Ten-Year outcome in adolescent onset anorexia nervosa

The purpose of the present study was to characterize the psychopathology measured ten years posttreatment in 51 women who had an adolescent onset of anorexia nervosa. Outcome status was determined using the modified categories of Ratnasuriya et al.[1991]. Anorexia Nervosa: Outcome and Prognostic Factors After 20 Years, British Journal of Psychiatry, Vol. 158, pp. 495–502). Psychopathology was assessed using a number of self-report questionnaires: Beck Depression Inventory, Hamilton Depression Inventory, Leyton Obsessionality Inventory, Social Adjustment Scale, and Minnesota Multiphasic Personality Inventory. Within this adolescent age of onset sample of anorexia nervosa, age of onset was not, in and of itself, associated with increased psychopathology at follow-up. Rather, severity of eating disorder outcome was associated with general psychopathology, with patients in the poor outcome group displaying elevations on several of the measures of psychopathology.Received Ph.D. in psychology from Rutgers Univesity. Major research interests are in eating behavior and attitudes toward foods in anorexia and bulimia nervosa, preoccupations and rituals associated with eating disorders, and comorbidity and eating disorders.Received M.D. from the University of Medicine and Dentistry in New Jersey. Research interests are in eating disorders.Received M.D. from University of Minnesota Medical School-Minneapolis, MN. Major research interests are anorexia nervosa and other eating disorders.Received M.D. from the University of Iowa—Iowa City. Research interests are in eating disorders.     

Binge eating in anorexia nervosa predicts later onset of substance use disorder: A ten-year prospective,longitudinal follow-up of 95 adolescents

The cooccurrence of binge eating and increased alcohol intake and substance abuse has been reported in clinical and community epidemiological samples. To further investigate the nature and causes of this comorbidity, we examined the 10-year prospective, longitudinal course of illness in 95 nonsubstance abusing adolescents hospitalized for treatment of anorexia nervosa. Survival analysis with Cox regression was used to quantitate the cumulative risk of developing substance use disorder (SUD) as a function of patterns of binge eating vs. dietary restraint within this cohort. Subjects who were binge eating at the time of intake were robustly distinguished from restrictors, having increased risk of SUD as well as greater likelihood of having at least one first-degree relative with SUD. The findings suggest binge eating that develops in the underweight stage of anorexia nervosa may reflect developmental, biological, and genetic risk processes shared in common with SUD.Received Ph.D. in clinical psychology from the University of Pittsburgh. Research interests include the etiology, course, and treatment of eating disorders, and the natural history and treatment of juvenile mood disorders.Received R.N. from Rush-Presbyterian Hospital. Research interests are in the area of adolescent mental health treatment and the treatment of anorexia nervosa.Received R.N. from Northeastern Univeristy. Research interest is the inpatient psychiatric treatment of adolescents.Received R.N. from the University of Windsor and her M.N. from UCLA. Research interest is the outcome studies of treatment effectiveness in adolescent and adult psychiatry.     

Outcome of anorexia nervosa related to treatment utilizing an adolescent medicine approach

The scientific literature suggests that outcome for adolescents with eating disorders bears little relation to the type of treatment used. Practitioners of adolescent medicine care for adolescents with eating disorders and have reported outcome in three studies, to which a fourth is added in this paper. This new sample of 34 adolescents represents consecutive admissions to an inpatient adolescent medicine unit who were then followed as outpatients by the same interdisciplinary treatment team. An average of more than 5 years after hospitalization, the group had a mean weight of 97.9% of normal and 94% were menstruating (87.5% regularly). Depending on the outcome criteria used, between one-half and two-thirds of the subjects had an excellent to good outcome, with only about 10% of subjects symptomatic at follow-up. Comparing the most recent cohort of 34 adolescents (Group II) with the older cohort of 49 subjects (Group I) reveals a trend toward behaviors associated with bulimia more commonly on entering treatment. These encouraging results suggest that adolescent medicine may offer a complementary approach to traditional methods for adolescents with eating disorders.Received M.D. from Temple University School of Medicine in Philadelphia, PA. Research interests are in bone mineral density in females with anorexia nervosa.Received M.D. from the University of Buffalo School of Medicine in Buffalo, NY. Research interests include examination of the relationship of violence and illicit substance use in adolescents and the relationship of physical abuse and bulimia nervosa.     

