Eating Disorders In Adolescents Research Articles

P02-298 - Clinical course of patients with anorexia nervosa in an in-patient adolescent eating disorder unit

IntroductionThis study examined adolescents with anorexia nervosa admitted to a tertiary referral unit in Dublin over a 3 year period.The aims of the study were to assess changes if any in patient clinical and laboratory parameters specifically weight change, body mass index (BMI), cardiovascular, haematological and biochemical measurements over the course of in-patient stay.MethodsHospital computerized databases and clinical case notes were examined for each patient.Results were compared with Royal College of Psychiatrists (RCP) and National Institute for Clinical Evidence (NICE) guidelines for treatment of in-patients with anorexia nervosa.ResultsThere were at total of 42 admissions over the 3 years.7 males and 35 females were admitted.Median length of admission was 88 days. Female patients gained on average 7.2 kilograms during their admission.The average female BMI on admission was 14.9 on admission and 17.6 on discharge. 82.3% of female admissions had blood abnormalities, the most common being anaemia and hypokalaemia.45.7% of female patients had an abnormal electrocariograph.25% of female patients required transfer out during their admission for medical review.ConclusionThe eating disorder unit fulfilled the RCP and NICE guidelines for 97.6% of patients in terms of blood results performed and 92.8% in terms of electrocardiographs performed.The average BMI on discharge for both males and females was above 17.5 which is regarded as the normal cut off point for anorexia nervosa.The importance of this study despite its limited sample size is that it is the first study of investigations and outcomes in an Irish in-patient adolescent eating disorder sample.

Understanding Body Image in African American and Caucasian First-Graders: A Partnership with the YMCA

Understanding Body Image in African American and Caucasian First-Graders: A Partnership with the YMCA Dawnavan S. Davis, Tracy Sbrocco, and Janice Williams What Is the Purpose of the Study? To examine parental influence on body image in African American and Caucasian first-graders through a CBPR partnership with the YMCA of Metropolitan Washington. What Is the Problem? Research suggests body dissatisfaction can develop by first-grade or 6 years of age, and may lead to eating disorders in adolescents and adulthood. Such pathology has been found to lead to severe dysfunction and even mortality. Parents seem to have significant influence on child body image. Few studies have examined the relationship between parental body image factors on child body image among this population using a community-based participatory research (CBPR) approach. What Are the Findings? • Significant body dissatisfaction among first-graders was found. • Only 12.1% of first-graders were satisfied with their bodies. • Of the 38 children of normal weight, 89.5% were dissatisfied with their current body size. • Relationships did emerge between child and parent body image such that as parents’ body dissatisfaction increased, so did their child’s degree of dissatisfaction. • The CBPR approach was critical to informing health-related programs across YMCA sites. Who Should Care Most? • Child psychologists, pediatricians, and other health professionals providing clinical services to young children. • Health educators. • Youth-centered community-based organizations (CBOs). • Academic researchers. • Parents of young children. Recommendation for Action • Increased research funding opportunities to explore body dissatisfaction among young children and its associated clinical implications. • Educational and training programs for pediatric health providers about the development and contributing factors of body image disturbance in young children. • Development of community-level programs and interventions targeting the promotion of positive body image among children and parents. • Community-level education programs about child body image pathology for health educators and CBOs servicing youth and families. [End Page 271] Dawnavan S. Davis University of Chicago, Department of Medicine; Tracy Sbrocco The Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology; Janice Williams The YMCA of Metropolitan Washington Copyright © 2009 The Johns Hopkins University Press

Adolescent eating disorders: treatment and response in a naturalistic study

This naturalistic study investigated the treatment and outcome of adolescents with eating disorders (EDs) in the community. Clinicians from a practice-research network provided data on ED symptoms, global functioning, comorbidity, treatment, and outcome for 120 adolescents with EDs. ED "not otherwise specified" was the most common ED diagnosed. After an average of 8 months of treatment, about one third of patients had recovered, with patients with anorexia nervosa showing the most improvement. Clinicians utilized a range of psychotherapy interventions and two thirds of the patients had received adjunct psychoactive medication. Although CBT showed the strongest association with outcome in a subsample characterized by poor relational/personality functioning, dynamic therapy was associated with better global outcome in the overall sample.

