Eating Disorders In Adolescents Research Articles

Assessment of Nutritional Status and Eating Disorders in Female Adolescents With Fibromyalgia

To assess eating disorders, nutritional status, body composition, and food intake in adolescents presenting with fibromyalgia. In a cross-sectional study, we evaluated the nutritional status (z score of body mass index [ZBMI]), waist circumference, body fat percentage by bioelectrical impedance analysis, symptoms of disordered eating, and possible eating disorders (Kids' Eating Disorders Survey [KEDS]) of 23 female adolescents with fibromyalgia and 23 matched healthy control subjects. Median age for both groups was 15 years. In the fibromyalgia group, the median time for diagnosis was 13.5 months. We did not observe a statistically significant difference between the control and fibromyalgia groups in relation to ZBMI, fat mass percentage, food intake, and symptoms of disordered eating (KEDS). In the fibromyalgia group, there was a significant correlation between fat mass percentage and the total KEDS score (r = .587, p = .003); the same correlation was observed for ZBMI (r = .0778, p < .001). This study verified an absence of nutritional and eating disorders in adolescents recently diagnosed with fibromyalgia that, in addition to the correlation between adiposity indexes and KEDS total score, emphasizes the importance of nutritional and body composition assessment, allowing an early and adequate nutritional intervention.

Developing an Evidence-Based Classification of Eating Disorders: Scientific Findings for DSM-5edited by Striegel-MooreRuth H., Ph.D., WonderlichStephen A., Ph.D., WalshB. Timothy, M.D., and MitchellJames E., M.D. Washington, DC, American Psychiatric Publishing, 2011, 429 pp., $65.00.

Developing an Evidence-Based Classification of Eating Disorders: Scientific Findings for DSM-5edited by Striegel-MooreRuth H., Ph.D., WonderlichStephen A., Ph.D., WalshB. Timothy, M.D., and MitchellJames E., M.D. Washington, DC, American Psychiatric Publishing, 2011, 429 pp., $65.00.

Observing Snack Time at a Psychoanalytic Parent-Toddler Group: Affect Regulation and Therapeutic Possibilities*

Nutritional, psychological, and psychoanalytic studies of toddler eating have focussed on food intake and the possible links to childhood and adolescent eating disorders, generally based on mothers' self-reports. The present study was based on video recordings of snack time at a psychoanalytic toddler group. The qualitative methodology employed involved line-by-line thematic extraction based on Interpretative Phenomenological Analysis. Extracts of observations are presented with accompanying explanatory text. These extracts are discussed in relation to affect regulation and psychopathology. In addition, the ways in which group leaders intervene therapeutically at snack time are described, and a broader analysis of the affective stages of eating is put forward.

Neuroimaging in Eating Disorders: Coming of Age

Neuroimaging in Eating Disorders: Coming of Age

Review of Electrocardiogram (ECG) Findings in Patients with Restrictive Eating Disorders Attending a Regional Child and Adolescent Eating Disorder Service in 2010

Background/aims: Prolonged corrected QT interval (QTc) has been widely reported in patients with restrictive eating disorders, and is known to be associated with significant morbidity and mortality. We sought to identify the incidence of prolonged QTc and cardiac morbidity in all patients with restrictive eating disorders referred to a tertiary child and adolescent mental health eating disorder service in 2010.

A Review of the Role of Psychiatrists and Pediatricians in Outpatient Treatment of Adolescents with Anorexia and Bulimia Nervosa

Eating disorders frequently have their onset in adolescence. This is problematic as Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Eating Disorder Not Otherwise Specified (EDNOS) often present with serious psychiatric and medical sequelae that can affect an adolescents physical and emotional development. It is well documented that complications from eating disorders in adolescence can result in long-term health consequences, rendering effective psychiatric and medical treatments a necessity. To combat the medical consequences associated with eating disorders in adolescents, pediatricians must identify, treat, and monitor medical complications. Pediatricians are also responsible for assessing the need for hospitalization due to medical instability. Some advances have been made regarding psychopharmacological treatments for eating disorders. For example, antidepressant medications, such as SSRIs, have demonstrated efficacy in the treatment of adults with BN. The true effectiveness of these medications in adolescent populations remains unknown. A multidisciplinary team approach is a common treatment model in outpatient practice, but further research is required to investigate how to facilitate the collaboration of psychiatric and medical professionals. The majority of psychiatric and medical trials for eating disorder patients have involved adult participants, and most studies have investigated either psychiatric or medical treatments for eating disorders. In this review, we will add to the current literature by focusing on both psychiatric and medical treatments for eating disorders, with particular emphasis on studies conducted with adolescents.

