Eat Weight Disord (2014) 19:233–240 DOI 10.1007/s40519-014-0112-9


Eating disorder symptoms, psychiatric correlates and self-image in normal, overweight and obese eating disorder patients Joakim de Man Lapidoth • Yvonne von Hausswolff-Juhlin

Received: 30 September 2013 / Accepted: 22 February 2014 / Published online: 18 March 2014 Ó Springer International Publishing Switzerland 2014

Abstract The impression from Swedish eating disorder (ED) units is that there has been an increase in the number of overweight or obese patients. There is, however, no research studying whether these patients differ from normal-weight ED patients in other aspects than weight. Differences between normal-weight and overweight or obese ED patients could indicate that these groups of patients need different treatment approaches. The aim of this study was to investigate possible differences between normal-weight and overweight or obese ED patients in psychiatric and psychological pre-treatment variables. The study was based on data from a Swedish quality assurance system for ED care. In total, data from 3,798 adult patients with body mass index C 18.5 were used. The sample included all normal-weight ED diagnoses. Significant differences between normal-weight, overweight and obese patients were found for five of eight self-image variables, for all eating disorder examination questionnaire subscales and for most key diagnostic symptoms. However, effect sizes were mostly small or very small. Overweight or obese patients did not display greater levels of psychiatric psychopathology than normal-weight patients. They did, however, show a tendency towards more negative self-image and more severe ED symptoms than normal-weight patients. Overweight and obesity in ED patients are thus not only associated with physical health problems, but also with mental health issues. Further studies are required to investigate the clinical relevance of these findings. Keywords Obesity  Overweight  Eating disorders  Self-image  Psychiatric comorbidity J. de Man Lapidoth (&)  Y. von Hausswolff-Juhlin Stockholm Centre for Eating Disorders and Karolinska Institutet, Wollmar Yxkullsgatan 25, 2 tr, 11850 Stockholm, Sweden e-mail: [email protected]

Introduction Worldwide, the prevalence of obesity has more than doubled since 1980 [1]. The impression from specialised eating disorder (ED) units in Sweden is that there has been an increase in the number of ED patients that are overweight (body mass index BMI = 25.0–29.9) or obese (BMI C 30.0). However, there is so far no published evidence to support this observation. Some ED units in Sweden offer treatment for obese patients, targeting binge eating disorder (BED) specifically [2]. Even though most research on obese patients with EDs has focused on BED [3, 4], obesity is also found in bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS) [5, 6]. Obesity is known to have a serious, adverse impact on somatic health and longevity [1, 7], as well as being associated with low quality of life [1] and psychological/ psychiatric distress [8]. However, data regarding differences between normal-weight ED patients and ED patients with overweight or obesity are very limited [3, 9–13]. Most available studies on ED and obesity have focused on BED with or without obesity [12, 13], while in some studies, BN patients have also been included [9]. There is evidence that BMI is positively associated with age in ED patients [3, 9, 11, 12]. Some studies also suggest that BED patients with higher BMI have more concerns about weight and report more objective binge eating episodes than their normal-weight counterparts [3, 9]. Wilfley and colleagues [14] compared groups of BN and BED patients, and found that BED patients (on average 61 % overweight) had fewer episodes of binge eating and scored significantly lower on the EDE subscales restraint and eating concern, compared with a group of BN patients with lower BMI (on average 3 % overweight). In contrast, Striegel-Moore and colleagues [11] found no difference



