Very early-onset bulimia nervosa: report of two cases

A comparison of women with child-adolescent versus adult onset binge eating: results from the National Women's Study

OBJECTIVE

Studies of age of first binge have been conducted in clinical samples of patients with bulimia nervosa (BN) and binge eating disorder (BED), but few studies have examined age of first binge using nationally representative samples.

METHOD

We examined age of first binge and its clinical correlates using data generated from the National Women's Study (n = 3,006). Participants who endorsed ever binge eating (n = 707) were divided into two groups: (1) child-adolescent onset (CO)--age of first binge <18 years, and (2) adult onset (AO)--age of first binge ≥18 years. We hypothesized that CO binge eating would be associated with greater (1) likelihood of developing BN/BED, (2) severity of BN/BED, (3) history of trauma and PTSD, and (4) history of psychiatric comorbidity, such as major depression and substance use.

RESULTS

Of those who ever endorsed binge eating, 212 reported CO (30%) and 495 (70%) reported AO. Although AO binge eating was more common, CO binge eating was associated with higher rates of lifetime BN, greater severity of bulimic symptoms, earlier age of first dieting; earlier age at highest weight, greater likelihood of ED treatment, and higher rates of molestation, physical assault, any direct victimization, lifetime PTSD, and substance abuse.

CONCLUSIONS

AO binge eating is more than twice as common as CO binge eating in women, but CO binge eating is associated with higher rates of lifetime BN, greater severity of BN, and higher rates of victimization, PTSD, and substance abuse.

Risk factors, correlates, and markers in early-onset bulimia nervosa and EDNOS

OBJECTIVE

This study aimed to investigate the specific risk factors, correlates, and markers associated with the development of symptomatology of early-onset BN and subclinical BN.

METHOD

Two semi-structured interviews were used to examine symptomatology and antecedent factors of bulimic symptoms in a sample of British adolescents.

RESULTS

Adolescents with early-onset eating pathology were significantly more likely to report an earlier age of menarche than those developing the disorder at the typical age, and were found to have a different pathway of symptom development.

DISCUSSION

Increased awareness of this may help identify those particularly at risk for developing an early-onset of eating pathology.

Insatisfação corporal em escolares de dois municípios da região Sul do Brasil

OBJETIVO: Avaliar a prevalência de insatisfação corporal e fatores associados em escolares de dois municípios de pequeno porte no Sul do Brasil. MÉTODOS: Estudo transversal, realizado com 573 escolares de 8 a 10 anos dos municípios de Dois Irmãos e Morro Reuter, Rio Grande do Sul. Foram coletados dados sobre insatisfação corporal e peso das crianças por meio de escala de imagem corporal (Children's Figure Rating Scale) e antropometria. As mães responderam questionário sobre preocupações e percepções relacionadas ao peso dos filhos. O Índice de Massa Corporal foi utilizado para classificar o estado nutricional. Fez-se análise de regressão logística para avaliar associações entre as variáveis estudadas e a insatisfação corporal. RESULTADOS: A prevalência de insatisfação corporal foi de 63,9%, sendo que 16,9% estavam com sobrepeso. As variáveis associadas com insatisfação corporal foram: risco para obesidade (Odds ratio=2,91; IC95% 1,26-6,74) e obesidade (Odds ratio=4,47; IC95% 1,12-17,9); residir em zona urbana (Odss ratio=1,75; IC95% 1,03-2,97); mães com menos de oito anos de escolaridade (Odds ratio=1,57; IC95% 1,03-2,40); percepções da mãe de que o filho estava abaixo ou acima do peso adequado (Odds ratio=1,65; IC95% 1,05-2,59) e de que ele se preocupava com o peso (Odds ratio=1,53; IC95% 1,05-2,23). CONCLUSÃO: Altos índices de insatisfação com o corpo também são observados em pré-adolescentes de cidades do interior. Os dados gerados por este estudo são suficientes para alertar pais, educadores e profissionais de saúde para a necessidade de desenvolver estratégias que visem a maior satisfação das crianças com o seu corpo.

