Complications of bereavement as seen in infant anorexia and adolescent anorexia nervosa

Prenatal maternal bereavement and risk of eating disorders in infants and toddlers: a population-based cohort study

BACKGROUND

Prenatal stress has been associated to a number of neuropsychiatric diseases but its role on the development of eating disorders (ED) remains unknown. Infants and toddlers with feeding or eating disorders are also at an increased risk of such diseases in later childhood and adolescence. We aimed to examine whether prenatal stress following maternal bereavement is associated with ED in infants and toddlers.

METHODS

This population-based cohort study included children born from 1977 to 2008 in Denmark (N = 2,127,126) and from 1977 to 2006 in Sweden (N = 2,974,908). Children were categorized as exposed if they were born to mothers who lost a close relative one year prior to or during pregnancy and were categorized as unexposed otherwise. They were followed until the age of 3 for a first diagnosis of ED. Poisson regression models were used to examine incidence rate ratio (IRR) between the exposed and the unexposed cohort.

RESULTS

A total of 9,403 ED cases were identified and 179 of whom were in the exposed cohort. Offspring born to mothers bereaved by loss of a core family member (older child or spouse) within the six months before pregnancy had a higher risk of ED than the unexposed offspring (IRR: 1.63, 95% confidence intervals (CI): 1.07-2.47). In stratified analyses, bereavement during the six months before pregnancy was associated with an increased risk of ED in boys (IRR: 2.21, 95% CI: 1.28-3.82), but not in girls (IRR: 1.18, 95% CI: 0.61-2.27).

DISCUSSION

This is the first population-based study to explore the association between prenatal stress and the risk of ED in infants and toddlers within two Nordic countries. This study added new evidence of early life stress for etiology of ED while the potential mechanism still needs further studies.

CONCLUSIONS

Prenatal stress following maternal bereavement by loss of a core family member is associated with an increased risk of ED among infants and toddlers. The six months before conception may be a susceptible time window, especially for boys.

Family therapy in the treatment of adolescent anorexia nervosa: current research evidence and its therapeutic implications

From the outset, the systemic and family movement has expressed an interest in eating disorders, more specifically anorexia nervosa, establishing causal links between family functioning and aetiology and advocating family therapy as the treatment of choice for this disorder. Because of high consistency between its explanatory and therapeutic dimensions, this model continues to dominate our conceptualizations and clinical practice, in spite of a lack of empirical support. This article summarizes present empirical evidence concerning both family functioning (explanatory dimension) and the effectiveness of family therapy (therapeutic dimension) in anorexia nervosa, and describes resulting changes in theoretical and clinical perspectives. A model of evidence-based family therapy is presented and several unresolved issues are raised. Overall, this overview of the literature supports the use of therapeutic models that are more flexible and normative, less guilt-inducing, more diversified (eclectic and integrative), and more rooted in the empirical literature.

Partial syndromes in eating disorders: a prevalence study on a sample of Italian adolescents

OBJECTIVE

Exploring the spectrum of eating disorders (ED) and its sociodemographic correlates in a population of adolescents.

METHOD

The sample included 788 adolescent students (384 females and 404 males, 12-14 years old) from Verona, Northern Italy. A two-stage sampling procedure was adopted. Eating Disorder Inventory-2 (EDI-2), Body Image Satisfaction Questionnaire (BISQ) and a socio-demographic questionnaire were applied to the sample in the first stage. The sample was then partitioned in two strata, "below-cutoff" and "above-cutoff", using the threshold DT > or = 14 for the Drive for Thinness (DT) subscale. A second sample of 59+58 subjects was selected from the two strata. The structural interview of the second stage consisted of the Structured Clinical Interview for DSM-IV Axis I Disorders and the Symptom Checklist of EDI-2.

RESULTS

Partial syndromes of ED were diagnosed in 9.4% of the interviewed sample with a sex ratio F/M=6. The following factors resulted to be related to partial syndrome of ED: dieting to be thin, body mass index, mother's occupation and being a menstruating girl.

CONCLUSION

This study represents one of the few prevalence and association studies about ED in young Italian adolescents. It evidences that partial syndromes of ED, in particular the partial syndrome of binge eating disorder, are the most frequent syndromes in early adolescence. Some social and parental factors resulted to be significantly related to these syndromes.