between BED patients and purging BN patients (M = BMI 34 vs. BMI 26), regarding shape concern or weight concern. Villarejo and colleagues [10] found higher ED scores and greater general psychopathology in female ED patients with lifetime obesity compared to those without obesity, although these data were retrospective and therefore difficult to evaluate in relation to the aim of the present study. The Swedish quality registry STEPWISE [15] assesses ED and other variables such as general psychopathology and self-image that may affect treatment outcome [16, 17]. To our knowledge, self-image has not yet been studied in relation to BMI, and in only one study, the association between psychiatric comorbidity and overweight has been examined in EDs. In that study of BED patients, Barry et al. [9] failed to find any difference in depression that was related to obesity. In the clinical experience of the present authors, obese ED patients may receive other ED treatments compared to their normal-weight counterparts with the same diagnoses, where weight loss is not one of the aims of treatment. In some Swedish ED clinics, obese ED patients are not even accepted for treatment. Such practices may reinforce the impression that overweight and obese ED patients are clinically distinct from normal-weight patients over and above their need for weight loss. However, there is as yet insufficient research to support such a conclusion. The aim of the present study was, therefore, to investigate possible differences between normal-weight ED patients and ED patients who are overweight or obese, regarding relevant psychiatric and psychological variables prior to treatment.

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ED patients in regard to pre-treatment variables, which is why all patients with BMI below 18.5 kg/m2 (i.e. the commonly used weight criterion for AN) were excluded. Only data from adult patients were included since different instruments are used for adults and children in STEPWISE. In total, the study sample comprised of 3,798 participants. Diagnoses Using clinical interviews, patients were classified as BN, EDNOS or BED (all patients with BMI \ 18.5 were excluded). Binge eating disorder is included in DSM-IV as an example of EDNOS, but was treated as a diagnosis in its own right, since research has confirmed that it is a significant clinical disorder [18, 19]. This has led to its inclusion in DSM5 [20] as a distinct diagnosis. Binge eating disorder has also been shown to be of particular interest in the research of overweight and obese patients with ED symptoms [4]. Instruments Structured clinical interview for DSM-IV Axis I (SCID-I) [21] Psychiatric diagnoses within STEPWISE were assisted by the structured clinical interview for DSM-IV Axis I disorder, research version (SCID-I/NP). Interviews were carried out face to face by trained clinicians (i.e. psychiatrists, clinical psychologists or behavioural scientists). The SCID-I has been shown to have good psychometric properties [22, 23]. Global assessment of functioning (GAF) [24]

Materials and methods This study is based on data from STEPWISE, a Swedish Internet-based quality assurance and data collection system for specialised ED care, which has been in use since 2005, and includes data from 34 treatment units (Birgega˚rd et al. [15]). Inclusion criteria for STEPWISE are medical or selfreferral to one of the participating treatment units, fulfilling criteria for an ED according to DSM-IV [2], and intent to treat the patient at the unit in question. Procedure and participants STEPWISE assessments are performed within the patient’s first three visits to the unit and take approx. 80 min. The battery includes a diagnostic interview and a series of clinical assessments that are performed by trained staff (psychiatrists, psychologists and behavioural scientists), as well as self-report measures. In the present study, data on adult ED patients were used. The aim was to compare differences between normal-weight, overweight and obese


Global assessment of functioning is the fifth axis of the DSM-IV and is commonly used by clinicians to indicate the overall severity of a patient’s psychiatric disturbances. This is done on a scale from 0 to 100. Eating disorder examination questionnaire (EDE-Q) [25] The EDE-Q contains 36 items and four subscales: dietary restraint, eating concern, shape concern and weight concern. Besides these subscales, ratings of key diagnostic symptoms are measured (e.g. objective and subjective bingeing, purging, laxative/diuretic use, exercise). Good agreement between EDE-Q and interview data has been reported [26, 27]. Social analysis of social behaviour (SASB)—introject self-image [28, 29] Self-image was assessed using the SASB Intrex (third surface). This questionnaire asks participants to rate the degree to which statements about themselves are true. The SASB is a

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circumplex model based on two orthogonal dimensions of interpersonal behaviour: affiliation and interdependence. Eight cluster scores are computed; self-love and self-hate (affiliation dimension), self-emancipation and self-control (interdependence dimension), and the combinations of the end points selfacceptance, self-protection, self-blame and self-neglect. Research on outcome prediction, treatment dropout and patient–therapist interaction supports the importance of measuring SASB self-image variables in ED patients [17, 30, 31].