Advances in Psychotherapy for Children and Adolescents with Eating Disorders

There is a significant lag in the development of evidence based approaches for eating disorders in children and adolescents despite the fact that these disorders typically onset during these developmental periods. Available studies suggest that psychotherapy is the best available approach to these disorders. Specific studies support the use of family based interventions, adolescent focused individual therapy, and developmentally adapted cognitive behavioral therapy in this age group. The current report summarizes the available evidence supportive of each of these treatment modalities, as well as, provides a description of the rationale and principle therapeutic targets and intervention types. Future directions in psychotherapy research in child and adolescent eating disorders are discussed.

Reduced bone mineral density in adult women diagnosed with menstrual disorders during adolescence

To evaluate the long-term effects on bone mineral density (BMD) in women diagnosed with menstrual disorders in their adolescence. Prospective follow-up study six years after the initial investigation. A youth clinic that is part of the school health system in Stockholm. Eighty-seven women diagnosed with secondary amenorrhea or oligomenorrhea in adolescence. Subjects underwent gynecological examination, evaluation of eating behavior and physical activity. Whole body Dual Energy X-ray Absorptiometry was used for measurement of BMD. BMD. The overall frequency of osteopenia/osteoporosis was 52%, and three girls had osteoporosis. Women with previous secondary amenorrhea had significantly lower BMD in the pelvis and lumbar spine than those with previous oligomenorrhea. The strongest predictor of low BMD was a restrictive eating disorder in adolescence and the most important counteraction was high physical activity at follow-up and a body mass index (BMI) > or = 22. Persistent menstrual dysfunction at follow-up was associated with polycystic ovary syndrome and lower frequency of osteopenia. This clinical follow-up study has demonstrated a high frequency of osteopenia in women diagnosed with menstrual disorders in adolescence. Previous anorectic behavior was the strongest negative predictor of BMD. It is important to pay attention to an underlying eating disorder in young women with menstrual dysfunction in order to promote bone health.

Influence of parent’s eating attitudes on eating disorders in school adolescents

To investigate the relationship between parents' cognitive and behavioural dimensions and the risk of eating disorders (ED) in non-clinical adolescents. From an initial sample of 1,336 boys and girls with a mean age of 11.37, a total of 258 subjects were selected either as being at risk of ED or as controls. These subjects and their parents comprised the sample at T1 and were followed-up 2 years later (T2). We examined disordered eating attitudes, body dissatisfaction (BD), body mass index (BMI) and ED diagnoses in the adolescents at two points in time. We also used the Eating Disorder Inventory-2 to examine the disordered eating attitudes of their parents at T1. The mother's BD, drive for thinness (DT), ineffectiveness and interoceptive awareness, and the father's DT and perfectionism were related to long-term ED. Logistic regression showed that predictors of ED were being female, mother's DT and social insecurity, and adolescent's BD. The BMI was not a predictor in this model. Father's perfectionism was a risk factor of ED. Specific cognitive and behavioural dimensions of ED in both parents can influence the development of an ED in early adolescents. This should be taken into account in the prevention and family oriented treatment of ED.

Is There a Relationship Between Parental Self-Reported Psychopathology and Symptom Severity in Adolescents with Anorexia Nervosa?

The current study aimed to screen for indications of psychopathology displayed by the parents of adolescents diagnosed with Anorexia Nervosa (AN), and examine the relationship between severity of adolescent eating disorder symptoms and parental psychopathology. Sixty female adolescents diagnosed with DSM-IV-TR AN (restricting-type and binge-purge-type) were administered the Eating Disorder Examination (EDE) and parents completed the Symptom Checklist 90-Revised (SCL-90-R). As compared to established non-patient norms, both fathers and mothers of adolescents with AN reported greater levels of obsessive compulsive behaviors, hostility, depression, and anxiety as measured by the SCL-90-R. In addition, duration of AN was positively associated with hostility scores in fathers, and global EDE scores were associated with hostility in mothers. While parental scores on the SCL-90 were elevated as compared to community samples, results of this study do not support a direct influence of parental psychopathology on symptom severity of adolescent AN. Increasing rates of hostility scores in parents with increased duration of AN may represent either a response to the presence of the disorder or be a maintaining factor for AN.

