Comorbidity in Anorexic Adolescents: Assessment Through ASEBA System and Semistructured Interviews

Abstract

A literature review on comorbidity in adolescent Anorexia Nervosa (AN) reveals a high rate of depressive and anxiety disorders broadly termed as internalizing conditions. The association between Axis II personality disorders (PD) and ED is also frequent with a prevalence of cluster C and B. Consequently, the accurate assessment of comorbidity is a key aspect in adolescent eating disorders to overcome the tendency to deny anorexic behavior as well as its comorbidity. The presence of comorbidity in ED is usually assessed with structured or semistructured clinical interviews, self-report questionnaires, and checklists. The assessment protocol used in the Eating Disorder Program at the Stella Maris Scientific Institute was elaborated by considering the type of patients and the clinical features of eating disorders at a young age: the Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS) for ED diagnosis and Axis I comorbidity; the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) for Axis II comorbidity; the Achenbach System of Empirically Based Assessment (ASEBA), especially the Child Behavior CheckList (CBCL) and Youth Self Report (YSR) for general psychopathology. In particular, a high percentage of our patients were found in the internalizing clinical range both at CBCL and YSR when using the ASEBA; these data were confirmed through Kiddie-SADS diagnosis with a prevalence of depressive disorders. High PD rates were found in our adolescent samples when using the SCID-II, similar to those of recent studies with a prevalence of cluster B and obsessive-compulsive personality disorder (OCPD). This accompanying comorbidity plays an important role in the outcome of ED and in the planning of therapeutic interventions.