An Eleven Site National Quality Improvement Evaluation of Adolescent Medicine-Based Eating Disorder Programs: Predictors of Weight Outcomes at One Year and Risk Adjustment Analyses

This quality improvement project collected and analyzed short-term weight gain data for patients with restrictive eating disorders (EDs) treated in outpatient adolescent medicine-based ED programs nationally. Data on presentation and treatment of low-weight ED patients aged 9-21 years presenting in 2006 were retrospectively collected from 11 independent ED programs at intake and at 1-year follow-up. Low-weight was defined as < 90% median body weight (MBW) which is specific to age. Treatment components at each program were analyzed. Risk adjustment was performed for weight gain at 1 year for each site, accounting for clinical variables identified as significant in bivariate analyses. The sites contained 6-51 patients per site (total N = 267); the mean age was 14.1-17.1 years; duration of illness before intake was 5.7-18.6 months; % MBW at intake was 77.5-83.0; and % MBW at follow-up was 88.8-93.8. In general, 40%-63% of low weight ED subjects reached ≥90% MBW at 1-year follow-up. At intake, patients with higher % MBW (p = .0002) and shorter duration of illness (p = .01) were more likely to be ≥90% MBW at follow-up. Risk-adjusted odds ratios controlled for % MBW and duration of illness were .8 (.5, 1.4)-1.3 (.3, 3.8), with no significant differences among sites. A total of 11 ED programs successfully compared quality improvement data. Shorter duration of illness before intake and higher % MBW predicted improved weight outcomes at 1 year. After adjusting for risk factors, program outcomes did not differ significantly. All adolescent medicine-based ED programs were effective in assisting patients to gain weight.

Psychometric evaluation of the compulsive exercise test (CET) in an adolescent population: Links with eating psychopathology

Compulsive exercise describes a rigid, driven urge to exercise that has been reported in different populations, including eating disorder patients. This compulsion can develop at an early age and yet the measurement of compulsive exercise in adolescents is limited by inappropriate assessment techniques. This study aimed to psychometrically evaluate the Compulsive Exercise Test (CET) in a sample of adolescents. The sample consisted of 1012 adolescents aged 12-14 years old, who completed the CET, the Commitment to Exercise Scale (CES), and selected subscales from the Eating Disorder Inventory-2 (EDI-2). Results confirmed the original five-factor solution of the CET. The CET's concurrent validity with the CES, as well as the convergent validity with the EDI-2, was established. The CET was not strongly related to exercise frequency. The CET appears to be valid and reliable for use with adolescents. Replication with an adolescent clinical eating disorder sample is now required.

Predictive effects of mother and peer influences on increases in adolescent eating disorder risk factors and symptoms: A 3-year longitudinal study

To investigate the relation of maternal and peer attitudes and behaviors to changes in eating disorder risk factors and symptoms in adolescent females. We tested whether maternal and peer eating attitudes, behaviors, and deficits in social support at baseline predicted subsequent increases in eating disorder risk factors and symptoms among 483 late adolescent females followed over 3 years. Data provide partial support for hypotheses, as eating disorder risk factors and symptoms increased over time and maternal thin ideal internalization significantly predicted a future increases in adolescent bulimic symptoms. There were no significant predictors of adolescent thin ideal internalization or body dissatisfaction. Findings only partially support the hypothesis that unhealthy attitudes and behaviors of mothers increase risk for eating disorder symptoms in their late adolescent daughters. These results underscore why eating disorder prevention programs should be based on risk factor research that has used prospective and rigorous designs.