Identificação de distúrbios da imagem corporal e comportamentos favoráveis ao desenvolvimento da bulimia nervosa em adolescentes de uma Escola Pública do Ensino Médio de Maringá, Estado do Paraná

Conscious of the importance of studying eating disorders in adolescents, this work identified the onset of body image disorders and bulimia nervosa in 187 adolescents. Using the Body Shape Questionnaire (BSQ), it was shown that 48.13% of adolescents displayed body image disorders. The application of the Bulimic Investigatory Test, Edinbugh (BITE) demonstrated that 3.74 and 39.04% of adolescents presented a high or medium level of eating disorder, respectively. In the subscale of BITE severity, it was detected that 2.67 and 7.49% of adolescents showed high and moderated gravity of bulimia nervosa. The results revealed some adolescents with attitudes and behaviors that favor the development of bulimia nervosa, due to a distorted perception of their body image. Therefore, educational campaigns are necessary to clarify that the cult of the body is associated with serious eating disorders.

Prevalencia de factores de riesgo asociados a trastornos del comportamiento alimentario en adolescentes de una institución educativa en Cali, Colombia 2005

Introducción: los trastornos de la conducta alimentaria (TCA) son un tema de interés actual para la investigación clínica, epidemiológica y básica. El objetivo de este estudio es determinar la prevalencia y las percepciones de riesgo asociadas a TCA en mujeres adolescentes de una institución educativa en la ciudad de Cali.Materiales y métodos: se realizó un estudio observacional tipo transversal con una muestra de adolescentes procedentes de una institución educativa en Cali, Colombia. Se diseñó y validó un cuestionario estructurado para la recolección de la información; se realizó análisis univariado y bivariado empleando intervalos de confianza (IC) al 95% y un nivel de significancia p <0.05; se diferenciaron conductas a nivel individual, familiar y social.Resultados: la edad promedio de las estudiantes fue 13 años, el 7,1% (IC: 95% 3,5% – 10,7%) refirieron vomitar como medida para reducir peso.En las conductas identificadas en sus familiares, el 86,9% (IC: 95% 82,2% – 86,9%) reportó uso de laxantes para adelgazar, mientras en amigos y pares el 15,7% (IC: 95% 10,6% – 20,8%) y el 12,6% (IC: 95%8,0% –17,2%) percibieron inducción al vómito y empleo de pastillas para adelgazar, respectivamente. La prevalencia de riesgo para los TCA fue 3,5%, siendo estadísticamente significativa en las mayores de 15 años y en adolescentes de grados superiores a noveno (p <0,05).Discusión: aunque la prevalencia del riesgo encontrada en esta investigación fue baja respecto a otras, se puede atribuir en parte a razones metodológicas, o porque la edad promedio de estas adolescentes era menor a otros estudios.

Fathers’ parenting, adverse life events, and adolescents’ emotional and eating disorder symptoms: the role of emotion regulation

To investigate the role of emotion regulation in the relation between fathers' parenting (specifically warmth, behavioral control and psychological control) and adolescents' emotional and eating disorder symptoms, after adjustment for controls. A total of 203 11-18 year-old students from a school in a socio-economically disadvantaged area in North-East London completed questionnaires assessing emotional symptoms (measured with the Strengths and Difficulties Questionnaire's (SDQ) Emotional Symptoms Scale), eating disorder symptoms (measured with the Eating Attitudes Test (EAT-26)), difficulties in emotion regulation (measured with the Difficulties in Emotion Regulation Scale (DERS)), and fathers' overprotection and warmth, measured with the Parental Bonding Instrument (PBI), as well as behavioral and psychological control. The confounding variables considered were number of proximal (i.e., during the last year) adverse life events experienced, gender, age, and socio-economic status (eligibility for free school meals). Adolescents' difficulties in emotion regulation mediated the link between fathers' psychological control and adolescents' emotional symptoms, but not the link between fathers' parenting and adolescents' eating disorder symptoms, which appeared to be more directly linked to fathers' psychological control and number of proximal adverse life events experienced. Proximal adverse life events experienced were also strongly associated with difficulties in emotion regulation. The study findings have implications for intervention programs which may prove more fruitful in addressing adolescent emotional problems by targeting underlying emotion regulation abilities, and in addressing adolescent eating disorder symptoms by protecting adolescents with a recent experience of multiple adverse life events. Parenting programs also stand to benefit from the evidence presented in this study that paternal psychological control may have uniquely harmful consequences for adolescent development through the hampering or atrophying of emotion regulation abilities and the encouragement of eating disorders.

