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.     

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.     

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.     

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.     

Depressive Symptoms Among Adolescent Girls in Relationships with Older Partners: Causes and Lasting Effects?

Previous research on adolescent girls in relationships with older partners suggests a range of negative outcomes for the adolescent. Using three waves of data from the National Longitudinal Survey of Adolescent Health and a life course perspective, we explore the connection between involvement in age discordant relationships (girls dating males three or more years older) and the course of depressive symptoms among adolescent girls. Our analyses are conducted on the 1,307 girls with data at all three waves who had been in a relationship in the last 18 months. The sample is 55% White, 22% Black, 7% other race and 16% Latina. When comparing early adolescent girls (13–15) and late adolescent girls (16–18), the younger girls are no more likely to have depressive symptoms before entry into the age discordant relationship, yet have greater depressive symptoms shortly after the relationship onset and 5 years later. Older adolescent girls in age discordant relationships, however, have similar levels of depressive symptoms at any time point relative to their peers. These data suggest that a girl’s developmental stage influences whether or not she experiences emotional distress as a result of being in an age discordant relationship.     

Understanding the Relationship Between Onset Age and Subsequent Offending During Adolescence

This article examines the well-documented relationship between early initiation or onset of criminal behavior and a heightened risk of involvement in offending. Previous research examining this question conducted by Nagin and Farrington (Criminology 30:235–260, 1992a; Criminology 30:501–523, 1992b) used data from the Cambridge Study in Delinquent Development and found that: (1) onset age was correlated with offending involvement; and (2) the correlation could be explained by stable individual differences in the propensity to offend rather than a causal effect of early onset age. In this study, similar analytic methods are applied to data from the Second Philadelphia Birth Cohort. This data set consists of all 13,160 males born in Philadelphia in 1958 who resided in the city continuously from ages 10 to 18, slightly more than half of whom were non-white. Information from each of the youths was collected from schools, juvenile justice agencies, other official sources and surveys. In a model that mimics previous analyses, we initially found that an early age of onset is associated with greater subsequent involvement in delinquent behavior. When unobserved criminal propensity was controlled, however, we found that a late rather than an early onset of delinquency was related to future offending. In finding a state dependent effect for age of onset, our findings are contrary to propensity theory in criminology. In finding that it is late rather early onset which puts youth at risk for future offending, our findings are contrary to developmental/life course theory. Our results are more compatible with traditional criminological theory that is friendly to state dependence processes, though they too have not to date articulated why a late onsetting of offending might be particularly criminogenic.

Age at Menarche and Adolescent Alcohol Use

Research has shown that early maturation is related to problematic alcohol use, yet the differential effect of early pubertal timing (i.e., younger age at menarche) on the onset of alcohol use and subsequent level of alcohol use has rarely been examined. This distinction is relevant, as younger age at menarche can have differential effects on these outcomes, which in turn can have long-lasting effects. Therefore, the present study examined the relationship between age at menarche and adolescent alcohol use among girls, hereby distinguishing between onset and level of alcohol use. In addition, the moderating effects of alcohol-specific rules, child disclosure and class gender composition were examined. Participants were 430 girls from a Dutch four-wave survey, with a mean age of 12.17 years (SD = 0.50) at the beginning of the study. Results showed that the probability of onset of alcohol use was increased by younger age at menarche, but only when girls were younger than 15. Moderation analyses showed that younger age at menarche increased the risk of alcohol onset only in low risk girls (with high levels of alcohol-specific rules and in classes with a high percentage of girls). Once adolescent girls started drinking alcohol, younger age at menarche was associated positively with alcohol consumption only for girls in classes with a moderate to high percentage of girls. These findings confirm that younger age at menarche is a risk factor for the onset of alcohol use, but strongly suggest that this effect is strongest for girls having restrictive alcohol-specific rules and in classes with a high percentage of girls. Possibly, in the absence of social factors that “push” to alcohol use, biological factors (like age at menarche) become more important. Another possibility is that adolescent girls start drinking alcohol to oppose their parents if they set too strict alcohol-specific rules.     

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.     

