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The abnormalities in eating behavior associated with bulimia nervosa suggest that patients with this illness may have a disturbance in satiety. The present study employed a six-meal protocol to assess satiety in both binge and non-binge eating episodes in women with bulimia nervosa and normal controls by examining whether an increase in the size of a soup preload led to a decrease in the amount of food consumed in a subsequent test meal. In control subjects, the increase in preload size was associated with an increase in fullness and a reduction in consumption of the non-binge test meal. Patients did not report consistent changes in ratings of hunger and fullness in response to the change in preload size, and few patients were able to complete the non-binge meals and refrain from vomiting afterwards. When instructed to binge eat, patients ate considerably more than control subjects, but patients did significantly reduce their intake of the test meal after the large compared to the small preload. These findings demonstrate that, although patients with bulimia nervosa exhibit abnormalities in the development of satiety, some mechanisms responsible for the control of food intake are functional during binge eating episodes.
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PMID:Behavioral assessment of satiety in bulimia nervosa. 151 Apr 65

Bulimia nervosa is a psychiatric syndrome associated with intense hunger, deficient satiety mechanisms, an obsessional preoccupation with the adverse consequences of eating, ritualistic binge eating, and subsequent purging to forestall the effects of the binge. The morbidity of this illness reflects both the psychological suffering associated with a life organized around pathological eating behaviors, as well as medical complications such as fluid and electrolyte imbalances that occur largely as a result of purging and laxative abuse. We report here a study of the osmoregulation of plasma arginine vasopressin secretion and of vasopressin levels in the cerebrospinal fluid. This study was undertaken because vasopressin not only functions as the antidiuretic hormone, and thus as a principal modulator of fluid and electrolyte balance, but also because, in animals, centrally directed vasopressin delays the extinction of behaviors acquired during aversive conditioning. Thirteen normal-weight female patients with bulimia nervosa were studied after at least 1 month of nutritional stabilization and supervised abstinence from binge eating and purging. Plasma vasopressin, plasma sodium, and subjective thirst were measured serially before and during a 2-h infusion of 3% hypertonic saline (0.1 ml/kg min). In addition, cerebrospinal fluid was obtained by lumbar puncture upon admission and at 1 week before hypertonic saline infusion in 11 of these patients and in an additional 11 female patients who did not participate in the hypertonic infusion study. Fifteen healthy normal weight individuals (4 female, 11 male) served as controls for the hypertonic saline infusion and a separate group of 11 healthy normal weight female controls underwent puncture. Compared to controls, bulimic subjects showed a significant reduction in the plasma vasopressin response to hypertonic saline; in 12/13, plasma vasopressin correlated closely with plasma sodium, whereas in one patient vasopressin fluctuated erratically, with no relation to plasma sodium. Cerebrospinal fluid vasopressin levels were significantly higher in patients, and correlated positively with basal thirst level, which was enhanced in bulimics. Compared to controls, patients showed significant polyuria. We conclude that patients with bulimia nervosa have abnormal levels of vasopressin in their plasma and cerebrospinal fluid during abstinence from binge eating and purging. The disturbance in osmoregulation may aggravate the maintenance of adequate fluid volume in these patients, while the increase in centrally directed vasopressin may have relevance to their obsessional preoccupation with the aversive consequences of eating and weight gain.
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PMID:Plasma and cerebrospinal fluid measures of arginine vasopressin secretion in patients with bulimia nervosa and in healthy subjects. 159 71

This paper selectively reviews available evidence concerning psychological characteristics associated with obesity, psychological changes accompanying very-low-calorie diets (VLCDs), and the influence of certain psychological factors on response to VLCD treatment. The obese population as a whole does not show an elevated incidence of psychopathology. Treatment-seeking obese do show more psychiatric disturbance, at a level comparable to other medical/surgical patients. There appear to be no global personality traits or profiles that are associated with obesity. However, obese people differ from non-obese groups on psychological and behavioral variables related to weight and eating and more frequently display perceptual and emotional body image anomalies. Binge eating appears rather common among obese groups. VLCDs have generally neutral to positive effects on hunger, depression, and anxiety. New data on body image suggest that VLCDs are associated with post-treatment underestimation of body size. Finally, recent data on possible psychological and behavioral correlates of VLCDs outcome are presented.
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PMID:Psychological aspects of obesity and very-low-calorie diets. 161 81

Twenty-three women with nonpurging bulimia underwent a 12-week, double-blind, placebo-controlled trial of desipramine hydrochloride. Repeated standardized rating scales, mood assessments, and self-reports of dietary habits were used to measure changes in binge frequency and cognitive processes associated with food intake. The women who received desipramine reduced their frequency of binge eating by 63%, but women receiving placebo increased their frequency of binge eating by 16%. Twelve weeks after initiating treatment, 60% of the treatment group but only 15% of the placebo group abstained from binge eating. The women who received desipramine showed significantly more dietary restraint and reported significantly less hunger, suggesting that desipramine acts to suppress appetite. These preliminary findings suggest that the therapeutic effects of desipramine established in the treatment of purging bulimia nervosa extend to patients with nonpurging bulimia.
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PMID:Successful treatment of nonpurging bulimia nervosa with desipramine: a double-blind, placebo-controlled study. 185 74