Prospective associations of early-onset Axis I disorders with developing eating disorders

Objective The purpose of this study is to analyze the developmental relationships of adolescent-onset Axis I mental disorders and eating disorders (EDs). Method One thousand three hundred eighteen adolescent twins born from 1983 to 1987 completed a professionally administered semistructured psychiatric interview at the age of 14 years and a questionnaire follow-up at the age of 17.5 years. Results Eating disorders at the age of 17.5 years were significantly predicted by major depressive disorder (odds ratio, 5.9; 95% confidence interval, 2.6-15.3) and generalized anxiety disorder (GAD) (odds ratio, 4.7; 95% confidence interval, 1.8-15.6) at the age of 14 years, when baseline EDs were excluded. Early-onset major depressive disorder in combination with GAD increased the likelihood of developing EDs compared with either mood or anxiety disorders alone. Similar risks and trends were evident in within-family analyses of twin pairs discordant for baseline predictors and ED outcome. Conclusions Depressive disorder and GAD that manifest at that age of 14 years predict future EDs. Analysis of discordant twins suggested that early-onset depressive disorder and GAD prospectively relate to EDs in adolescence, even after familial factors are taken into account.

Diagnosing eating disorders in adolescents: A comparison of the eating disorder examination and the development and well‐being assessment

To compare the diagnostic properties of the Eating Disorder Examination (EDE) and the online version of the Development and Well-Being Assessment (DAWBA). Fifty-Seven adolescents (mean age 15.7 years) who attended consecutive assessments at a specialist eating disorders clinic completed the DAWBA, the EDE, and a standard clinical assessment with a multidisciplinary team. Cohen's Kappas were used to make pairwise comparisons between the diagnoses generated by the three assessments. Participants had anorexia nervosa (n = 30), eating disorders NOS (n = 21) or no eating disorder (n = 6) according to the clinical diagnosis. Agreement between the clinical and DAWBA diagnoses was moderate (kappa = 0.59), agreement between the DAWBA and EDE diagnoses was fair (kappa = 0.21), and agreement between the clinical and EDE diagnoses was poor (kappa = 0.10). The EDE did not identify an eating disorder in 20 participants (35% of the sample) who were clinically assessed as cases. Computerized measures using multiple informants may be more suitable for assessing clinical samples of adolescents with anorexia nervosa or eating disorders NOS than individual interviews with young people.

Parenting styles and weight-related symptoms and behaviors with recommendations for practice

With the incidence of eating disorders increasing in recent years, the role of parents in the pathology of these illnesses is of great interest, particularly the impact of their parenting style. Few studies have investigated the connection between parenting styles and adolescent eating disorders. Reviewed here are key studies on parenting style categorized into the following four broad areas related to eating disorder pathology: food-related symptoms, feeding style, research on ethnic populations, and populations with eating disorders. The results reflect previous findings on the benefits of the authoritative parenting style. Suggestions for parenting programs and further research are included.

48: Outpatient Adolescent Eating Disorder Quality Improvement Project: Weight Outcomes at One Year

48: Outpatient Adolescent Eating Disorder Quality Improvement Project: Weight Outcomes at One Year

The Prevalence of Eating Disorders in Adolescents with Idiopathic Scoliosis

This study examines the hypothesis of an association between adolescent idiopathic scoliosis (AIS) and eating disorders (EDs). A population of young females affected by AIS has been interviewed for a possible diagnosis of EDs. The proportion of individuals with EDs resulted significantly larger than normative epidemiological data: Prevalences were 9.2% for anorexia nervosa (AN), 7.7% for bulimia nervosa (BN) and 5.3% for eating disorders not otherwise specified (EDNOS). The relationship between EDs and AIS was further tested through a second analysis. Severity of the rachides pathology was correlated with the presence of AN. Our study supports the hypothesis of a comorbidity between AIS and EDs: Some possible clinical explanations for this association are discussed.

Eating disorders in childhood and adolescence Bryan Lask Eating disorders in childhood and adolescence and Rachel Bryant-Waugh Routledge Third 424 £22.99 9780415425896 0415425891

This is an excellent book, full of extensive information written in a simple manner. It is divided into three parts. Part one provides valuable insights into the inner turmoil and dilemmas faced by children with eating disorders and their parents, while the second part offers an overview of the eating disorders, covering aetiology, outcome and prognosis. The balanced and well-researched information is written by a range experts.