interview data were undertaken to help understand possible similarities and differences. These data were analysed dichotomously using recommended cut-off points for the CPRS-S-A [32] and the depression and anxiety scales. v2 test was used to analyse CPRS-S-A depression and anxiety for agreement in relation to ‘‘any mood disorder’’ and ‘‘any anxiety disorder’’. Since no suitable comparison was found in the SCID for the CPRS-S-A obsessive–compulsive subscale, no such analysis was conducted for this scale.

Comprehensive psychopathological rating scale (CPRS-SA) [32]


The CPRS-S-A is a 19-item questionnaire measuring depression, anxiety and obsession–compulsion. This is a short version of a measure designed to cover DSM-IV Axis I in a self-report format. Responses are given on a 0–3 scale in .5increments, with nine items for depression, nine for anxiety and eight for obsession–compulsion; some items overlap and belong to more than one scale. The correlation between self and expert ratings has been show to be strong for the depression and anxiety subscales in psychiatric outpatients [33]. Data analysis Age and BMI differences between BMI groups were analysed using t tests. Since age correlates with BMI in ED [3, 9] and community samples [34], it was used as an ANCOVA covariate when examining between BMI group differences in SASB, EDE-Q, GAF and CPRS-S-A. Both statistical significance and effect sizes are presented, but due to multiple testing, a conservative significance level of .005 was used. Comparison of patients’ main activity in regard to BMI groups was done using the v2 test. Psychopathology was assessed dichotomously using the SCID-I interview [21]. Due to the large number of separate disorders in the SCID-I, these data were grouped in three groups, representing the most frequently observed psychiatric disorders among ED patients (according to Striegel-Moore et al. [11] and unpublished STEPWISE-data). The three diagnostic groups formed were any mood disorder (i.e. major depression, dysthemia and depression not otherwise specified); any anxiety disorder (i.e. agoraphobia, panic disorder, posttraumatic stress disorder, social phobia, specific phobia, obsessive–compulsive disorder and generalised anxiety disorder); and any addictive disorder (i.e. alcohol abuse, alcohol addiction, substance abuse and substance addiction). Rates of psychopathology were compared in the three BMI groups by means of v2 analyses. In addition to the clinical interview (SCID-I), data on psychopathology were also examined through self-report data (CPRS-S-A). In spite of obvious differences between the two assessment methods, comparisons between self-rating and

Demographics and diagnoses The mean age of the 3,798 participants was 26.7 years (SD = 8.2), with a mean BMI of 24.1 kg/m2 (SD = 5.7). There were 119 (3.1 %) males in the sample, with a mean age of 29.8 years (SD = 10.7) and a mean BMI of 26.1 kg/ m2 (SD = 7.8). Males were both older (t = 3.2, p \ 0.001) and had a higher BMI (t = 2.8, p \ 0.001) compared to females. The BMI distribution of the total sample was normal weight 71.6 % (n = 2,720); overweight 15.2 % (n = 577); and obese 13.2 % (n = 501). Table 1 presents BMI, age and the diagnostic distribution of the three BMI groups. The distribution of diagnoses was shown to differ significantly between the three BMI groups (v2 = 1,054.7, p \ 0.001), suggesting a higher rate of BED in the groups with higher BMI. Among males, 59.7 % (n = 71) were normal weight, 16.0 % (n = 19) were overweight, and 24.4 % (n = 29) were obese; 31.9 % (n = 38) fulfilled criteria for BN, 50.4 % (n = 60) were classified as EDNOS, and 17.6 % were classified as (n = 21) as BED. The distributions of males in BMI (v2 = 13.0, p \ 0.01) and diagnostic groups (v2 = 9.2, p \ 0.05) were significantly different compared to females. Table 2 indicates that the participants’ main activity varies significantly between the BMI groups (v2 = 18.6, p \ 0.001). Age differed between the three BMI groups (F = 259, p \ 0.001). Normal-weight participants were on average 25.1 years of age (SD = 6.8), overweight participants 28.3 years of age (SD = 9.2) and obese 33.4 years of age (SD = 10.2). In line with these differences, age was significantly correlated with initial BMI (r = 0.36, p \ 0.001). Among males, age and BMI were significantly correlated (r = 0.34, p \ 0.001). Self-image, eating pathology and psychopathology Differences between BMI groups on self-report measures are presented in Table 3. All associations were corrected for age in ANCOVA.