A psychometric analysis of the Rigorous Eating Scale was carried out based on data of Smead from 1986 and also from 1987 by Smead and Boyd. This 13-item scale was designed to measure hunger, deprivation, and restraint in eating style and used in both of the foregoing studies to investigate the relationship between dieting and eating style and scoring higher on measures of subclinical symptoms of anorexia and bulimia. This brief report highlights internal consistency reliability, factor structure, and item-criterion correlations. Results indicate appropriately high reliability, but inadequate factor structure. Item-criterion correlations suggest several aspects of eating style which may be important to include in similar scales of the future.
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PMID:A psychometric investigation of the Rigorous Eating Scale. 226 9

Despite our strong belief in the utility of laboratory studies of eating behavior, we also note several caveats on the data thereby obtained. First, it must be assumed that subjects' behavior is influenced by the laboratory environment and is not identical to eating behavior in a "normal" setting. Second, not all bulimic subjects who were screened for these studies actually participated, so that it is possible that the sample of patients from whom we obtained data differed in some ways from a general clinical population of women with bulimia. Nonetheless, we believe that our data provide compelling evidence that the disturbed eating behavior characteristic of bulimia nervosa can be profitably studied in the laboratory. Even under structured laboratory conditions, most bulimic patients rated one of their multicourse meals as typical of a binge, and, during that meal, consumed a much larger amount of food and ate more rapidly than did controls who were asked to overeat. The significant correlations between the sizes of the multicourse and single-course binge meals and between the size of laboratory binge meals and the size of the "naturally occurring" binge meals reported to the dietician suggest that a reproducible phenomenon is being examined. The results of our studies suggest that the abnormalities of eating behavior in bulimia nervosa cannot be viewed simply as a disturbance of carbohydrate consumption or even as the episodic consumption of a certain type of food. Rather, eating behavior in this syndrome appears more generally disturbed. The most striking difference between the binge and the nonbinge meals of bulimic patients and between the binge eating of patients and the overeating of normal persons is the amount of food consumed, not the macronutrient composition of the meals. In addition, for all four meal types, the patients were hungrier after the end of the meal than were the controls, even though the patients' average caloric intakes were generally larger and their average hunger ratings before the meals did not differ from those of the controls. Certainly, self-induced vomiting may contribute to this abnormality, but it was also observed after nonbinge meals when vomiting did not occur. Together, these data are consistent with the notion that the essential appetitive abnormality in bulimia nervosa lies in the control of the amount of food consumed, not in the consumption of a particular macronutrient or type of food. Patients with bulimia nervosa appear less responsive than normal to the signals that lead to the termination of a meal.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Eating behavior in bulimia. 263 74

To obtain objective information about binge- and non-binge-eating behavior, 12 women with bulimia and ten women without eating problems (controls) were asked to eat four meals in a structured laboratory setting, on separate nonconsecutive days. The same instructions were given to both groups. On two days, they were asked to eat a normal amount, and on two days, they were asked to eat as much as they could, ie, to binge. For each type of instruction, they were given a single- and a multiple-course meal. The patients ate significantly more than the controls when asked to binge, both on the multiple-course meals that they rated as typical of binges and on the single-course meals. When they were asked to eat normally, there was no significant difference in intake between patients and controls on either single- or multiple-course meals. After all meals, hunger ratings of patients were significantly higher than hunger ratings of controls. There was also a significant positive correlation between intakes of single- and multiple-course binge meals and an inverse correlation between intake of multiple-course binge meals in bulimic patients and their rating of how well they controlled their eating. Thus, a structured laboratory eating situation can be used to reveal differences between bulimic and normal individuals and has the potential for assessing clinical status and exploring mechanisms responsible for binge eating.
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PMID:Eating behavior of women with bulimia. 291 Feb 21

The hunger perceptions and satiety responses to a high-calorie, carbohydrate-rich food among 10 normal-weight females who met the DSM-III criteria for bulimia were compared with 10 normal-weight females who denied a current or past history of eating or weight disorders. As indicated by self-report responses on the Hunger-Satiety Questionnaire, bulimics did not differ from the normals in their perceptions of hunger sensations. Differences, however, were detected in the responses following eating. Most notably, the bulimics reported feelings of irritability, nervousness, tenseness and depression which persisted 30 minutes later. These findings and directions for future research are discussed.
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PMID:Hunger perceptions and satiety responses among normal-weight bulimics and normals to a high-calorie, carbohydrate-rich food. 346 Jan 5

This study compared male and female students on measures characteristic of eating disordered behavior. Measures investigated were subscales of the Eating Disorders Inventory and of the Restrained Eating Scale. Results indicated that both males and females reported a fundamental pattern of eating disordered behavior. This pattern consisted of going on and off diets with an accompanying complaint of a lack of confidence in recognizing and identifying sensations of hunger and satiety. Females differed from males in that they reported more anorexic behavior and scored significantly higher on most measures of eating disordered behavior. Although the fundamental pattern of disordered eating leading to bulimia may be similar between the sexes, females appear to be at greater risk to the development of these behaviors.
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PMID:Eating disordered behaviors: a comparison of male and female university students. 346 91

The present study examined those factors which differentially lead to normal eating and binge eating. Twenty-one bulimic subjects and comparison subjects monitored their mood, hunger, and food intake hourly over a number of days. The bulimic sample ate fewer meals and had lower overall mood. Positive mood, food abstinence combined with intensified hunger, and being in the company of another person preceded normal eating (i.e. retained meal). Negative mood, recent consumption of food, and being alone preceded bulimic episodes.
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PMID:Mood and food: an analysis of bulimic episodes. 386 32


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