Race and Perceived Pubertal Transition Effects on Girls’ Depressive Symptoms and Delinquent Behaviors

Most past research on the effects of early pubertal timing on girls’ depressive symptoms and delinquent behavior has focused on either age of menarche or has combined multiple indicators of development into a single index of puberty. Past research has rarely examined both the onset of puberty such as age of menarche, as well more psychologically mediated impressions of puberty (i.e., perceived pubertal timing) within the same study. This study extends past research on racial differences and pubertal related effects on girls’ depressive symptoms and delinquent behavior by examining the independent influence of different indicators of puberty (age of menarche, development of breasts, and perceived pubertal timing). Two waves of data (100 % females) were used from African Americans (N = 481) and European Americans (N = 1259) who were enrolled in seventh- and eighth-grade during the first wave of data collection in the National Longitudinal Study of Adolescent Health. Early age of menarche was associated with high levels of depressive symptoms at Wave 1. Additionally, both early and late perceived pubertal timing were associated with high levels of depressive symptoms and high delinquent behaviors at Wave 1. The structural relationships among these variables were similar for African Americans and European Americans. Age of menarche and perceived pubertal timing influenced depressive symptoms and delinquent behavior at Wave 2 through depressive symptoms and delinquent behavior reported at Wave 1. The implications of these findings are discussed with an emphasis on how the specific indicator used to assess puberty is important in efforts to understand pubertal timing effects.     

Ethnicity,Perceived Pubertal Timing,Externalizing Behaviors,and Depressive Symptoms Among Black Adolescent Girls

An accumulation of research evidence suggests that early pubertal timing plays a significant role in girls’ behavioral and emotional problems. If early pubertal timing is a problematic event, then early developing Black girls should manifest evidence of this crisis because they tend to be the earliest to develop compared to other girls from different racial and ethnic groups. Given the inconsistent findings among studies using samples of Black girls, the present study examined the independent influence of perceived pubertal timing and age of menarche on externalizing behaviors and depressive symptoms in a nationally representative sample of Black girls (412 African American and 195 Caribbean Black; M = 15 years). Path analysis results indicated that perceived pubertal timing effects on externalizing behaviors were moderated by ethnic subgroup. Caribbean Black girls’ who perceived their development to be early engaged in more externalizing behaviors than Caribbean Black girls’ who perceived their development to be either on-time or late. Age of menarche did not significantly predict Black girls’ externalizing behaviors and depressive symptoms. The onset of menarche does not appear to be an important predictor of Black girls’ symptoms of externalizing behavior and depression. These findings suggest ethnic subgroup and perceived pubertal timing are promising factors for better understanding the adverse effects of early perceived pubertal timing among Black girls.     

Pubertal Development,Spare Time Activities,and Adolescent Delinquency: Testing the Contextual Amplification Hypothesis

Extensive evidence supports associations between early pubertal timing and adolescent externalizing behavior, but how and under which conditions they are linked is not fully understood. In addition, pubertal development is also characterized by variations in the relative speed at which individuals mature, but studies linking pubertal ‘tempo’ and outcomes are scarce. This study examined the mediating and moderating roles of spare time activities in associations between pubertal development and later delinquency, using data from a large (4,327 girls, 4,250 boys) longitudinal UK cohort (Avon Longitudinal Study of Parents and Children). Self-reports of Tanner stage were available from ages 9 to 14, spare time activities at age 12 and delinquency at age 15. Pubertal development was examined using latent growth models. Spare time activities were categorized using factor analyses, yielding four types (hanging out at home, hanging out outside, consumerist behavior, and sports/games), which were examined as mediators and moderators. Earlier and faster maturation predicted delinquency in boys and girls. Spare time activities partially mediated these links such that early maturing girls more often engaged in hanging out outside, which placed them at greater risk for delinquency. In addition, compared to their later and slower maturing counterparts, boys who matured earlier and faster were less likely to engage in sports/games, a spare time activity type that is linked to lower delinquency risk. No moderation effects were found. The findings extend previous research on outcomes of early maturation and show how spare time activities act as proxies between pubertal development and delinquency.     