Psychometric Evaluation of SAFA P Test for Eating Disorders in Adolescents: Comparative Validation with EDI‐2

This study evaluates the psychometric properties of self-administered psychiatric scale for children and adolescents with psychogenic eating disorders (SAFA P)--a brief self-report designed to screen and assess eating disorders (ED) in children and adolescents. Although SAFA P belongs to a broad battery of tests (SAFA) that explores different psychiatric conditions, it has not undergone appropriate validation until now. We administered SAFA P and Eating Disorder Inventory 2 (EDI-2) to 87 ED patients, with an average age of 15.4 ± 1.6 years. The internal reliability of SAFA P is good (Cronbach α = .776). Convergent validity with EDI-2 was assessed: both SAFA P subscale P1 (p < .005) and EDI-2 subscale bulimia (p < .001) showed a statistically significant difference among the three diagnostic categories (anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified). Sensibility and specificity range from 62 to 91%, depending on the subscales. McNemar's test did not reveal statistically significant differences in assessing the concordance of the two measures. Statistically significant correlations were found between specific couples of subscales (p < .001). Cross-validation with EDI-2 showed good results. SAFA P may be an alternative, useful and reliable instrument for assessing cursory ED in childhood and adolescence.

70. Eight Years of Experience in a Hospital-Based Eating Disorders Program

Eating disorders in adolescents are serious conditions that can result in physical, emotional, and behavioral complications, including premature death. Our hospital-based program at Rhode Island Hospital in Providence Rhode Island includes outpatient, partial (day) hospitalization, and inpatient levels of care. We examine our experience with this program.

SLaM launches treatment programme for adolescent eating disorders

Laura Crowden outlines the recently-launched intensive treatment programme at South London and Maudsley NHS Foundation Trust (SLaM) for adolescents with eating disorders

Body image dissatisfaction and eating symptoms in mothers of adolescents with eating disorders

The purpose of the present study was to assess body dissatisfaction and eating symptoms in mothers of eating disorder (ED) female patients and to compare results with those of a control group. The case group consisted of 35 mothers of female adolescents (aged between 10 and 17 yrs) diagnosed with ED who attended the Interdisciplinary Project for Care, Teaching and Research on Eating Disorders in Childhood and Adolescence (PROTAD) at Clínicas Hospital Institute of Psychiatry of the Universidade de São Paulo Medical School. Demographic and socioeconomic data were collected. Eating symptoms were assessed using the Eating Attitudes Test (EAT-26) and body image was assessed by the Body Image Questionnaire (BSQ) and Stunkard Figure Rating Scale (FRS). The case group was compared to a control group consisting of 35 mothers of female adolescents (between 10 and 17 years) who attended a private school in the city of São Paulo, southeastern Brazil. With regard to EAT, BSQ and FRS scores, we found no statistically significant differences between the two groups. However, we found a positive correlation between BMI and BSQ scores in the control group (but not in the case group) and a positive correlation between EAT and FRS scores in the case group (but not in the control group). It appears to be advantageous to assess body image by combining more than one scale to evaluate additional components of the construct.

Effectiveness of self‐esteem and social skills group therapy in adolescent eating disorder patients attending a day hospital treatment programme

To evaluate self-esteem and social skills in adolescent eating disorder patients before and after specific group therapy as part of a Day Hospital Programme. One hundred and sixty adolescent eating disorder patients, classified as anorexia nervosa and related disorders (AN-rd) (N = 116) or bulimia nervosa and related disorders (BN-rd) (N = 44) received structured group therapy for developing self-esteem and social skills. BN-rd patients had poorer perceptions of some self-esteem and social skills variables. After group therapy, both groups presented significant improvements in their perceptions of physical appearance, their self-concept related to weight and shape and to others, happiness and satisfaction, social withdrawal and leadership. BN-rd patients presented more changes on many of the variables. Specific self-esteem and social skills group therapy in patients with eating disorders can be useful in improving certain core features.

Assessment Measures for Child and Adolescent Eating Disorders: A Review.

Several diagnostic and screening instruments are available for child and adolescent eating disorders. However, limitations have been identified in many of these. We review the most frequently used assessment measures for eating disorders in children and adolescents. Several of the available instruments have significant limitations, although relevant strengths are identified. Limitations in the current available instruments for child and adolescent eating disorders should be addressed in order to improve recognition and treatment.

