ED.

Case-control study in cohort of suicide attempters (n = 1563). Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity.

AN patients were more likely to have made a serious attempt (OR = 3.4, 95% CI 1.4–7.9), with a higher expectation of dying (OR = 3.7, 95% CI 1.1–13.5), and an increased risk of lethality (OR = 3.4, 95% CI 1.2–9.6). BN patients did not differ from the control group.

There are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Deaths from suicide in AN may not be the result simply of their greater physical frailty.

The symptoms of depression are often found in patients suffering from eating disorders.

The aims of this research were to find out if depression in patients with eating disorders (ED) like anorexia nervosa (AN) or bulimia nervosa (BN) is an additional condition accompanying the ED diagnose, or if it is an integral element being part of emotional problems related to maturation. The estimation of patients’ social condition is also considered in comparison to matched group with no ED diagnose.

Subjects: Group B - 19 females diagnosed, age 12 – 24; group C - matched control group of 30 healthy females, group F - 19 patients out of group B examined in a follow up research two years after hospital treatment. Tools used: Beck Depression Inventory (BDI), Life Quality Questionnaire (Q), Body Mass Index measurement (BMI).

BDI results: depression symptoms are more intense in the early phase of the treatment of ED (group B) than in the follow up -group F (two years after hospitalization) and also more intense than in group C (controls). Q Questionnaire shows no differences between groups B, C, and F.

Depression is an additional condition in patients diagnosed with ED mostly in the early phase of the treatment. No differences have been found in the social condition between groups B, C, and F.

Eating disorders are associated with two or four comorbid diagnoses especially mood, anxiety, obsessive compulsive, substance abuse and personality disorders.

Psychotic disorders are seen rarely with eating disorders which have been reported as case reports.

40 years old male patient suffering for vomiting after eating and drinking large amounts of water and then purge. Recently vomiting has became habituation; he felt dysphoria after eating and forced himself to vomit. He didn’t want to be thin and wanted to gain weight. He didn’t think that condition could be a disease.

In his childhood he had bizarre behaviours. For instance he pulled up the paints of walls and then ate the pieces of paints. He teared off the skin nearby his nails. Since adolescence he was social isolated, introverted, affective flattened. His self appearance was poor. He couldn’t perform his grooming and cleaning by himself. He didn’t want to take a bath. Eight years ago with his mother's death he developed binge eating and vomiting problems.

He was hospitalized in internal clinics for two times due to losing weight. Then he was admitted to psychiatry clinic. The level of plasma potassium was 2.4 mEq/lt during hospitalization. The patient was treated both for weight restoration, electrolite regulation and psychiatric condition. Olanzapine 20 mg/day, ketiapine 600 mg/day was administered. Within 1 month his medical condition was remitted but he couldn’t gain weight, his negative symptoms.

This case is a male diagnosed as schizophrenia comorbid with atypic eating.

The risk for developing and preserving symptoms of anorexia nervosa (AN) in children seems to be multifactorial: individual, familial, socio-cultural, and biological factors interact within the developmental framework. A disruption of attachment processes with the mother in an early stage of child development has been proposed as a contributing factor; however, the evidence is controversial.

To address the research question of how childhood AN patients recognize disorder-specific provocative factors such as body type, high-calorie food, and attachment between mother and child.

The aim of this study was to investigate the prefrontal activation in childhood AN patients when imaging those symptom-provocative factors.

The prefrontal activations during each task, in terms of blood volume changes, were measured by near infrared spectroscopy. Twelve females with childhood AN (mean age, 14.4 years old) and 13 age-matched healthy female controls participated in this study.

Both groups showed increased prefrontal blood volume when viewing images of each symptom-provocative factor. Unexpectedly, there was no significant difference in the prefrontal blood volume increases between the control group and the childhood AN group when viewing images of slender and obese body types and high-calorie food. On the other hand, images of mother-child attachment resulted in significantly greater increases in prefrontal blood volume in the childhood AN group than in the control group.

These results indicated that prefrontal activation in AN might be associated with imaging attachment between mother and child, but not associated with imaging body type or high-calorie food.

The Authors investigate the conceptualization of a group of patients with the same clinical and psychological patterns, affected by eating disturbances arisen during the age of latency.

Four cases are presented and discussed. Each subject was diagnosed as Food Avoidance Emotional Disorder (FAED).

The described subjects present some of the typical features of eating disorders of adolescence. Moreover, regressive aspects, obligingness, dichotomyc behaviors and thoughts were noticed. The Authors observed that parental expectations and needs were transmitted to their sons.

Through the refusal of food the dochotomyc and fearful thoughts are crystallized. The child cannot comprehend the existence of a false Self built on the Other's expectations. The Authors believe that FAED can be a precursor of Anorexia nervosa in the affected children, who show a less organized cognitive structure due to their young age.