Outcome,psychosocial functioning,and prognostic factors in adolescent anorexia nervosa as determined by prospective follow-up assessment

The aim of this prospective longitudinal study was to examine outcome, psychosocial functioning, and prognostic factors in adolescent anorexia nervosa. Thirty-four (88%) out of a consecutive series of 39 inpatients were reinvestigated three and seven years after discharge. The patients and 34 controls matched for age, sex, and occupational status were interviewed using structured interviews on their Diagnostic Statistical Manual, third edition, revised (DSM-III-R) eating disorder diagnoses, specific eating disorder psychopathology, comorbid psychiatric disorders, and psychosocial functioning. At the seven-year follow-up 15 patients (44%) still fulfilled DSM-III-R criteria for some form of eating disorder diagnosis, 21 (62%) for some other psychiatric diagnosis. Patients with a poor outcome showed significantly more problems in most areas of psychosocial functioning than the good-outcome group, but even recovered anorectic patients had more psychosexual difficulties than healthy controls. From a large range of potential prognostic factors, only low body weight at intake and low minimum weight during course of illness proved to be of predictive value.Received M.D. from Rheinische Friedrich-Wilhelms University, Bonn. Major research interests are childhood and adolescent eating disorders including links to affective disorders.Received M.D. from Philipps University. His current interests include follow-up studies of adolescent eating disorders.Received M.D. from Philipps University. His interests are body image disturbances in eating disorders and research in neurophysiology and neuropsychology.Received M.D. from Friedrich-Alexander University, Erlangen, Germany, and Ph.D. from Rupprecht-Karls University, Tübingen. Current research interests are eating disorders, affective disorders, and early onset schizophrenia.     

An eight-year follow-up: Outcome from adolescent compared to adult onset anorexia nervosa

Seventy-five women were traced and reassessed on average eight years after the onset of anorexia nervosa. All patients received treatment and 88% were hospitalized at least once. Comparisons between early (11–15 years; N=35), late (16–18 years; N=24) adolescent and adult (19–27 years; N=14) onset revealed no significant differences in outcome for age at onset. For 70% of adolescent and 42% of adult onset patients the outcome was good, meaning that the weight was within ± 15% of norm with regular cyclical menstruation,17% and 21% had an intermediate, and 9% and 21%, respectively, had a poor outcome, 5.3% had died. Taken together, 59% had physically recovered and were free of any eating disorder. Severity of illness reflected in a low body mass index, excessive exercise, and poor psychosocial functioning at intake were poor prognostic indicators;length of illness and food restriction or bulimia as eating patterns were unrelated to outcome. The observation that all women with chronic anorexia nervosa, and even a third of those who had physically recovered from anorexia nervosa, qualified for one or more psychiatric diagnoses suggests that the psychosocial correlates of anorexia nervosa require further study.Supported by grant MH ROI35585-01A1.Received an M.D.-Ph.D. degree from Albert-Ludwig University in Freiburg, Germany. Research interests have been depressive disorders, eating disorders, in particular anorexia nervosa, and more recently women's health.Received M.D. degree from the University of Illinois in Chicago, Illinois. Research interest is in preventive medicine.     

A six-year follow-up study of anorexia nervosa subjects with teenage onset

Fifty-one adolescent onset anorexia nervosa (AN) cases recruited after community screening were compared with fifty-one age-, sex- and schoolmatched cases with regard to comorbidity and personality disorders at age 21 years. All 102 cases had originally been examined at a mean age of 16 years. Outcome according to the Morgan-Russell scales was fairly similar to that reported in recent clinic-based samples. Most of the former AN cases were recovered in respect of weight but outcome in social areas was restricted. Obsessive compulsive and avoidant personality disorders and empathy disorders were very much more common in the AN than in the comparison group. Obsessive compulsive behaviors showed a high degree of stability over time and were unrelated to weight problems. Together with empathy disorders they tended to predict outcome better than the eating disorder as such. Affective disorders were common but tended to follow the course of the eating disorder rather than precede or postdate it.Received Ph.D. on Anorexia Nerevosa in Swedish Urban Teenagers at Göteborg University in 1990. Major research interests concern the epidemiology and background factors of eating disorder.Received Ph.D. in 1981 at the University of Uppsala on Neuropsychiatric aspects of perceptual, motor, and attentional deficits in seven-year-old Swedish children. Major research interests are autism, Asperger syndrome, anorexia nervosa, attention deficit hyperactivity disorder, dyslexia, mental retardation, lefthandedness, and behavioral phenotypes.Received Ph.D. in 1987 at The University of Uppsala on Deficits in Attention, Motor Control and Perception: Follow-Up from Pre-School to Early Teens. Her major research interests concern attention deficit hyperactivity disorder.     

