Stealing behavior in eating disorders: Characteristics and associated psychopathology

doi:10.1016/S0010-440X(96)90012-7

Comprehensive Psychiatry

Volume 37, Issue 5, September–October 1996, Pages 316-321

https://doi.org/10.1016/S0010-440X(96)90012-7 Get rights and content

Abstract

The objective of the study was to identify, in detail, the characteristics of stealing behavior and eventual associated psychopathology in a large group of eating-disordered patients. A sample of 155 females meeting DSM-III-R criteria for anorexia nervosa (AN) or bulimia nervosa BN completed the Stealing Behavior Questionnaire (SBQ) and other self-reporting measures, including the Dissociation Questionnaire (DIS-Q). In a subgroup of 80 patients, the SBQ was repeated after 2 months' treatment. A total of 47.1% of the patients admitted a history of stealing; compared with restricting AN (35.3%), the proportion of stealers was higher in binge-eating/purging AN (54.8%) and BN (48.7%). The number of patients admitting to stealing did not change after 2 months of intensive treatment. Compared with other patients, stealers did not differ in signs of general psychopathology, but showed more abnormal scores on the DIS-Q (especially “loss of control”). The patients whose stealing was clearly related to their eating disorder did not show a distinct pattern of eating pathology or associated psychopathology. If studied in a systematic way, stealing appears to be more frequent than expected; with its relationship to bulimic tendencies and “loss of control,” it might indicate a more severe (stage of an) eating disorder and, as such, deserves more attention from researchers and clinicians than the scarce literature is reflecting up to now.

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Cited by (29)