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Table 1 Mean BMI, mean age and rates of ED diagnoses in each of the three BMI classes


BMI M (std)

Age M (std)

BMI class Normal weight




23.6 (4.2)

26.6 (7.6)

43.9 % (n = 1,195)

55.5 % (n = 320)

26.7 % (n = 134)

43.4 % (n = 1,649)


22.52 (4.4)

25.8 (7.8)

52.9 % (n = 1,440)

30.5 % (n = 176)

22.2 % (n = 111)

45.5.0 % (n = 1,727)


32.6 (7.9)

31.5 (10.1)

3.1 % (n = 85)

14.0 % (n = 81)

51.1 % (n = 256)

11.1 % (n = 422)

100 % (n = 2,720)

100 % (n = 577)

100 % (n = 501)

100 % (n = 3,798)

Table 2 Rates of patients’ main activity in the BMI groups (missing data n = 7) Main activity

BMI class


Normal weight



Paid work

52.6 % (n = 1,427)

44.7 % (n = 257)

47.5 % (n = 238)



45.2 % (n = 1,228)

52.9 % (n = 304)

48.5 % (n = 243)


Unemployment/ sick leave

2.2 % (n = 60)

2.4 % (n = 14)

4.0 % (n = 20)


100 % (n = 2,715)

100 % (n = 575)

100 % (n = 501)

94 3,791

In spite of numerous significant differences between BMI groups, small effect sizes tended to be found. The above analyses found no significant associations between BMI group and any of the three psychopathology groups. Agreement between psychopathology assessments The CPRS-S-A depressive subscale (cut-off score of nine [32]) was further compared for agreement with the SCID group ‘‘any mood disorder’’, which showed fair agreement (j = 0.34, p \ 0.0001). The CPRS-S-A anxiety subscale score (cut-off score of nine [32]) was also compared for agreement with the SCID group ‘‘any anxiety disorder’’. Also here, data suggested fair agreement between the two measures (j = 0.35, p \ 0.0001).


the present sample was either overweight or obese. This suggests that clinicians working with ED meet not only underweight and normal-weight patients, but also overweight and obese individuals in everyday practice. Underweight patients have been studied considerably, but there is as yet insufficient knowledge about overweight and obesity in ED. To help shed light on this matter, the variables chosen in the study were those often used in planning ED treatment, taken from the Swedish quality assurance and data collection system STEPWISE [15]. Since there is little research on males with ED, we chose not to exclude them. Males were found to differ from females in terms of diagnostic and BMI group distribution. Moreover, since research in the field of overweight and obesity in ED is still scarce, we chose to focus on the bigger picture and present a more naturalistic description of adult ED patients with BMI 18.5 kg/m2 and above (Table 4). In general, results suggest a number of significant differences between the three BMI groups prior to treatment, including self-image (five out of eight SASB clusters), all EDE-Q subscales, all but one key diagnostic eating symptom and self-rated anxiety. However, the effects of these comparisons are small or even very small. Only EDEQ dietary restraint attained a medium effect size. Despite small effect sizes, results point in the same direction, suggesting slightly more difficulties in ED patients with obesity or overweight, compared to normal-weight patients. Comorbid psychopathology