The outcome of adolescent anorexia nervosa: Findings from Berlin and Sofia

As part of a multisite collaborative outcome study of eating disorders in adolescence, two samples from West Berlin and Sofia were compared. The study was based on a systematic evaluation of the clinical status during the first inpatient treatment after onset of the disorder, and personal interviews with the former patients at follow-up. Despite the differences in the cultural background, the clinical features, the diagnostic pattern, the developmental histories, the family background, and the follow-up findings were remarkably similar. The mortality rate was higher in the West Berlin than in the Sofia sample. However, the outcome in terms of the distribution of eating disorders was similar in the surviving patients of the two samples.Received M.D. and Ph.D. in psychology at the University of Hamburg, Germany. Major research interests are eating disorders, developmental psychopathology, and neuropsychiatry.Received M.D. at the University of Sofia. Major research interest is in eating disorders.     

The Contribution of Emotion Regulation to Body Dissatisfaction and Disordered Eating in Early Adolescent Girls

To understand whether difficulties in emotional functioning distinguish between body dissatisfaction and disordered eating, a set of emotion regulation (i.e., negative emotion, emotional awareness, coping), demographic (i.e., age), and physical (i.e., BMI (Body Mass Index)) factors were assessed in 234 early adolescent girls, grades six to eight. Compared to younger girls, older girls had higher BMI and reported increased body dissatisfaction. Age, BMI, and negative affect predicted body dissatisfaction, whereas BMI, body dissatisfaction, and lack of emotional awareness predicted disordered eating. Further, girls who reported high levels of disordered eating reported experiencing increased levels of negative affect, greater difficulties with emotional awareness, and more difficulty coping constructively with negative emotion than girls who reported low levels of disordered eating. Results support the contention that body dissatisfaction, combined with difficulties in emotional awareness are related to disordered eating.Leslie Sim is an assistant professor at the Mayo Medical School, a Senior Associate at the Mayo Clinic, and Clinical Director of the Mayo Inpatient Eating Disorders Program. She received her Ph.D. from University of Maine in Developmental and Clinical Psychology. Her research interests include eating disorders, self-injurious behavior, and emotion regulation skills in children and adolescents.Janice Zeman is an associate professor at the College of William and Mary. She received her Ph.D. from Vanderbilt University in Developmental and Clinical Psychology. Her research interests include children's and adolescents' emotion regulation skills particularly as they relate to maladaptive functioning with other research interests in parental and peer socialization of emotion.     

Outcome of early onset anorexia nervosa: What do we know?

Six recent studies on the outcome of early onset anorexia nervosa (AN) are reviewed. It would appear that the intermediate term outcome of early onset AN is not different from that of later onset AN. No prognostic indicators were identified and effect of treatment is unknown. Early onset AN may be a disabling and chronic disorder for 25% of patients seen at psychiatric clinics.Received M.D. from the University of Hong Kong, Faculty of Medicine. Major research intersts are eating disorders and cross-cultural psychiatry.     

Manifestations of depressive affect in adolescence

This paper discusses the manifestations and correlates of depressive affect disorders in adolescents. It begins with some definitions and a discussion of the concept (from adult psychiatry) of depression and depressive disorders. The clinical picture of depressive disorders in adults is described, and the interrelationship is considered between them and the depressive disorders of adolescents and prepubertal children. Data are discussed regarding the external validity of adolescent depressive disorders (including their familial and biological correlates, their course and treatment outcome). Finally, the relevance of these data is summarized with regard to the process of establishing a diagnosis of a depressive disorder in adolescents.Received M.D. from Washington University. Research interests are the diagnosis and assessment of childhood psychopathology, especially Attention Deficit Disorder and Depressive Disorders.Received Ph. D. from UCLA. Research interests are language and learning disorders and childhood psychopathology.     