Eating disorders in adolescents and young adults

Adolescence and young adulthood mark the convergence of substantial biologic and social change. Individuals differ in their innate capacity to tolerate change. Research suggests that some of the personality characteristics that are fundamental to individuals with eating disorders may render them particularly vulnerable to the impact of a changing body and changing social demands. The fact that eating disorders emerge primarily during adolescence and often run a protracted course can deprive the afflicted individual of the core social, emotional, and biologic developmental processes that normally occur during this time of life.

Bulimia in children and adolescents

Although there have been many recent advances in research, much work remains to be done in the area of child and adolescent eating disorders. More data are needed regarding the normal development of eating behavior, resilience and risk factors for eating pathology, and treatment studies in children and adolescents. The best studied areas include epidemiology, short-term treatment for bulimia nervosa (BN), and outcome in anorexia nervosa. A case report of the single blind use of repetitive transcranial magnetic stimulation in a patient with BN has been reported, but its safe use in children and adolescents remains to be established.

Unterschiede zwischen jugendlichen Patientinnen mit Anorexia und Bulimia nervosa im Hinblick auf psychologische und psychosoziale Merkmale

Zusammenfassung: Fragestellung: Die Studie widmet sich der Frage, inwieweit sich jugendliche Patientinnen mit Anorexia und Bulimia nervosa in psychologischen Merkmalen und Lebensverhältnissen unterscheiden. Methode: Die Krankengeschichten von 140 Patientinnen (110 mit Anorexia nervosa und 30 mit Bulimia nervosa), die in den Jahren 1982 bis 1992 in der Klinik für Kinder- und Jugendpsychiatrie der Universität Würzburg stationär behandelt wurden, wurden im Rahmen einer retrospektiven Studie ausgewertet. Alle Patientinnen erfüllen die Kriterien nach ICD-10 für Anorexia- oder Bulimia nervosa. Daten aus der Basis-Dokumentation und aus der multiaxialen Klassifikation (MAS) wurden herangezogen, standardisierte Verfahren wie der Anis-32, MMPI, BDI, HAWIK-R und HAWIE kamen zur Auswertung. Die Ergebnisse zeigen signifikante Unterschiede zwischen den beiden Stichproben. Das häufigste Alter bei erster stationärer Aufnahme war bei anorektischen Patientinnen 14,5 und bei bulimischen Patientinnen 16,5 Jahre. Die störungsspezifischen Symptome betreffend unterschieden sich die beiden Stichproben hinsichtlich ihres Essverhaltens im Faktor Bulimie des Anis-32. Beim Vergleich der Persönlichkeitsmerkmale beschrieben sich die anorektischen Patientinnen im MMPI weniger psychopathisch als die Bulimia nervosa Patientinnen. Im BDI war die depressive Symptomatik bei Anorexia nervosa als klinisch relevant einzustufen. Andere Charakteristika der anorektischen Patientinnen waren ein überdurchschnittlicher IQ, Überfürsorglichkeit innerhalb der familiären Beziehungen, vermehrte Trennungsängste und Kontaktstörungen in der Schule. Im Vergleich dazu zeigten die bulimischen Patientinnen häufiger Leistungs- und Disziplinierungsschwierigkeiten in der Schule, innerhalb der Familie wurde das Kontaktverhalten und die Kommunikation beeinträchtigter als bei Familien anorektischer Patientinnen erlebt.

Eating disorders in elementary and middle school children: risk factors, early detection, and prevention

Eating disorders (EDs) are significant problems that are typically diagnosed during adolescence. However, the risk factors for and early symptoms of EDs often develop in the elementary and middle school years. Dieting, body dissatisfaction, obesity, parental attitudes, and the influence of the media are some of the significant identifiable risk factors. Prevention programs need to be developed that focus on education, consultation, and consciousness-raising. Early detection involves screening, assessment, and referral for appropriate treatment. School nurses are skilled, educated, and positioned to develop programs for the prevention and early detection of EDs.