Effects of an overweight and obesity intervention on adolescent eating disorder risk profile

Effects of an overweight and obesity intervention on adolescent eating disorder risk profile

The Ontario experience of involuntary treatment of pediatric patients with eating disorders

In this paper, the authors (two clinicians with specialized practices in child and adolescent eating disorders and a lawyer who practices health law in Ontario, Canada) review pertinent aspects of clinical capacity assessment, with elaboration of the specific unique and complex issues which shape that assessment in children and adolescents with eating disorders. The relevant Ontario legislation and institutional framework governing consent and capacity in children and adolescents are reviewed. The literature on involuntary treatment and consent and capacity in patients with eating disorders is reviewed. Specific cases involving child and adolescent patients with eating disorders that have been heard by the Ontario Consent and Capacity Board (OCCB) in the past decade are discussed in order to elucidate the Board's views of consent and capacity in this vulnerable and challenging patient population. Strategies to support clinicians' therapeutic alliances with their patients while both are going through what can be a lengthy and potentially adversarial-seeming legal process are also discussed.

Classification of eating disturbance in children and adolescents: Proposed changes for the DSM‐V

Childhood and adolescence are critical periods of neural development and physical growth. The malnutrition and related medical complications resulting from eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth than during other age periods. The consensus opinion of an international workgroup of experts on the diagnosis and treatment of child and adolescent eating disorders is that (a) lower and more developmentally sensitive thresholds of symptom severity (e.g. lower frequency of purging behaviours, significant deviations from growth curves as indicators of clinical severity) be used as diagnostic boundaries for children and adolescents, (b) behavioural indicators of psychological features of eating disorders be considered even in the absence of direct self-report of such symptoms and (c) multiple informants (e.g. parents) be used to ascertain symptom profiles. Collectively, these recommendations will permit earlier identification and intervention to prevent the exacerbation of eating disorder symptoms.

Drug Prescribing in Child and Adolescent Eating Disorder Services

Psychotropic drugs are not recommended for child and adolescent eating disorders, though they are used empirically for symptomatic treatment and co-morbid conditions. Little is known about rates of prescribing or the beneficial and adverse effects. To ascertain rates and outcomes of psychotropic drug prescribing in child and adolescent eating disorder services. Retrospective case note study of eating disorder cases (n = 308), seen in one year in seven specialist UK services, covering indications, response to treatment, beneficial and adverse effects. Drugs were prescribed for 27%, (mainly anorexia nervosa), 12% before referral to specialist services. The most commonly prescribed drugs were fluoxetine and olanzapine, but 26 different drugs were used. The most common indications were depression, anxiety and 'pseudo-psychotic' concerns about weight. Drugs were generally well tolerated, but their effectiveness was uncertain. Non-specialists commonly prescribe psychotropic medication to this vulnerable group without reference to specialist services. Specialists prescribe regularly on empirical grounds, without apparent undue consequences, though these may be under-reported. A prospective clinical trial would further clarify risks and benefits.

Is There a Role for Occupational Therapy within a Specialist Child and Adolescent Mental Health Eating Disorder Service?

In Northern Ireland, only two occupational therapists work within the specialist field of child and adolescent mental health (CAMH). This is despite recommendations made by the Bamford Review of Mental Health and Learning Disability (Northern Ireland) that occupational therapy should be a core element of CAMH provision. The College of Occupational Therapists has urged practitioners to challenge inequalities in health and social care provision and to use occupational language to reinforce the relationship between occupation, recovery and wellbeing. This opinion piece highlights occupational therapy core skills and occupational therapy frames of reference or modalities, underlining the application of both to eating disorders. The treatment models discussed are the Model of Human Occupation, the Canadian Model of Occupational Performance and sensory integration. Evidence reinforces that the models discussed are applicable, appropriate and valuable when treating children and adolescents with an eating disorder. It is argued that the valuable and unique role of occupational therapy must be recognised by health and social care commissioners and CAMH providers and be vocalised by occupational therapists. CAMH teams are advised to embrace the unique skills that occupational therapists have to offer children and adolescents with eating disorders in order to ensure that clients receive truly multidisciplinary and client-centred evidence-based services.