Monday, June 24, 2013

Eating Disorder Symptoms: Differences among Ethnic Groups

Dr. David Herzog, Emeritus Professor of Psychiatry at Harvard Medical School, is an internationally renowned expert on eating disorders.  He founded and directed the Harvard Eating Disorders Center, which later became the Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital.

Detection of high-risk attitudes and behaviors is critical in the goal of preventing eating disorders. In 1996, the National Eating Disorders Screening Program (NEDSP) was launched on 409 college campuses across the United States. The NEDSP reached a diverse student population and used a self-report screening questionnaire to identify those at risk for eating disorders.  NEDSP participants were offered an opportunity to meet with an on-site counselor to review their responses to the questionnaire in order to receive a recommendation for what, if any, further clinical evaluation would be necessary.

Dr. Herzog and his team analyzed data from 5,435 NEDSP questionnaires for a study of ethnic differences in the prevalence of eating disorder symptoms and related distress. Questionnaire items assessed the presence and frequency of restrictive eating, amenorrhea, binge eating, self-induced vomiting, use of laxatives and diuretics, and potentially problematic exercise behaviors. Three questions were used to measure distress related to the reported symptoms. Participants were asked to select the best response on 4-point scales ranging from ‘‘never’’ to ‘‘all of the time’’ reflecting the degree to which eating and weight concerns (a) caused a great deal of distress, (b) interfered with relationships, and (c) interfered with academic/work performance.

The frequency of binge eating, restrictive eating, vomiting, and amenorrhea
did not differ significantly across ethnic groups.  However, significant between-group differences were found with respect to modes of purging. Binge correlates (such as eating until uncomfortably full) were significantly more frequent among Caucasian than African American participants. Binge eating was the best predictor of distress among Caucasians, African Americans, and Latinos, whereas vomiting was the best predictor of distress among Asians. Asian participants who used laxatives were significantly less likely to receive a recommendation for further evaluation than non-Asian participants.

The findings suggest there may be some important differences among ethnic groups in regard to eating disorder symptoms, symptom-related distress, and likelihood for referral that merit further investigation. Clinician recognition of this
potential diversity may enhance culturally competent care for eating disorders.


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