[Anorexia nervosa]

Anorexia and Depression: Depressive Comorbidity in Anorexic Adolescents

Frequently, depression is a concomitant pathology in anorexia nervosa. To verify this, we carried out a comparative case/control study with 50 anorexic patients, restricting-type (ANP), 50 depressed patients (DP) and 50 non-patients (NP), aged between 13 and 16. We used the Rorschach Test and the Minnesota Multiphasic Personality Inventory (MMPI) and compared the results to parent's observations collected from the Achenbach Child Behavior Checklist (CBCL). Results showed two clearly different groups among participants: ANP with depression (36%) and ANP without depression (64%). This seems to indicate that depression is not a core element in anorexic disorders. However, we also observed a significant increase in the MMPI scale 2, which was probably related to starvation and weight loss. We confirmed the absence of general anxiety in the ANP group and obtained differences between depressive symptoms and those derived from coping deficit disorders. The discussion emphasizes the importance of using several tests to reduce bias in results and conclusions.

[Prevalence of anorexia nervosa, bulimia nervosa and other eating disorders in adolescent girls in Reus (Spain)]

INTRODUCTION

Eating disorders are characterized by changes in eating patterns associated with a series of psychosocial conflicts, low self-esteem and poor empathy, and an obsession with slimming.

OBJECTIVES

The aims of the present study were: 1. To determinate the prevalence of anorexia nervosa, bulimia nervosa and other eating disorders in a representative sample of adolescent girls between the ages of 12 and 21 living in the city of Reus (Spain). 2. To evaluate the association between eating disorders and alterations on the Eating Attitudes Test-40 (EAT-40), Body Attitudes Test (BAT), and the Aesthetic Body Shape Questionnaire (CIMEC).

MATERIAL AND METHOD

We performed a cross-sectional observational study in a random sample of adolescent girls aged between 12 and 21 years old. Information was gathered from a structured questionnaire on demographic and anthropometric factors (age, place of birth, education, etc.), clinical examination, clinical interview, DMS-IV diagnostic criteria, and three self-administered tests: EAT-40, BAT and CIMEC.

RESULTS

A total of 551 adolescents were analyzed. The mean age was 17.6+/-2.5 years. Diagnostic criteria of anorexia nervosa were found in 0.9% (95% CI: 0.4-2.4), bulimia nervosa in 2.9% (95% CI: 1.7-4.7), and other eating disorders in 5.3% (95% CI: 3.6-7.5). The test showing the greatest alterations was the CIMEC (38%), followed by the BAT (27.1%) and EAT-40 (23.1%). All the adolescents that met the diagnostic criteria of anorexia nervosa showed alterations in all three tests.

CONCLUSIONS

The high prevalence of eating disorders indicates the need for greater direct involvement among health professionals. The EAT-40, BAT and CIMEC are effective screening instruments for these disorders.

Cognitive Functioning and Other Discriminatory Variables in Anorexic Patients

This study is part of a larger research study (doctoral dissertation), in which a comparative study with adolescent samples is done: 50 anorexic restricting patients (ANP), 50 patients diagnosed with depression (DP) and 50 non patients (NP). The proposed objective is two-fold: 1) To try to clarify the existing relationship between Anorexia (AN) and Depression (D), investigated from diverse disciplines but without conclusive results. 2) To detect in the ANP personality different traits from those of other groups, which should, if possible, allow to detect them at an early stage for an adequate prognosis.

The current article presents the Rorschach findings in relation to the cognitive functioning of the ANP. In them, the following has been detected: (1) An information processing similar to that of the other groups, even with a more complete (L ≤ .99), more complex (DQ+↑) and better discriminated (Zd↑) grasp of the stimulus; (2) Mediating processes very similar to those of the other groups, sharing with them the perceptive maladjustments (X–%↑) and an excessive individualism (Xu%↑); (3) A clearly differentiating ideation disorder.

Definitely, the ANP use predominantly ideation (M↑), but their thought, usually well-adjusted (MQo↑), presents eventual operations of delusional type (MQnone↑). Above that, their thinking is marked by a great passivity (Mp↑), which makes them more vulnerable to accept ideas without criticizing them and it results in a very inefficient thinking, which spins around these concepts without finding solutions, entering into a sort of ruminating which is completely unproductive. The differences toward the obsessive pathology are established.

The discriminant analysis conducted with all the Rorschach variables that resulted as significant throughout the research, provides quite a consistent function which discriminates the ANP: MQnone↑, Mp↑, FD↓, Ma↑, MQo↑, AdjD↑, Sum H↑, (H)↑. Based on this we can understand that these adolescents, being in a developmental period of big changes and disorientations in relation with their own image, confronted with life events, and possibly starting off with some biologic vulnerability: (1) Due to the alterations of their ideation, accept without criticism (Mp) irrational ideas dominating in our culture, in which slimness appears as the only model, synthesis of intelligence, beauty and success; remaining captured in this type of mental activity (MQnone), which they cannot escape nor criticize (Mp), despite they reason adequately on other topics (MQo); (2) Their alterations of self-perception [(H)] make them hide themselves in a fantasized image, which is the axis of their interests and the only thing that really matters to them; (3) The resources they have to decide on behaviors and to finish these deliberately (AdjD), and their scarce tendency to the introspection (FD) lead to their decision of not eating, based on distorted and passively accepted thinking, which has great power and thus, so difficult to modify. Finally, based on the Rorschach data obtained, the hypothesis of a personality disorder as underlying pathology is pointed out.