Family influences,school behaviors,and risk for the later development of an eating disorder

Interviews were conducted with parents of 136 female and 45 male adolescents categorized into risk groups for the later development of an eating disorder. The family and school concomitants of risk status in females were demonstrated to be different from that in males. Risk group female adolescents rated family cohesion, parent-adolescent communication processes, and overall family satisfaction more negatively than the comparison group. Mothers of moderate risk group females reported lower family cohesion than the comparison group; there were no group differences for adolescent females in fathers' ratings of family measures. However, no group differences were found on any of the family measures between male risk and comparison males. For both females and males, there were no significant group differences in family history of eating and mood disorders, or alcohol dependence. Teacher ratings indicated relatively greater internalizing tendencies in the high-risk female group.This investigation was supported by NICHD Grant Number 1R01-HD24700 awarded to Gloria R. Leon.Received Ph.D. from University at Maryla. Research interests include precursors of eating disorders and stress and coping in extreme environments. To whom correspondence should be addressed.Received M.A. from San Diego State University. Research interests include precursors of eating disorders, substance abuse, and personality.Received Ph.D. from Stanford University. Research interests include psychosocial aspects of health promotion and disease prevention.Received B.A. from University of Maine. Research interests life span development and family issues.     

Introduction to special issue

As regards prognosis, none of these cases, however exhausted, are really hopeless whilst life exists: and, for the most part, the prognosis may be considered favourable. (Gull, 1873)Received M.D. Ph.D. from Albert-Ludwig University in Freiburg, Germany. Research Interests are depressive disorders, eating disorders, in particular anorexia nervosa, and more recently women's health.     

Eating disorders among high performance athletes

The purpose of this study was to examine whether athletes in certain sports display a higher tendency toward eating disorders than athletes in other sports. The Eating Attitudes Test (EAT) was administered to 191 athletes (104 females, 87 males). The athletes were classified into three groups (i.e., sport classes) according to type of sport. Overall, 10.6% of the female athletes and 4.6% of the male athletes scored over 30 in the EAT, placing them in the anorexic range. The prevalence of the results for the female athletes is comparable to other research on college university populations, while male athletes appeared to have a higher tendency toward eating disorders than the general population. Significant differences between sport classes were found for only among the female athletes' groups. Activities that emphasize leanness and athletes in weight-matched activities were related to higher EAT scores than in nonweight-restricting activities. The study indicates that different groups of athletes may be at different risks for developing eating disorders.Received Master of Education in Counselling Psychology from the University of Alberta. Major areas of research interest include sports psychology and eating disorders.Received Doctorate in Counselling Psychology from the University of Calgary. Major areas of research interest include health psychology and counselor education.     

A comparative analysis of personality organization in juvenile anorexia nervosa

To identify distinguishing features of personality associated with anorexia nervosa in adolescence, univariate and multiple group discriminant function analyses were used to compare the Cattell High School Personality Questionnaire responses of 50 anorectics and matched groups of depressed and antisocial adolescent females. Results indicated the presence of two major sources of discriminating variance. Relative to both control groups, anorectics were characterized by significantly greater conformity, neurotic anxieties, control of emotionality, and stimulus avoidance. These findings suggest that at the level of personality functioning, the anorectic has failed to acquire the sense of individuation, mastery, and general plasticity of psychological functioning necessary to cope effectively with critical developmental tasks and progress toward identity formation. Results are discussed in terms of the extant literature on anorexia nervosa and future research needs.Received his Ph.D. from the University of Pittsburgh. Primary research interests are empirical studies of clinical psychopathology and psychosomatic disorders in adolescents.     