Latent class analysis of eating and impulsive behavioral symptoms in Taiwanese women with bulimia nervosa
2012, Journal of Psychosomatic Research
Citation Excerpt :
The presence of stealing was ascertained by a history of at least one instance in the past. Stealing was defined as the taking without permission of any object, regardless of value, that did not belong to the taker [52]. Excessive buying was defined as “have ever been bothered by spending much more money than you can afford”.
The implications of impulsivity in its relationship with binge-eating or purging behaviors remain unclear. This study examined the patterns of eating behaviors and co-morbid impulsive behaviors in individuals with bulimia nervosa n optimally homogeneous classes using latent class analysis (LCA).
All participants (n=180) were asked to complete a series of self-reported inventories of impulsive behaviors and other psychological measures. Information regarding the lifetime presence of symptoms of eating disorder was assessed by clinical interviews. LCA was conducted using eating disorder symptoms, impulsive behaviors, and the number of purging methods.
Three latent classes of bulimic women were identified. These were women who exhibited relatively higher rates of purging, symptoms of impulsive behavior, and multiple purging methods (17.8%), women who used no more than one purging method with a low occurrence of impulsive behavior (41.7%), and women who showed higher rates of purging behaviors and the use of multiple purging methods with a low rate of impulsive behavior (41.7%). The impulsive sub-group had comparable severity of eating-related measures, frequency of binge-eating, and higher levels of general psychopathology than that of the other two sub-groups.
This study provides empirical support for the existence of an impulsive subgroup with distinctive features among a non-Western group of BN patients. This study also suggests that mechanisms other than impulse dysregulation may exist for the development of binge-eating and purging behaviors in bulimia nervosa patients, or the mechanisms contributing to binge-eating and impulsive behaviors may be different.
Impulsive behaviors in female patients with eating disorders in a university hospital in northern Taiwan
2011, Journal of the Formosan Medical Association
Citation Excerpt :
There were no significant differences in depression, anxiety, phobia, or hostility subscale scores or GSI between AN-BP, BN, or EDNOS patients and psychiatric controls, but the scores for these subscales were significantly lower in patients with AN-R, compared with controls. Table 22,7,8,10–17,20 shows the prevalence of different impulsive behaviors among subgroups of ED patients and psychiatric controls. More than 60% of ED patients and psychiatric controls had at least one impulsive behavior.
Eating disorders (EDs) are often associated with various impulsive behaviors. This study investigated the prevalence of impulsive behaviors in ED patients in Taiwan. Three hundred sixteen female outpatients with ED and 142 psychiatric controls were recruited. All participants completed self-administered questionnaires assessing lifetime presence of impulsive behaviors, including suicide, self-injury, stealing, alcohol use, illicit drug use, excessive spending, sexual promiscuity, and general psychopathology. More than 60% of the ED patients had at least one impulsive behavior. The most common impulsive behaviors among ED patients were excessive spending (34.9%), deliberate self-harm (32.7%), and stealing (26.3%). However, there were no significant differences in prevalences of any impulsive behaviors between ED patients and psychiatric controls. Clinicians should routinely assess and treat impulsive behaviors in female psychiatric patients with negative affectivity, regardless of the presence of ED, to help prevent potential adverse outcomes related to impulsive behaviors.
Impulse control disorders in eating disorders: clinical and therapeutic implications
2006, Comprehensive Psychiatry
Few studies have explored impulse control disorders (ICDs) in women with bulimia nervosa (BN). We explored the prevalence of lifetime ICDs in women with BN, compared the severity of eating disorder symptoms in women with BN with and without ICD, and compared their personality profiles to females with one form of ICD, namely, pathologic gambling.
A total sample of 269 female patients consecutively admitted to our unit participated in the current study (173 BN without comorbid ICD [BN − ICD]; 54 BN with comorbid ICD [BN + ICD]; and 42 pathologic gamblers [PG]). All participants were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.
Assessment measures included the Symptom Checklist–90 revised and the Temperament and Character Inventory–revised, as well as a number of other clinical and psychopathologic indices.
In BN, the observed lifetime prevalence of ICD was 23.8%. Lifetime compulsive buying (17.6%) and intermittent explosive disorder (13.2%) were the most frequently reported ICD. Bulimia nervosa subtype was not significantly associated with lifetime ICD (P = .051) or with ICD subtype (P = .253). After using multinomial regression models, we observed that BN + ICD and PG showed the highest scores on novelty seeking (P < .0001). But BN + ICD women had the lowest scores on self-directedness (P < .03) and higher scores on general psychopathology (P < .01) and drug abuse (P < .01).
Individuals with BN + lifetime ICD presented more extreme personality profiles, especially on novelty seeking and impulsivity, and general psychopathology than individuals with BN without ICD. On some personality traits, those BN + ICD more closely resembled individuals with PG than those with BN without ICD.
From Malthus to motive: How the HPA axis engineers the phenotype, yoking needs to wants
2006, Progress in Neurobiology
The hypothalamo–pituitary–adrenal (HPA) axis is the critical mediator of the vertebrate stress response system, responding to environmental stressors by maintaining internal homeostasis and coupling the needs of the body to the wants of the mind. The HPA axis has numerous complex drivers and highly flexible operating characterisitics. Major drivers include two circadian drivers, two extra-hypothalamic networks controlling top-down (psychogenic) and bottom-up (systemic) threats, and two intra-hypothalamic networks coordinating behavioral, autonomic, and neuroendocrine outflows. These various networks jointly and flexibly control HPA axis output of periodic (oscillatory) functions and a range of adventitious systemic or psychological threats, including predictable daily cycles of energy flow, actual metabolic deficits over many time scales, predicted metabolic deficits, and the state-dependent management of post-prandial responses to feeding. Evidence is provided that reparation of metabolic derangement by either food or glucocorticoids results in a metabolic signal that inhibits HPA activity. In short, the HPA axis is intimately involved in managing and remodeling peripheral energy fluxes, which appear to provide an unidentified metabolic inhibitory feedback signal to the HPA axis via glucocorticoids. In a complementary and perhaps a less appreciated role, adrenocortical hormones also act on brain to provide not only feedback, but feedforward control over the HPA axis itself and its various drivers, as well as coordinating behavioral and autonomic outflows, and mounting central incentive and memorial networks that are adaptive in both appetitive and aversive motivational modes. By centrally remodeling the phenotype, the HPA axis provides ballistic and predictive control over motor outflows relevant to the type of stressor. Evidence is examined concerning the global hypothesis that the HPA axis comprehensively induces integrative phenotypic plasticity, thus remodeling the body and its governor, the brain, to yoke the needs of the body to the wants of the mind. Adverse side effects of this yoking under conditions of glucocorticoid excess are discussed.
Multi-impulsivity of Japanese patients with eating disorders: Primary and secondary impulsivity
2000, Psychiatry Research
Several studies have noted that multi-impulsive bulimia nervosa tends to be refractory to treatment. However, it is not known whether these impulsivities are an expression of more fundamental psychopathology or simply the consequence of chaotic eating behaviors. Studies of the temporal relationship between the onset of eating disorder and the occurrence of impulsive behaviors will facilitate a better understanding of these issues. Subjects consisted of 60 patients with anorexia nervosa restricting type (AN-R), 62 patients with anorexia nervosa binge-eating/purging type (AN-BP), 114 patients with bulimia nervosa purging type (BN) and 66 control subjects. Impulsive behaviors and childhood traumatic experiences were assessed by self-report questionnaire. Multi-impulsivity (defined by at least three of the following: heavy regular alcohol drinking; suicide attempt; self-mutilation; repeated shoplifting of items other than food; sexual relationships with persons not well known to the subject) was found in 2% of AN-R, 11% of AN-BP, 18% of BN and 2% of control subjects. Eighty percent of BN patients with multi-impulsivity had a history of suicide attempts or self-mutilation history prior to the onset of bulimia nervosa. In BN patients, there tended to be a relationship between childhood parental loss or borderline personality disorder and multi-impulsivity. In conclusion, primary impulsivity (chronological prior occurrence of impulsive behaviors) does exist even in a very different culture, although the number of patients of this type is very limited.
The Prevalence of Impulse Control Disorders and Behavioral Addictions in Eating Disorders: A Systematic Review and Meta-Analysis
2022, Frontiers in Psychiatry

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Stealing behavior in eating disorders: Characteristics and associated psychopathology

Abstract

J Psychiatr Res

Gen Hosp Psychiatry

J Am Acad Child Adolesc Psychiatry

Compr Psychiatry

The heterogeneity of stealing behaviors in Chinese patients with anorexia nervosa in Hong Kong

J New Ment Dis

Bulimia and kleptomania: psychodynamics of compulsive eating and stealing

Do bulimics really steal?

Br Rev Bulimia Anorexia New

Kleptomania: clinical characteristics and associated psychopathology

Psychol Med

Kleptomania: a report of 20 cases

Am J Psychiatry

Compulsive buying: descriptive characteristics and psychiatric comorbidity

J Clin Psychiatry

Denial of illness and the use of self-reporting measures in anorexia nervosa

Int J Eating Disord