ScienceDaily (June 21, 2012) - Eating disorders are commonly seen as an issue faced by teenagers and young women, but a new study reveals that age is no barrier to disordered eating. In women aged 50 and over, 3.5% report binge eating, nearly 8% report purging, and more than 70% are trying to lose weight. The study published in the International Journal of Eating Disorders revealed that 62% of women claimed that their weight or shape negatively impacted on their life.

The researchers, led by Dr Cynthia Bulik, Director of the University of North Carolina Eating Disorders Program, reached 1,849 women from across the USA participating in the Gender and Body Image Study (GABI) with a survey titled, 'Body Image in Women 50 and Over -- Tell Us What You Think and Feel.'

"We know very little about how women aged 50 and above feel about their bodies," said Bulik. "An unfortunate assumption is that they 'grow out of' body dissatisfaction and eating disorders, but no one has really bothered to ask. Since most research focuses on younger women, our goal was to capture the concerns of women in this age range to inform future research and service planning."

The average age of the participants was 59, while 92% were white. More than a quarter, 27%, were obese, 29% were overweight, 42% were normal weight and 2% were underweight.

Results revealed that eating disorder symptoms were common. About 8% of women reported purging in the last five years and 3.5% reported binge eating in the last month. These behaviors were most prevalent in women in their early 50s, but also occurred in women over 75.

When it came to weight issues, 36% of the women reported spending at least half their time in the last five years dieting, 41% checked their body daily and 40% weighed themselves a couple of times a week or more.

62% of women claimed that their weight or shape negatively impacted their life, 79% said that it affected their self-perception and 64% said that they thought about it daily.

The women reported resorting to a variety of unhealthy methods to change their body, including diet pills (7.5%), excessive exercise (7%), diuretics (2.5%), laxatives (2%) and vomiting (1%).

Two-thirds, 66%, were unhappy with their overall appearance and this was highest when it came to their stomach, 84%, and shape, 73%.

"The bottom line is that eating disorders and weight and shape concerns don't discriminate on the basis of age," concluded Bulik. "Healthcare providers should remain alert for eating disorder symptoms and weight and shape concerns that may adversely influence women's physical and psychological wellbeing as they mature." 

Wiley-Blackwell (2012, June 21). Eating disorder behaviors and weight concerns are common in women over 50. ScienceDaily. Retrieved October 19, 2012, from http://www.sciencedaily.com­/releases/2012/06/120621070915.htm

For the first time, scientists have tracked the activity, across the lifespan, of an environmentally responsive regulatory mechanism that turns genes on and off in the brain's executive hub. Among key findings of the study by National Institutes of Health scientists: genes implicated in schizophrenia and autism turn out to be members of a select club of genes in which regulatory activity peaks during an environmentally-sensitive critical period in development. The mechanism, called DNA methylation, abruptly switches from off to on within the human brain's prefrontal cortex during this pivotal transition from fetal to postnatal life. As methylation increases, gene expression slows down after birth.

 Epigenetic mechanisms like methylation leave chemical instructions that tell genes what proteins to make - what kind of tissue to produce or what functions to activate. Although not part of our DNA, these instructions are inherited from our parents. But they are also influenced by environmental factors, allowing for change throughout the lifespan.

"Developmental brain disorders may be traceable to altered methylation of genes early in life," explained Barbara Lipska, Ph.D., a scientist in the NIH's National Institute of Mental Health (NIMH) and lead author of the study. "For example, genes that code for the enzymes that carry out methylation have been implicated in schizophrenia. In the prenatal brain, these genes help to shape developing circuitry for learning, memory and other executive functions which become disturbed in the disorders. Our study reveals that methylation in a family of these genes changes dramatically during the transition from fetal to postnatal life - and that this process is influenced by methylation itself, as well as genetic variability. Regulation of these genes may be particularly sensitive to environmental influences during this critical early life period." 

Lipska and colleagues report on the ebb and flow of the human prefrontal cortex's (PFC) epigenome across the lifespan, February 2, 2012, online in the American Journal of Human Genetics. 

"This new study reminds us that genetic sequence is only part of the story of development. Epigenetics links nurture and nature, showing us when and where the environment can influence how the genetic sequence is read," said NIMH director Thomas R. Insel, M.D. 

In a companion study published last October, the NIMH researchers traced expression of gene products in the PFC across the lifespan. The current study instead examined methylation at 27,000 sites within PFC genes that regulate such expression. Both studies examined post-mortem brains of non-psychiatrically impaired individuals ranging in age from two weeks after conception to 80 years old. 

