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.     

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.     

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 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.     

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.     

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.     

School aptitude and achievement in children of adolescent mothers

The effects of adolescent childbearing and parenting on the academic aptitude and achievement of fourth-grade children were examined by comparing children of mothers in three age groups at the birth of the first child: 15–17 years, 18–19 years, and 20–24 years. The data are from a longitudinal study of a community population of schoolchildren. Outcome measures were tests of cognitive skills at preschool screening, parent and teacher ratings of school performance at grade 3, and tests of aptitude and achievement at grade 4. After controlling for gender, birth order, family structure, and maternal education, results indicated that children of adolescent mothers, whether early or late adolescence, were generally not different from children of mothers in their early 20s with respect to academic ability and performance. Maternal education had a far greater impact on the outcome measures than did maternal age.This research was supported by NIMH Grant No. 5-R01 MH-27458 to Dr. Reinherz.Received Ph.D. degree at Brandeis University in 1978. Her major interests are child mental health and child abuse.Received Sc. D. degree at Harvard School of Public Health in 1965. Her major interests are child health and development.     

Timing of first sexual intercourse: the role of social control,social learning,and problem behavior

Prior research has pointed to several distinct processes that may affect the timing of first intercourse among adolescents. In the present study, the role of six hypothesized processes was assessed in a sample of 289 rural adolescent boys and girls. Results support the importance of family socialization and problem-behavior for both sexes, the role of biological factors for boys, and the role of social control processes for girls. Two other hypothesized influences—social class and poor psychosocial adjustment—were not supported in either gender. These results indicate that multiple processes influence the timing of first intercourse; thus, they underscore the need for eclectic predictive models that incorporate the multiplicity of influences.Received Ph.D. in Human Development from the University of Chicago. Current research interests include adolescent psychosocial development and risk behaviors.Received Ph.D. in Human Development and Family Studies from the Pennsylvania State University. Current research interests include adolescent sexuality and health-related behaviors.Received Ph.D. in Health Education from The Pennsylvania State University. Current research interests include adolescent health.Received Ph.D. in Education from The Pennsylvania State University. Current interests include adolescent substance abuse and pregnancy, as well as community health interventions.     

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.     

Parental involvement and the effectiveness of an adolescent day treatment program

Results on an outcome study with adolescents in a partial hospitalization program reflect parental involvement during the treatment process. The study compared behavioral outcomes of adolescent patients with high parental involvement with outcomes of adolescent patients with low parental involvement. The partial hospitalization program led to improvement for adolescents aged 13–17 years with significant differences for improvement by parental involvement. Improvements were in primary function areas, school and home as perceived by the adolescent, and in a reduction in severity level and total pathology as rated by the parent. Further, adolescents with high parental involvement were less likely to need rehospitalization.Received M.A. in psychology, from Governors State University. Research interests focus on adolescent treatment.Received Ph.D. in counselor education from Loyola University of Chicago. Research interests concern individual and career development, and service delivery issues.     

Attitudes toward sexuality in a group of 1500 middle class teen-agers

The purpose of the study was to determine the attitudes toward sexuality in a group of randomly selected middle class teen-agers. The sample included boys and girls, young (13–14) and older (16–18) teen-agers, in a variety of geographic locations from 1962 to 1970. Results demonstrated significant differences between the sexes and between younger and older teen-agers. It did not show differences between teen-agers' attitudes toward sexuality from 1962 to 1970 and neither were there any differences in the attitudes of adolescents in the American cities and in Hobart, Australia. The main finding is that there is no evidence to suggest that the adolescent population is in the midst of a sexual revolution. Presented at the VIIIth International Congress for Child Psychiatry and Allied Professions, Jerusalem, Israel, August 1970.Received M.D. from the University of Chicago; psychiatric training at Michael Reese Hospital; and is a graduate of the Chicago Institute for Psychoanalysis. Main interests are the developmental psychology of adolescents and young adults and juvenile delinquency.The paper was prepared with the collaboration of H. Diesenhaus, Ph.D., Assistant Professor of Psychology, University of Illinois College of Medicine, Chicago, Illinois, and E. Ostrov, Research Associate, Michael Reese Unit, Illinois State Psychiatric Institute, Chicago, Illinois.     

Substance use by hispanic and white non-hispanic pregnant adolescents: A preliminary survey

White non-Hispanic and Hispanic adolescents aged 17 years and under n= 81) who delivered in San Jose, California area hospitals during a 6-week period were interviewed within 24 hours concerning their use of cigarettes, marijuana, and alcohol during pregnancy, and a number of background, social support, and psychosocial factors. Before 12–16 weeks of pregnancy, each of the substances studied was used by over 50% of this population, with 53% smoking cigarettes, 51% smoking marijuana, and 58% consuming beer or wine. Most substance use ceased after 12–16 weeks of pregnancy. There were no significant differences between ethnic groups in substance use. Multiple regression analyses showed that cigarette smoking decreased when social support was provided by the adolescent's partner and it was higher if parents smoked and/or used alcohol p<.001. Parental substance use, combined with lack of social support, was also associated significantly with marijuana use p<.001, explaining 30% of the variance. Use of birth control prior to pregnancy was related to beer and wine consumption p<.05, explaining 16% of the variance. Active inclusion of members of the adolescent's support network in pregnancy care, and initiative by educators and clinicians in discussing substance use, may accelerate its cessation. Ethnicityrelated behavior change strategies may be of little relevance to adolescent substance use during pregnancy.This study was funded by grant no. MCR-060466-01-0 from the Maternal and Child Health and Crippled Children's Services Research Program, Bureau of Health Care Delivery and Assistance, DHHS, to the Department of Gynecology and Obstetrics, Stanford University School of Medicine. The first author is supported by a fellowship from the Pew Memorial Trust.Received Ph.D. from Stanford University. Main interest is adolescent pregnancy and health of Latino populations.Received M.D. and Ph.D. from the University of Kansas. Main interest is perinatology.     

