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Adolescent Medicine
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Perry B. Dinardo, Jennifer Hyland, Ellen S. Rome
The course of illness for adolescents with EDs varies widely across research studies, depending on the patient population studied, length of follow-up, and how recovery is defined. Adolescents tend to recover more successfully than adults with EDs with a recovery rate among adolescents of about 70%. Significant factors contributing to increased likelihood of positive treatment outcome include a higher percentage of median body weight for age at initial presentation, as well as shorter duration of symptoms prior to presentation. In a study of adolescents who were treated for AN in the outpatient setting, about a third of patients were found to be in remission at the 12-month follow-up time point; 4 years later, less than 10% of these patients were found to have relapsed. Relapse rates may be higher for BN, BED, and purging disorder in adolescents, and about 25% of BN patients will be characterized as having chronic disease. Patients should be monitored both for signs of remission of ED and for other possible psychiatric co-morbidities, as high levels of depressive symptoms have also been reported in this population and suicide rates are also increased among patients with EDs. In children and adolescents, early recognition and engagement with a team of care providers, including a medical specialist, therapist, and dietitian, can make the difference between wellness and illness.
Eating Disorders
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
Anorexia nervosa has a multi-factorial aetiology (Herle, 2020). Eating behaviours in childhood are considered as risk factors for eating disorder behaviours and diagnoses in adolescence. Researchers investigated associations between childhood eating behaviours during the first ten years of life and eating disorder behaviours, i.e. binge eating, purging, fasting and excessive exercise, and diagnoses, i.e. anorexia nervosa, binge-eating disorder, purging disorder and bulimia nervosa, at 16 years of age. Data from 4,760 participants from the Avon Longitudinal Study of Parents and Children were included. They recorded parent and self-recorded questionnaires over eight time points. Objectively measured anthropometric data were obtained at 16 years.
Classification of eating disorders
Published in Stephen Wonderlich, James E Mitchell, Martina de Zwaan, Howard Steiger, Eric F van Furth, Annual Review of Eating Disorders Part 1 – 2007, 2018
Jill M Holm-Denoma, Kathryn H Gordon, Thomas E Joiner
This proposed disorder, previously referred to as “subjective BN” (Keel et al. 2001), is characterized by individuals who recurrently purge in the absence of objectively large binges and who are of a normal weight (Keel et al. 2005). A recent study by Keel et al. (2005) suggests that purging disorder (PD) may be a clinically significant and potentially distinctive eating disorder from BN. Specifically, in a study of women with PD (n = 72), BN (n = 39), and no eating-disordered behaviors (n = 35), individuals with PD displayed significantly lower eating concerns, disinhibition, and hunger than those with BN. These individuals also displayed significantly higher eating, Axis I, and Axis II pathology than control subjects. The authors also reported that crossover between BN and PD was rare, which provides further support for the segregation of the two disorders. An additional study by Binford and le Grange (2005) suggests that some adolescents exhibit clinical presentations that are much like the PD described by Keel et al. (2005) in adult women.
Updates in the treatment of Eating Disorders in 2022: a year in review in Eating Disorders: The Journal of Treatment & Prevention
Published in Eating Disorders, 2023
Cassandra E. Friedlich, Andrea Covarrubias, Hyoungjin Park, Stuart B. Murray
With such high relapse rates in EDs spanning BED, BN, and AN, mitigating relapse risk is essential, and maintaining treatment outcomes through specialized interventions can be a vital way of supporting remission. To understand the efficacy of different maintenance treatments, MacDonald et al. (2022) compared a group-based intensive outpatient program (IOP) with individual CBT for EDs. The group-based maintenance treatment included one supported meal and up to five group therapy sessions a week for 16 weeks in which participants were expected to continue adhering to their prescribed meal plan and use tools targeted toward keeping up with newly learned behaviors. The CBT maintenance program focused on relapse prevention, cognitive restructuring, and inducing a greater sense of autonomy in the participants through 16 sessions over the span of 14 weeks. Using a retrospective sequential cohort design, the participants had previously been involved in intensive day treatment or inpatient treatment programs at the investigators’ Centre for Mental Health, in Toronto, Canada. The patients met criteria for either anorexia nervosa, restrictive subtype (AN-R), anorexia nervosa, binge and purge subtype (AN-BP), bulimia nervosa (BN), or purging disorder (PD) in which they achieved at least partial remission (MacDonald et al., 2022).
Empirically derived classes of eating pathology in male and female college students
Published in Eating Disorders, 2018
Brittany L Stevenson, Mun Yee Kwan, Robert D Dvorak, Kathryn H Gordon
Pinheiro, Bulik, Sullivan, and Machado (2008) examined ED phenotypes in women using the Eating Disorder Examination-Questionnaire (EDE-Q; Fairburn & Beglin, 2008). This is a self-report questionnaire that produces a global score and scores on four subscales: restraint, eating concern, shape concern, and weight concern. These subscales are unique to the EDE interview and EDE-Q, which is derived from the interview. In addition, there are behavioral items that ask about the frequency of overeating, binge eating, and compensatory behaviors (laxative use, self-induced vomiting, and excessive exercise). Although the EDE-Q is designed to assess the cognitive and behavioral features of EDs, the measure also includes questions measuring diagnostic criteria and has been useful in detecting clinical cases of ED (Binford, Le Grange, & Jellar, 2005). In their study, Pinheiro et al. (2008) examined latent classes of the behavioral items, finding four classes for women: healthy, binge eating, purging, and bulimic symptoms. These classes were validated with the four subscales and global score of the EDE-Q, showing a trend of scores increasing in order from the healthy class to the bulimic symptom class. These results supported the differentiation between the clinical diagnoses of purging disorder and bulimia nervosa, but classes resembling anorexia nervosa (AN) were not derived due to no behavioral items addressing unique AN symptoms.
Psychological characteristics and childhood adversity of adolescents with atypical anorexia nervosa versus anorexia nervosa
Published in Eating Disorders, 2022
Ashley Pauls, Gina Dimitropoulos, Gisele Marcoux-Louie, Manya Singh, Scott B. Patten
We included adolescents with AN-R and not AN, binge-eating/purging type (AN-B/P) in this study. Adolescents with AN-R are an appropriate comparison for the AAN group given that diagnostically, adolescents with AAN do not have significant binge-eating and purging. If adolescents did demonstrate binge-eating or purging, they were classified as having Bulimia Nervosa, Other Specified Feeding or Eating Disorder (OSFED)- Bulimia Nervosa low frequency or limited duration, or OSFED-Purging Disorder, and were excluded in this study. By comparing adolescents with AAN to AN-R, we aimed to focus on the difference in BMI between these two groups, rather than the difference in binge-eating and purging behaviours.