Family Functioning and School Success in At-Risk, Inner-City Adolescents

The relation between family functioning and school success was examined in 211 at risk, African American, inner city adolescents attending middle school (grades 6–8). Interviews with adolescents and caregivers yielded data on family cohesion, parental monitoring, and school engagement; school records provided data on grade point average. Results showed that both family cohesion and parental monitoring predicted school engagement, but neither family characteristic predicted GPA. Important gender differences also emerged. For boys only, the relation between family cohesion and school engagement was stronger when parental monitoring was high. For girls only, the effects of cohesion and monitoring on school engagement were additive: girls with both high family cohesion and high parental monitoring were most likely to be engaged in school. These findings extend the research base on family protective factors for antisocial behavior in young adolescents. Implications for future examination of family process characteristics in high-risk adolescents are discussed. This work is based on the dissertation research of the first author submitted to the Department of Psychology at Fordham University. Research Associate, Hudson Valley Cerebral Palsy, Patterson, NY. Professional Training: PhD, Developmental Psychology, Fordham University. Major interests include etiology and treatment research on developmental disabilities and psychological health problems in children and adolescents. Senior Research Associate, The National Center on Addiction and Substance Abuse (CASA) at Columbia University, New York, NY. Professional Training: PhD, Clinical Psychology, Temple University. Major interests include development of family-based interventions for adolescent drug use and delinquency, adherence and process research on family intervention models. Research Associate, National Clinical Assessment Authority, London, England. Professional Training: PhD, Developmental Psychology, Fordham University. Major interests include mental health services research and program evaluation. Professor and Director, Center for Treatment Research on Adolescent Drug Abuse, University of Miami School of Medicine, Miami, FL. Professional Training: EdD, Counseling Psychology and Family Therapy, Northern Illinois University. Major interests include developing, testing, and disseminating family-based treatment for adolescent substance abuse and related behvioral problems.     

Locus of control in severely disturbed adolescents: Loci for Peers,Parents, Achievement,Relationships, and Problems

The validity of a multifactor conceptualization of locus of control (LOC) in severely disturbed adolescents was investigated. Ninety-two adolescents (44 female, 48 male) from a private psychiatric hospital completed the Children's Nowicki-Strickland Internal-External Locus of Control scale 3 months following admission. Five factors were found by both principal components and common factor analyses; the factors were named Peers, Parents, Achievement, Relationships, and Problems. Factors items had minimum loadings of 40, numbered 4 to 8 per factor, and accounted for 36.8% of the variance in principal components analysis and 28.5% of the variance in common factor analysis. Whereas traditional LOC was significantly related only to Global Assessment Scale (GAS) scores at admission and 3 months later, and to initial Diagnostic and Statistical Manual (3rd edition, revised) diagnosis of psychosis, individual factors were significantly related to IQ; GAS at admission, 3 months, and 15 months following admission; externalized aggression prior to admission; and diagnoses of psychosis, depression, and conduct disorder.Received doctorate in psychology from Stanford University. Current research interests include cost effectiveness and cost-benefit analysis of mental health services and substance abuse treatment programs, and cognitive determinants of premature cessation of therapy.Received doctorate in clinical psychology from George Washington University. Her current interests include individual psychotherapy with children and adolescents and research on the effectiveness of home-based services.Received doctorate in clinical psychology from George Washington University. His research interests include comorbidity of depression and conduct disorder, and outcome studies of adolescent disorders.Received M.D. from Harvard Medical School and is the former Head of Child and Adolescent Psychiatry, University of Rochester, and former Chief, Child Research Branch, National Institute of Mental Health. Major interests are inpatient adolescent treatment, family therapy, and individual psychotherapy.     

Hungarian adolescents' self-concept

Hungarian and United States adolescents' self-image was studied using the Offer Self-Image Questionnaire (OSIQ). In Hungary, 1,163 younger and older male and female adolescents were studied using a Hungarian translation of the OSIQ. Analyses of endorsement patterns of OSIQ items showed that Hungarian and American adolescents endorsed many items in the same way. Similarities in endorsement patterns were much more common between the two countries than were differences. Analyses of OSIQ scales showed that for most scales younger Hungarian adolescents reported better adjustment than younger American adolescents. Differences were not as great or reversed in the older age groups. Implications for cross-cultural studies of adolescent self-image were drawn based on these results.Received M. D. from the Semmelweis Medical university in Budapest. Research interest is complex somato-mental health care of adolescents.Received M. D. from the University of Chicago. Major interests are concepts of mental health and the developmental psychology of adolescence.Director, Forensic Psychology, Michael Reese Hospital and Medical Center. Received J. D. from the University of Chicago School of Law; received Ph. D. in human development from the University of Chicago. Research interests are adolescence and delinquency.Professor of Psychology, Northwestern University. Received Ph. D. in psychology from the University of Chicago. Major interests are psychotherapy research and adolescence.     