Discussion The aim of the present study was to investigate possible differences in psychiatric and psychological variables between normal-weight ED patients and ED patients who are overweight or obese. The relevance of this study is underlined by the fact that more than 28 % of


Similar to previous research [3, 9], the data support a lack of association between BMI categories and depressive symptoms (regarding both CPRS-S-A depression and SCID-I ‘‘any mood disorder’’), even if comparisons between studies differ regarding diagnostic groups. Although a significant difference was found between BMI groups and CPRS-S-A anxiety, the very small effect size

Eat Weight Disord (2014) 19:233–240 Table 3 Differences between ED patients in BMI groups, in regard to pre-treatment variables. Results are corrected for age (n = 3,757)


Normal weight (n = 2693)

Overweight (n = 568)

Obese (n = 496)



SASB Self-emancipation

31.8 (16.1)

33.2 (16.3)

34.9 (15.2)




27.9 (19.2)

27.1 (18.9)

26.2 (19.1)



Active self-love

31.1 (19.2)

30.8 (18.6)

27.4 (19.1)




41.5 (19.3)

41.6 (18.6)

37.2 (19.3)




56.2 (18.2)

52.13 (17.4)

49.2 (18.6)




56.8 (23.3)

57.9 (21.9)

58.3 (22.8)




44.5 (24.2)

44.3 (22.8)

48.2 (23.3)




39.2 (21.1)

41.8 (20.5)

48.2 (20.4)



Restriction Shape concern

3.7 (1.4) 4.8 (1.2)

3.3 (1.6) 5.1 (1.0)

2.5 (1.7) 5.1 (1.0)

120.0** 37.1**

0.060 0.019

Eating concern

3.3 (1.2)

3.5 (1.3)

3.5 (1.4)




Weight concern

4.1 (1.3)

4.4 (1.0)

4.4 (1.0)



Objective binge episodes (OBE)

7.4 (11.3)

9.1 (8.9)

11.6 (12.7)



Subjective binge episodes (SBE)

7.3 (11.5)

5.5 (8.7)

4.6 (9.4)




14.6 (18.1)

14.6 (14.7)

15.8 (18.4)



Purging episodes Laxatives and diuretics

12.5 (19.9) 2.1 (7.5)

8.5 (17.8) 2.1 (7.4)

3.7 (10.6) 1.1 (5.0)

43.9** 5.5*

0.023 0.003

Excessive exercise

8.8 (11.5)

6.08 (9.1)

2.33 (6.4)



48.6 (9.4)

49.4 (9.6)

49.4 (9.9)



10.6 (4.7)

10.3 (4.6)

10.8 (4.5)




9.3 (4.2)

9.4 (4.3)

10.3 (4.4)




9.0 (4.2)

8.7 (4.2)

8.9 (4.2)



GAF CPRS-S-A Depression * p \ 0.005 ** p \ 0.001

Table 4 Rate of psychopathology (according to SCID-I) in each BMI group and comparison of differences in psychopathology between BMI groups

SCID-I psychopathology

Normal weight (n = 2,720)

Overweight (n = 577)

Obese (n = 501)


Any mood disorder

1,113 (40.9 %)

243 (42.1 %)

227 (45.3 %)

3.4, NS

Any addictive disorder

322 (11.8 %)

67 (11.6 %)

53 (10.8 %)

0.6, NS

Any anxiety disorder

1,523 (56.0 %)

328 (56.8 %)

300 (59.9 %)

2.6, NS

and the lack of other differences between BMI groups fail to support a notion of general differences in psychopathology among BMI categories. The comparisons between clinical SCID-I data and self-report measures found only fair levels of agreement. In spite of difficulties in interpreting results from these comparisons, the present data suggest that there may be important differences in the information provided by expert clinical assessments and patient’s selfreports. More research in the field of obesity and mental health is needed to bet a better understanding of these differences.