A prospective follow-up of children with anorexia nervosa

We report on a prospective follow-up (mean 3.1 years) of 22 children with anorexia nervosa (mean age at onset—12.1). Adequate information was obtained for 18 children. The specific outcome was good in 10 (55.5%), intermediate in 5 (27.8%), and poor in 3 (16.7%); none had died. No prognostic factors were identified. The findings are compared with those from the long term follow-up of a previous cohort of children with anorexia nervosa, and confirm the unsatisfactory prognosis for this age group.Major research interest concerns the etiology and treatment of eating disorders in children and adolescents.Has been with the Eating Disorders Research Team since 1992. His major interest is research methodologyHas been with the eating disorders Research Team since 1989. Her major interests are in obsessional-compulsive problems and eating disorders in children.Major research interests include eating disorders in children and adolescents, cystic fibrosis, the effects of transplantation in children and adherence to treatment. Chief Editor ofClinical Child Psychology and Psychiatry. Has been collaborating with the Eating Disorders Research Team since 1985.     

Adolescent Sexual Onset: An Intergenerational Analysis

Adolescents have begun to initiate sexual activity at increasingly early ages in the past few decades. Using a sample of 2,494 adolescents from the National Longitudinal Survey of Youth (NLSY97), structural and parental process variables were examined in the prediction of sexual onset. Results indicated that the age at which youth initiate sexual intercourse is related to the structural characteristics of their grandmothers and mothers, as well as puberty, gender, and race. There is support for partial mediation of the effects of these grandmother characteristics via mother characteristics and parental process. Results are discussed within the framework of the life course perspective and provide support for the importance of previous generations in the explanation of adolescent sexual behavior. Implications for families and adolescents are also addressed. Katherine A. Johnson, is a doctoral student at the University of Nebraska–Lincoln. Her research interests include the study of crime, gender, and high-risk youth using both qualitative and quantitative methodology. Kimberly A. Tyler, is an associate professor in the Department of Sociology at the University of Nebraska–Lincoln. Her research interests include homelessness, child abuse and neglect, victimization, and high-risk behaviors among adolescents and youth.     

Childhood and Adolescent Predictors of Late Onset Criminal Careers

This study explores the emergence of a criminal career in adulthood. The main hypothesis tested is that late criminal onset (at age 21 or later) is influenced by early factors that delay antisocial manifestations. The Cambridge Study in Delinquent Development (CSDD) was used to examine early determinants of criminal behavior. 400 Inner London males were followed from ages 8–10 to 48–50, and were classified as follows: 35 late onsetters who were first convicted at age 21 or later, and did not have high self-reported delinquency at ages 10–14 and 15–18; 129 early onsetters first convicted between ages 10 and 20; and 236 unconvicted males. Odds ratios and logistic regression analyses revealed that the best predictors of late onset offenders compared with early onset offenders included nervousness, having few friends at ages 8–10, and not having sexual intercourse by age 18. The best predictors of late onset offenders compared with nonoffenders included teacher-rated anxiousness at ages 12–14 and high neuroticism at age 16. It is concluded that being nervous and withdrawn protected boys against offending in adolescence but that these protective effects tended to wear off after age 21. These findings show that adult offending can be predicted from childhood, and suggest that early intervention might prevent a variety of maladjustment problems and difficulties in adult life.

Cortisol Stress Response Variability in Early Adolescence: Attachment,Affect and Sex

Attachment, affect, and sex shape responsivity to psychosocial stress. Concurrent social contexts influence cortisol secretion, a stress hormone and biological marker of hypothalamic–pituitary–adrenal axis activity. Patterns of attachment, emotion status, and sex were hypothesized to relate to bifurcated, that is, accentuated and attenuated, cortisol reactivity. The theoretical framework for this study posits that multiple individual differences mediate a cortisol stress response. The effects of two psychosocial stress interventions, a modified Trier Social Stress Test for Teens and the Frustration Social Stressor for Adolescents were developed and investigated with early adolescents. Both of these protocols induced a significant stress reaction and evoked predicted bifurcation in cortisol responses; an increase or decrease from baseline to reactivity. In Study I, 120 predominantly middle-class, Euro-Canadian early adolescents with a mean age of 13.43 years were studied. The girls’ attenuated cortisol reactivity to the public performance stressor related significantly to their self-reported lower maternal-attachment and higher trait-anger. In Study II, a community sample of 146 predominantly Euro-Canadian middle-class youth, with an average age of 14.5 years participated. Their self-reports of higher trait-anger and trait-anxiety, and lower parental attachment by both sexes related differentially to accentuated and attenuated cortisol reactivity to the frustration stressor. Thus, attachment, affect, sex, and the stressor contextual factors were associated with the adrenal-cortical responses of these adolescents through complex interactions. Further studies of individual differences in physiological responses to stress are called for in order to clarify the identities of concurrent protective and risk factors in the psychosocial stress and physiological stress responses of early adolescents.     