Age differences in adolescent future-oriented goals,concerns, and related temporal extension in different sociocultural contexts

The aim of this study was to investigate the extent to which differences in agegraded sociocultural contexts influence adolescent future-oriented goals, concerns, and related temporal extension. Ninety-five 13–14-year-old Australian boys and 104 girls, 87 16–17-year-old Australian boys and 81 girls, 67 13–14-year-old Finnish boys and 86 girls, and 56 16–17-year-old Finnish boys and 107 girls were investigated. Half of the subjects in each group came from an urban environment and half from rural regions. The subjects filled in the Hopes and Fears Questionnaire measuring the content and temporal extension of goals and concerns. Overall, the results showed that adolescent goals, concerns, and related temporal extension reflected the major developmental tasks of their own age and early adulthood. However, interesting cross-cultural, gender, and urban rural differences were also found, reflecting variation in societal options and cultural values. For example, Australians were more interested in leisure and more concerned about their own health and global issues. Later school transitions meant that in older age groups the Finnish adolescents expected goals related to their future education and occupation to be actualized later than Australian youths did. Because of a lack of career options, interest in a future occupation decreased with age among adolescents living in rural regions.Received Ph.D. from University of Helsinki. Research interests are adolescent development and cognitive and attributional strategies as pathways to problem behavior. To whom correspondence should be addressed.Received Ph.D. from La Trobe University. Research interests are higher education policy, research management, women and careers, and adolescence.Received M.A. from University of Helsinki. Research interests are identity development and problem solving.     

Cognitive factors and classification issues in adolescent depression

A review and critique of the cognitive research among adolescent depressives are presented. It is concluded that the cognitive data and other research indicate a cooccurrence of depression, anxiety and conduct disorders among adolescents. Implications for clinical classification and gender differences among these diagnoses are discussed. Suggestions are offered for how these diagnoses among adolescents relate to diagnoses during young adulthood. It is argued that the cooccurrence of disorders must be taken into account in the study of adolescent depression both as a continuous personality construct and as a diagnosed conduct disorder.This paper was prepared for the SRCD Conference on Development and Adolescent Depression, ETS and Princeton University, Princeton, NJ, June 3–6, 1987.Received Ph.D. from University of Illinois at urbana-Champaign. Research interests are in life-span factors and treatments of mood disorders.     

Contraceptive behavior in adolescence: A decision-making perspective

The contraceptive behavior of adolescent girls was viewed from a decision-making perspective. A semistructured interview protocol was used in interviewing 120 girls aged 12–19 in three clinics (Teen Family Planning, Prenatal, Pediatric Acute Care) at Michael Reese Hospital and Medical Center on (1) demographic in formation; (2) sexual and obstetric history; (3) contraceptive and sexual knowledge, attitudes, and practices; (4) environmental pressures; (5) personality factors; and (6) decision-making style. We found that the girls were generally poor contraceptors. They viewed the costs of contraception (in terms of safety) to be high; and they positively valued physical intimacy, opportunities for which come up unexpectedly and sporadically. These factors, along with their ambivalent views toward pregnancy and childbearing seemed to encourage their risk-taking behavior. Once pregnancy occurred, it was carried to term because of the strong internal and external pressures they felt to have and keep the baby. The peer-led intervention program that we are developing based on the survey findings will focus on (1) the teenagers' lack of accurate and complete knowledge about birth control and conception, (2) their limited sense of options concerning birth control and pregnancy outcomes, and (3) their poor understanding of and lack of insight into what motivates their behavior.This study is part of the investigation being conducted by the YADMAC (Young Adult and Adolescent Decision Making About Contraception) Project at Michael Reese Hospital and Medical Center, 2959 South Cottage Grove, Chicago, Illinois 60616. The authors are all members of the YADMAC research team.Received Ph.D. from the University of Chicago. Current interests are human sexuality and reproductive behavior. Currently at Department of Psychology, St. Xavier College.Received M.D. from the University of Michigan. Current interests are liaison child psychiatry and adolescent sexuality.Received Ph.D. from the University of Chicago. Current interests are early adolescent development issues.Current interests are puberty and sex differences.B. A. candidate in social work, Roosevelt University. Current interests are adolescent sexuality and contraceptive behavior.     

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.     

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.     

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.     

Factors affecting perception of pregnancy risk in the adolescent

Perception of pregnancy risk, fertility knowledge, and probability-based teaching examples of risk were assessed in 104 primiparous urban adolescents 13–18 years of age in their second and third trimester of pregnancy. Perception of risk was not associated with age, actual frequency of intercourse, or level of fertility knowledge. Sexually active adolescents were surprised at subsequent conceptions. Adolescents were unable to utilize concepts of risk taking, even after concrete examples and teaching techniques had been presented.This study was conducted under the auspices of the Department of Obstetrics and Gynecology, Baylor College of Medicine, which provides medical faculty to the Harris County Hospital District, Houston, Texas.Received Ph.D. from the University of Texas at Austin. Current interests are patterns of adolescent child bearing and rearing.Received M.P.H. from the University of Texas School of Public Health. Current interests are adolescent contraceptive behavior.Received D.P.H. from the University of Texas School of Public Health. Current interests are biological psychiatry and socio-medical research.Received M.D. from Baylor College of Medicine. Current interests are continuing education in medical and nonmedical settings.