Self-image To our knowledge, no study has yet been published where SASB self-image has been studied in relation to BMI categories, although there have been a number of studies focusing on cognitive and behavioural components, such as self-efficacy, self-esteem and self-attribution in the obese [35]. Even though only two SASB clusters demonstrated small effect sizes, there was a trend in the present data towards greater negative self-image in overweight and obese ED patients, which could affect ED treatment outcome. Higher self-neglect (Cluster 8) could reflect



difficulties in adhering to treatment in obese patients, while less self-control (Cluster 5) in obese patients could be a manifestation of an inability to control food intake and difficulties with resisting impulses to eat. Differences in relation to BMI group were most prominent regarding the interdependence axis (i.e. self-emancipation vs. self-control) and least prominent with respect to the affiliation dimension (i.e. self-love vs. self-hate). Since self-hate has previously been shown to be a predictor of negative outcome in ED patients [17], it may be important for clinicians to focus on this during treatment. Eating behaviour All four eating behaviour subscales of the EDE-Q were significantly different in the three BMI groups. Effect sizes of these comparisons were, however, medium, small or very small. In contrast to Dingemans et al. [3], the present study found lower scores in the overweight and obese groups on dietary restraint. This is consistent with results from Welch et al. [36], which found lower EDE-Q dietary restraint scores in BED patients with higher BMI. These findings raise the question of how to interpret results from the dietary restraint subscale in obese ED patients. Is greater restraint (as traditionally interpreted [37]) an indication of greater eating disorder psychopathology in ED patients with overweight and obesity? This would suggest that overweight and obese ED patients overall may present with equal or greater psychopathology except for restraint where there may be less psychopathology. The dietary restraint subscale should perhaps instead be used an indicator of difficulties in restricting food intake, which has contributed to weight gain. Given the contradictory findings on dietary restraint in overweight and obese ED patients, consideration should be given to omitting this subscale in these patients until the issue is further analysed. Taken together, the present data only partly confirm the findings of Dingemans and colleagues [3] concerning higher weight concern in obese BED patients, compared to non-obese BED patients. The difference between the studies is perhaps explained by the inclusion of other diagnoses than BED in the present research, but also by the use of different diagnostic methods.

Key diagnostic symptoms of the EDE-Q The key diagnostic symptoms assessed by the EDE-Q can be seen as a manifestation of expected diagnostic differences. In line with this, more objective binge eating (OBE) and less compensatory behaviour (purging, laxative/diuretics and excessive exercise) were found in the overweight and obese groups, where BED was more common. The least intuitively


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explained association though was that of subjective binge eating (SBE). In contrast to OBE, SBE was less frequent in overweight and obesity. When the frequency of OBE and SBE was added together and compared, there was no longer any difference between the BMI groups. Research has previously failed to find significant differences in clinical severity between patients with SBE or OBE [38]. Differences between BMI groups in the present study may not indicate differences in loss of control over eating, but instead differences in food intake during binge eating. Overweight and obese ED patients in the present study were not classified as having greater psychopathology than normal-weight ED patients. Still data seemed to suggest a trend of more negative eating behaviours and more negative self-image in overweight and obesity, even though effect sizes were mostly small or even very small. This raises the question of whether overweight and obese ED patients are not only at risk for serious consequences for physical health [1, 7], but also at risk for serious mental health issues, perhaps due to the stigma of obesity. This may have further impact on how these persons perceive themselves, including their perceptions of self-worth and self-esteem [39], which may in turn affect the treatment process. Strengths The main strength of the present study was the large sample from the STEPWISE register, which allowed for a multitude of comparisons in regard to BMI groups. Other strengths included the use of clinical interview-assessed diagnostic data and patient self-ratings, as well as an investigation of the full range of ED diagnoses. To present a more complete treatment sample, we have also chosen not to exclude males in this study, even if they have not been analysed separately. Since data in the STEPWISE registry are growing, separate analyses of differences between men and women are planned for the future. Limitations A limitation of the present study, besides not analysing men separately, was that it was limited to patients aged 18 and above. This was due to the different assessment methods used in STEPWISE for assessing children and adults. A similar study to the present one focusing on children and adolescents is therefore planned.