Partial syndromes in eating disorders: A prevalence study on a sample of Italian adolescents

Exploring the spectrum of eating disorders (ED) and its sociodemographic correlates in a population of adolescents. The sample included 788 adolescent students (384 females and 404 males, 12-14 years old) from Verona, Northern Italy. A two-stage sampling procedure was adopted. Eating Disorder Inventory-2 (EDI-2), Body Image Satisfaction Questionnaire (BISQ) and a socio-demographic questionnaire were applied to the sample in the first stage. The sample was then partitioned in two strata, "below-cutoff" and "above-cutoff", using the threshold DT > or = 14 for the Drive for Thinness (DT) subscale. A second sample of 59+58 subjects was selected from the two strata. The structural interview of the second stage consisted of the Structured Clinical Interview for DSM-IV Axis I Disorders and the Symptom Checklist of EDI-2. Partial syndromes of ED were diagnosed in 9.4% of the interviewed sample with a sex ratio F/M=6. The following factors resulted to be related to partial syndrome of ED: dieting to be thin, body mass index, mother's occupation and being a menstruating girl. This study represents one of the few prevalence and association studies about ED in young Italian adolescents. It evidences that partial syndromes of ED, in particular the partial syndrome of binge eating disorder, are the most frequent syndromes in early adolescence. Some social and parental factors resulted to be significantly related to these syndromes.

Evidenced-based Treatments for Children and Adolescents with Eating Disorders: Family Therapy and Family-facilitated Cognitive-Behavioral Therapy

This article summarizes recent research on effective treatments for children and adolescents with eating disorders and illustrates two of the main evidenced based approaches through case descriptions. There are few systematic studies of treatments for children and adolescent eating disorders despite the serious medical and psychological problems attendant to them. One form of family therapy developed at the Maudsley Hospital in London has been the subject of several small to medium sized studies that support the effectiveness of the approach for adolescents with Anorexia Nervosa. The main tenets of the approach include parental empowerment to be active in re-feeding their emaciated children through decreasing parental guilt and anxiety. There are no published controlled trials of any treatment for adolescent Bulimia Nervosa (BN). There are, however, a large number of treatment studies of adults with BN suggesting that cognitive behavioral therapy (CBT) is the treatment of choice for the disorders. A case description of the use of a modified form of CBT for adolescent BN is provided.

A clinical sample of children and adolescents with eating disorders in Brazil: Comorbidities and socio-demographic characteristics

Adolescent onset eating disorders incidence has been rising over the past decades. The peak of incidence occurs in adolescence and the prevalence is 9 times higher in females. It was initially believed that anorexia nervosa manifested only in higher socio-economic levels. More recent studies have identified similar incidence of this disorder also in lower socio-economic levels, rural areas and Asian communities. This study aims to describe comorbidity, socio-demographic and clinical features of a sample attending the Child and Adolescent Eating Disorders Clinic of the University of Sao Paulo. The sample includes all patients attending the clinic between September 2001 and October 2006. Data was obtained from a package of clinical interviews named Development and Well-Being Assessment (DAWBA)[1,2] containing a session for eating disorders and from a socio-economic questionnaire, and analysed using the SPSS10 package. During the last 6 years 82 patients were treated, and approximately 11% were males. The main diagnosis was atypical anorexia nervosa followed by anorexia nervosa according to ICD 10. The main comorbidity was depression followed by anxiety disorders. Approximately 50% of the sample attended free government schools, a indicator of lower social classes. We concluded that our sample, although coming from a public hospital in a developing country presents similar characteristics to other clinical samples in the developed world.

Plasma homocysteine levels in female patients with eating disorders

To examine plasma homocysteine, vitamin B(12), and folate levels in females with restricting and bingeing/purging eating disorders (EDs). Adolescent and adult female patients were compared to appropriate control groups with regard to plasma homocysteine levels. The plasma homocysteine level of the adult ED patients was higher than that of controls for all age groups examined. In adolescents, no significant difference was found comparing ED patients younger than 16 years of age to control data, whereas in the 16-20 year age group, the plasma homocysteine level was significantly higher among the ED group, regardless of the type of ED. Vitamin B(12) and folate levels were within normal limits in all ED groups. Elevated plasma homocysteine levels were found in adult and older adolescent female ED patients (but not in younger adolescents) compared to controls. This finding is not related to deficiencies in vitamin B(12) or folate.