Working to Better Understand the Effects of Self-Starvation

A new questionnaire is designed to identify compulsive food restriction in anorexia nervosa.

Although self-starvation is the central behavior in anorexia nervosa (AN), that behavior itself has not always generated attention from researchers. The compulsive behavior seen in patients with AN has been compared to compulsive drug-seeking behavior, and the serious consequences and lack of control have clear similarities. Two psychiatrists at Oxford University recently developed a new measure of compulsive self-starvation in AN (Eat Behav. 2015; 17:10). They theorized that using the concept of ‘dependence’ on starvation might be useful to understand compulsive behaviors in eating disorders such as AN.

The Self-Starvation Scale

The scale was developed as an offshoot of the Yale Food Addiction Scale, or YFAS (Appetite. 2009; 52:430), and was redesigned to capture the compulsive element of self-starvation among people with eating disorders and specifically those with AN. The questionnaire includes 17 items as “I have restricted my food intake so much that I have concentrated on this instead of doing other activities.”

Three groups of patients were studied with the Self-Starvation Scale: those with acute AN, (n=41), weight-restored individuals with a history of AN (n=18), and individuals who were fully recovered from AN (n=19). Using the Internet, Drs. Lauren R. Godier and Rebecca J. Park recruited 126 healthy individuals with no prior history of eating disorders and who were between 18 and 65 years of age. A second group included 78 participants between 18 and 65 years of age.

In addition to the Self-Starvation Scale, the researchers used a set of online questionnaires, including the Eating Disorders Examination Questionnaire (EDE-Q) and the Clinical Impairment Assessment, the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder Assessment-7. The mirror image concept of serotonin addiction-‘food addiction’ was measured with the YFAS. Impulsivity, excessive exercise, and substance abuse symptoms were also measured. Demographic data, including gender, age, weight, and occupation, were gathered, and self-reported height and weight, were gathered to calculate body mass index.

‘Starvation dependence’ may have clinical importance

The scale showed good reliability and criterion-related results. With the scale, the authors were able to predict eating disorders symptoms, use of compulsive exercise, and depression and anxiety in all study participants. The scale was particularly good for predicting these symptoms when the results were compared with the restraint subscale of the EDE-Q. That subscale centers on the rigid control of eating behavior and thus the results are likely to reflect the compulsive and rule-driven nature of self-starvation measured by the SS. The predictive ability was especially good in the group of patients with acute AN. The authors feel this suggests that the test may be particularly useful in clinical samples, in which extreme self-starvation behaviors are likely to be more evident and of potential importance in maintaining the illness. Thus, the concept of ‘starvation dependence’ may be of clinical and theoretical importance among people with eating disorders.