Conclusions Overweight and obese ED patients do not display greater levels of psychopathology compared to ED patients at

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normal weight. Overweight and obese ED patients do, however, exhibit a trend towards greater negative selfimage and more negative eating behaviours compared to normal-weight ED patients, although small effect sizes raise questions about the clinical relevance of these findings. Taken together, our results provide an indication of the physical and mental distress that overweight and obesity add to ED and which may be important to address in treatment. Future studies are needed to learn more about how overweight and obese patients can best be treated for their ED. Conflict of interest of interest.

The authors declare that they have no conflict

References 1. World Health Organization (2013) Obesity and overweight. http:// Accessed 20 sept 2013 2. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Press, Washington DC 3. Dingemans AE, van Furth EF (2012) Binge eating disorder psychopathology in normal-weight and obese individuals. Int J Eat Disord 45:135–138 4. Niego SH, Kofman MD, Weiss JJ et al (2007) Binge eating in the bariatric surgery population: a review of the literature. Int J Eat Disord 40:349–359 5. Fichter MM, Quadflieg N, Hedlund S (2008) Long-term course of binge eating disorder and bulimia nervosa: relevance for nosology and diagnostic criteria. Int J Eat Disord 41:577–586 6. de Man Lapidoth J, Ghaderi A, Norring C (2006) Eating disorders and disordered eating among patients seeking non-surgical weight-loss treatment in Sweden. Eat Behav 7:15–26 7. Sjo¨stro¨m L (2008) Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes 32(Suppl 7):93–97 8. Greenberg I, Perna F, Kaplan M et al (2005) Behavioural and psychological factors in the assessment and treatment of obesity surgery patients. Obes Res 13:244–249 9. Barry DT, Grilo CM, Masheb RM (2003) Comparison of patients with bulimia nervosa, obese patients with binge eating disorder, and nonobese patients with binge eating disorder. J Nerv Ment Dis 191:589–594 10. Villarejo C, Ferna´ndez-Aranda F, Jime´nez-Murcia S et al (2012) Lifetime obesity in patients with eating disorders: increasing prevalence, clinical and personality correlates. Eur Eat Disord Rev 20:250–254 11. Striegel-Moore RH, Cachelin FM, Dohm FA et al (2001) Comparison of binge eating disorder and bulimia nervosa in a community sample. Int J Eat Disord 29:157–165 12. Goldschmidt AB, LeGrange D, Powers P et al (2011) Eating disorder symptomatology in normal-weight vs. obese individuals with binge eating disorders. Obesity 19:1515–1518 13. Carrard I, Van der Linden M, Golay A (2012) Comparison of obese and nonobese individuals with binge eating disorder: delicate boundary between binge eating disorder and non-purging bulimia nervosa. Eur Eat Disord Rev 20:350–354 14. Wilfley DE, Schwartz MB, Spurell EB et al (2000) Using the eating disorder examination to identify the specific psychopathology of binge eating disorder. Int J Eat Disord 27:259–269