Measuring physical status and timing in early adolescence: A developmental perspective

Recently, the timing-of-events model typically used for exploring adult development has been proposed for studying early adolescence and the pubertal processes occurring then. As a consequence, new interest has been generated about the psychological effects of being early, on time, or late in sexual maturation during early adolescence. A major issue has to do with the choice of maturational events to study, since puberty is a process involving numerous events, all of which have a different developmental course. This paper reviews some of the maturational events that are applicable in studying psychological effects of pubertal status and timing. Nine changes are reviewed (bone, height, weight, body fat, breast, body hair, penile, testicular, and menarcheal changes) in terms of measurement techniques, psychometric properties, and intercorrelations with other pubertal events. In addition, the usefulness of each measure for psychological research on maturational timing and status is discussed. Finally, how pubertal measures may be incorporated into a developmental perspective is considered, especially with regard to rate, duration, and asynchrony of pubertal changes.Research Interests: Girl's psychological adaptation to pubertal change, biosocial aspects of female reproductive events, development of biological and socially at risk children and adolescents.Research Interests: Reproductive endocrinology, anorexia nervosa, neuroendocrinology, adolescence.     

Impulsivity in Juvenile Delinquency: Differences Among Early-Onset, Late-Onset, and Non-Offenders

The present research investigated differences in levels of impulsivity among early-onset, late-onset, and non-offending adolescents. 129 adolescents (114 males, 15 females), of whom 86 were institutionalised (M age=15.52 years) and 43 were regular school students (M age=15.40 years) participated. Each participant completed the Adapted Self-Report Delinquency Scale, Stroop Colour and Word Test, Time Perception task, Accuracy Game, Risk-Taking Game, and the Eysenck Impulsiveness Questionnaire. Results suggest that adolescents who display rapid cognitive tempo, poor mental inhibitory control, and high impulsivity are more likely to be early-onset offenders. Offender and non-offender groups showed significant differences on several measures of impulsivity, which may suggest that late-onset offenders acquire or exacerbate impulse-related problems through social mimicry of early-onset offender peers. Potentially important implications for our understanding of delinquency and the design and provision of prevention programs are highlighted.Senior Lecturer in Educational Psychology at the School of Education, The University of Queensland, Brisbane, Australia. She received her PhD in educational psychology from The University of Western Australia. Her major research interests include at-risk behaviours of children and adolescents, self-regulation and goal setting, and developmental trajectories of antisocial and aggressive behaviours School of Education, The University of Queensland, Brisbane Q 4072 AustraliaDoctor of Clinical Psychology student within the School of Psychology at The University of Queensland, Brisbane, Australia. Her research interests include at-risk children and adolescents, mental health in adolescents and adults, cognitive-behavioural interventions, and self-regulationMaster of Philosophy student within the School of Education, The University of Queensland, Brisbane, Australia. Her research interests include self-regulation, youth at-risk, Indigenous youth issues, and prevention and intervention approachesProfessor of Education and Head of the School of Education, The University of Queensland, Brisbane, Australia. He received his PhD in educational psychology from the University of Alberta, Canada. His research interests include cognitive educational psychology, classroom-based instruction, strategy training, problem solving, and at-risk youthProfessor of Education and Director, Centre for Attention and Related Disorders at the Graduate School of Education, The University of Western Australia. He received his PhD in educational psychology from the University of Birmingham, UK. His research interests include attentional disorders, severe antisociality in children and adolescents, emotion regulation, complex information processing and cognitive processes of at-risk adolescents Graduate School of Education, The University of Western, AustraliaProfessor of Psychology in the Department of Psychology, University of Strathclyde, United Kingdom. He received his PhD in developmental psychology, specialising in cognitive and communicative development in childhood and adolescence from Cambridge University, UK. His research interests include developmental psychology, at-risk children and adolescents, and the impact of media on children’s behaviour