Adolescent Sexuality and Positive Well-Being: A Group-Norms Approach

The link between adolescent sexual activity and psychological well-being is a controversial issue in developmental psychology. This cross-sectional study investigated the association between three aspects of teenage sexuality (genital sexual experience, age of sexual onset, and number of sex partners) and positive well-being (hedonic, eudaimonic, and overall) in a sample of 475 high school seniors (48% female; 89% White) from a single school district in a rural upstate New York community. Based on a group-norms perspective, we expected higher well-being in adolescents whose sexual behaviors followed group-normative patterns. As expected, sexually experienced and on-time (at age 16) students reported higher well-being than sexually inexperienced or late-onset (17 or older) students. Contrary to expectations, a high number of sex partners and an early sexual onset (15 or younger) were not related to lower well-being. Early-onset girls reported higher levels of well-being than normative-onset peers. Findings are discussed in relationship to theoretical perspectives and past empirical findings of teenage sexuality as a developmental asset versus risk.     

The Developmental Unfolding of Sibling Influences on Alcohol Use over Time

Research has long demonstrated that siblings are similar in their alcohol use, however much of this work relies on cross-sectional samples or samples of adolescents alone and/or exclusive focus on older siblings’ impact on younger siblings. Using a three time-point design from early adolescence to early adulthood (M ages?=?14.9, 18.3, and 22.4 years, respectively; 55% female; 54% European ancestry, 38% Asian ancestry), we evaluated the prospective older and younger sibling influences on alcohol use across time (N?=?613 sibling pairs; 35% sisters, 26% brothers, 39% mixed-gender; average age difference?=?2.34 years; 34% full-biological siblings, 46% genetically-unrelated adopted siblings, 20% pairs where one child was the biological offspring of parents and the other was adopted). The results from both the traditional and random-intercept cross-lagged panel analyses showed that older siblings’ alcohol use predicted younger siblings’ alcohol use across each developmental transition and across a variety of sibling contexts (e.g., gender composition, age difference, genetic relatedness). On the other hand, younger siblings’ alcohol use only predicted older siblings’ alcohol use when siblings were close in age (1.5 years or less) and under conditions of high sibling companionship. These results add to a body of literature illustrating how both older and younger siblings are important socializing agents of adolescent and early adult alcohol use. Assessing or co-treating siblings for alcohol problems may be an important add-on to existing adolescent and early adult alcohol prevention and intervention programs.     

The Cultivation of a Prosocial Value Orientation Through Community Service: An Examination of Organizational Context, Social Facilitation, and Duration

Community service is widely regarded as a fundamental experience in preparation for good citizenship, but it remains unclear whether common variants of service are consequential for civic outcomes. This study examines changes in the relative importance assigned to prosocial and egoistic values associated with service through different types of organizations, service prompted by external contingencies, and service that spans a narrow or wide frame of time. Data were drawn from the survey responses of 16,749 secondary school students (50 percent female, 28 percent ethnic minority, modal age = 15) who participated in the National Educational Longitudinal Study during their sophomore year in 1990 and completed a follow-up survey during their senior year in 1992. Results from a propensity score analysis indicated that service through humanitarian organizations but not other types of organizations was positively associated with the adoption of a prosocial value orientation. Service prompted by an institutional mandate or social pressure was negatively associated with prosociality relative to service characterized as strictly voluntary, although all students except those with an initially egoistic value orientation benefited from mandatory service relative to no service. While short-term service during the sophomore year had no enduring effect, long-term service predicted gains in prosociality above and beyond the effect of concurrent service. The findings suggest that the relationship between community service and prosocial value development can be optimized to the extent that service through a humanitarian organization is prompted by autonomy-supportive conditions over the course of 2 years.