239 15. Birgega˚rd A, Bjo¨rck C, Clinton D (2010) Quality assurance of specialised treatment of eating disorders using large-scale internet-based collection systems: methods, results and lessons learned from designing the Stepwise database. Eur Eat Disord Rev 18:251–259 16. Blinder BJ, Cumella EJ, Sanathara VA (2006) Psychiatric comorbidities of female inpatients with eating disorders. Psychosom Med 68:454–462 17. Bjo¨rck C, Clinton D, Sohlberg S et al (2007) Negative self-image and outcome in eating disorders: results at 3-year follow-up. Eat Behav 8:398–406 18. Dingemans AE, Bruna MJ, van Furth EF (2002) Binge eating disorder: a review. Int J Obes Relat Metab Disord 26:299–307 19. Wilfley DE, Wilson GT, Agras WS (2003) The clinical significance of binge eating disorder. Int J Eat Disord 34:S96–S106 20. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington 21. First MB, Spitzer RL, Gibbon M, Williams JR (2002) Structured clinical interview for DSM-IV-TR axis I disorders, research version, non-patient edition (SCID-I/NP). New York State Psychiatric Institute, New York 22. Lobbestael J, Leurgans M, Arntz A (2010) Inter-rater reliability of the structured clinical interview for DSM-IV axis I disorders (SCID I) and axis II disorders (SCID II). Clin Psychol Psychother 18(1):75–79 23. Steiner JL, Tebes JK, Sledge WH et al (1995) A comparison of the structured clinical interview for DSM-III-R and clinical diagnoses. J Nerv Ment Dis 183:365–369 24. Endicott J, Spitzer RL, Fleiss JL, Cohen J (1976) The global assessment scale: a procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 3:766–771 25. Fairburn CG, Beglin SJ (1992) Evaluation of a new instrument for the detection of eating disorders in community samples. Psychiatry Res 3:191–201 26. Binford RB, Le Grange D, Jellar CC (1995) Eating disorders examination versus eating disorders examination-questionnaire in adolescents with full and partial-syndrome bulimia nervosa and anorexia nervosa. Int J Eat Disord 37:44–49 27. Luce KH, Crowther JH (1999) The reliability of the eating disorder examination-self-report questionnaire version (EDE-Q). Int J Eat Disord 25:349–351 28. Benjamin LS (1974) Structural analysis of social behavior. Psychol Rev 81:92–425 29. Benjamin LS (2000) SASB Intrex user’s manual. University of Utah, Utah 30. von der Lippe AL, Monsen JT, Rønnestad MH et al (2008) Treatment failure in psychotherapy: the pull of hostility. Psychother Res 18:420–432 31. Birgega˚rd A, Bjo¨rck C, Norring C et al (2009) Anorexic selfcontrol and bulimic self hate: differential outcome prediction from initial self-image. Int J Eat Disord 42:522–530 ˚ sberg M, Montgomery SA, Perris C et al (1978) A compre32. A hensive psychopathological rating scale. Acta Psychiatr Scand 271:5–27 33. Mattila-Evenden M, Svanborg P, Gustavsson P et al (1996) Determinants of self-rating and expert rating concordance in psychiatric out-patients, using the affective subscales of the CPRS. Acta Psychiatr Scand 94:386–396 34. World Health Organization (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation of obesity. WHO, Geneva 35. Van Dorsten B, Lindley EM (2011) Cognitive and behavioral approaches in the treatment of obesity. Med Clin N Am 95:971–988 36. Welch E, Birgega˚rd A, Parling T et al (2011) Eating disorder examination questionnaire and clinical impairment assessment


240 questionnaire: general population and clinical norms for young adult women in Sweden. Behav Res Ther 4:85–91 37. Mond JM, Hay PJ, Rodgers B et al (2004) Validity of the eating disorder examination questionnaire (EDE-Q) in screening for eating disorders in community samples. Behav Res Ther 42:551–567 38. Watson HJ, Fursland A, Bulik CM et al (2013) Subjective binge eating with compensatory behaviors: a variant presentation of bulimia nervosa. Int J Eat Disord 46:119–126


Eat Weight Disord (2014) 19:233–240 39. Lewis S, Thomas SL, Blood RW et al (2011) How do obese individuals perceive and respond to the different types of obesity stigma that they encounter in their daily lives? A qualitative study. Soc Sci Med 73:1349–1356

Eating disorder symptoms, psychiatric correlates and self-image in normal, overweight and obese eating disorder patients.

The impression from Swedish eating disorder (ED) units is that there has been an increase in the number of overweight or obese patients. There is, how...
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