In most cases, when chemicals called methyl groups attach to regulatory regions of genes, they silence them. Usually, the more methylation, the less gene expression. Lipska's team found that the overall level of PFC methylation is low prenatally when gene expression is highest and then switches direction at birth, increasing as gene expression plummets in early childhood. It then levels off as we grow older. But methylation in some genes shows an opposite trajectory. The study found that methylation is strongly influenced by gender, age and genetic variation. 

For example, methylation levels differed between males and females in 85 percent of X chromosome sites examined, which may help to explain sex differences in disorders like autism and schizophrenia. 

Different genes - and subsets of genes - methylate at different ages. Some of the suspect genes found to peak in methylation around birth code for enzymes, called methytransferases, that are over-expressed in people with schizophrenia and bipolar disorder. This process is influenced, in turn, by methylation in other genes, as well as by genetic variation. So genes associated with risk for such psychiatric disorders may influence gene expression through methylation in addition to inherited DNA. 

Scientists worldwide can now mine a newly created online database of PFC lifespan DNA methylation from the study. The data are accessible to qualified researchers at: http://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?study_id=phs000417.v2.p1. BrainCloud, a web browser application developed by NIMH to interrogate the study data, can be downloaded at http://BrainCloud.jhmi.edu.

The severity and impact of bipolar disorder and bipolar-like symptoms are similar across international boundaries, according to a study partially funded by NIMH. The results were published in the March 2011 issue of the Archives of General Psychiatry.

Background

Although several studies report prevalence rates of mental disorders on an international level, the numbers have varied because each study tends to use different methodology and definitions. To remedy this, the World Health Organization's World Mental Health (WMH) survey initiative used consistent data collection methods in 11 countries in the Americas, Europe, Asia, the Middle East and New Zealand. The survey also applied common diagnostic definitions for mental disorders found in the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV).

NIMH researcher Kathleen Merikangas, Ph.D., and colleagues used WMH data to track prevalence rates of three subtypes of bipolar spectrum disorder-bipolar I, bipolar II and bipolar disorder not otherwise specified (BD-NOS). Bipolar I disorder is considered the classic form of the illness, in which a person experiences recurrent episodes of mania and depression. People with bipolar II disorder experience a milder form of mania called hypomania that alternates with depressive episodes. People with BD-NOS, sometimes called subthreshold bipolar disorder, have manic and depressive symptoms as well, but they do not meet strict criteria for any specific type of bipolar disorder noted in the DSM-IV. Yet, BD-NOS can significantly impair those who have it.

Results of the Study

The prevalence rates of bipolar I, bipolar II and BD-NOS were 0.6 percent, 0.4 percent, and 1.4 percent, respectively, with an overall bipolar spectrum rate of 2.4 percent. The United States had the highest prevalence rate of bipolar spectrum (4.4 percent), while India had the lowest rate (0.1 percent). More than half of those with bipolar disorder in adulthood note that their illness began in their adolescent years.

Across all countries studied, 75 percent of those who had bipolar symptoms met criteria for having at least one other disorder. Anxiety disorders, especially panic disorder, were the most common coexisting disorders, followed by behavior disorders and substance use disorders. Patterns of coexisting conditions were similar across countries.

Less than half of those with bipolar symptoms received mental health treatment. In low-income countries, only 25 percent reported having contact with a mental health professional.

Significance

This study provides the first international prevalence data on bipolar disorder using reliable, standardized methodology. It highlights the international impact of bipolar disorder and the need for better recognition and treatment availability. The findings also support the notion that, given its multi-dimensional nature, bipolar disorder may be better characterized as a spectrum disorder.

In addition, because so many people note that their illness began in adolescence - a critical time of life for educational, occupational and social development - early detection, intervention, and possibly prevention of subsequent coexisting disorders and complications should be emphasized.

What's Next

More research is needed to better define the thresholds and boundaries of bipolar symptoms. In addition, further research is needed to better understand why and how the disorder tends to originate in adolescence and persist into adulthood, and how it intersects with coexisting mental disorders.

Reference

Merikangas KR, Jin R, He J, Kessler RC, Lee S, Sampson NA, Viana MC, Andrade LH, Hu C, Karam EG, Mora MEM, Browne MO, Ono Y, Posada-Villa J, Sagar R, Zarkov Z. Prevalence and correlates of bipolar spectrum disorder in the World Mental Health Survey Initiative. Archives of General Psychiatry. March 2011. 68(3):241-251.