1
|
Andrés-Pepiñá S, Plana MT, Flamarique I, Romero S, Borràs R, Julià L, Gárriz M, Castro-Fornieles J. Long-term outcome and psychiatric comorbidity of adolescent-onset anorexia nervosa. Clin Child Psychol Psychiatry 2020; 25:33-44. [PMID: 30764636 DOI: 10.1177/1359104519827629] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the outcome of adolescents with anorexia nervosa (AN) about 20 years after first treatment. METHODS Sixty-two women diagnosed with AN during adolescence were invited to participate. Of these 62 patients, 38 agreed to participate and were assessed with a battery of questionnaires and interviews. A control group of 30 women of similar age was also assessed. RESULTS Of the patients who completed the full assessment, 13 (34%) presented some degree of eating disorder (ED) at follow-up (10 (26%) met full Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for an ED and 3 (8%) showed partial remission of an ED). The remaining 25 (66%) patients had fully recovered from AN. The duration of untreated illness before admission was significantly associated with an increased risk of a current ED (odds ratio (OR) = 3.334 (1.3-8.7); p = .014). Of the patients who had recovered totally from their ED, 24% showed another psychiatric disorder. This percentage rose to 70% in patients with a current ED. CONCLUSION Sixty-six percent of adolescents who completed the assessment achieved remission of their AN. Comorbidity was more common in the current ED group. The variable that best predicted complete remission was the number of years without treatment, showing the importance of detection and early intervention.
Collapse
Affiliation(s)
- Susana Andrés-Pepiñá
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neurosciences, Hospital Clinic de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Maria Teresa Plana
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neurosciences, Hospital Clinic de Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Itziar Flamarique
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neurosciences, Hospital Clinic de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Sonia Romero
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neurosciences, Hospital Clinic de Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Roger Borràs
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neurosciences, Hospital Clinic de Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Laia Julià
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neurosciences, Hospital Clinic de Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Miguel Gárriz
- Institut de Neuropsiquiatria i Addiccions, CSMA La Mina, Parc de Salut Mar, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neurosciences, Hospital Clinic de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.,Department of Medicine, University of Barcelona, Spain
| |
Collapse
|
2
|
Graell M, de Andrés P, Sepúlveda AR, Moreno A, Villaseñor Á, Faya M, Martínez‐Cantarero C, Gómez‐Martínez S, Marcos A, Morandé G, Nova E. The adolescent onset anorexia nervosa study (ANABEL): Design and baseline results. Int J Methods Psychiatr Res 2018; 27:e1739. [PMID: 30133037 PMCID: PMC6877151 DOI: 10.1002/mpr.1739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 06/05/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022] Open
Abstract
The anorexia nervosa adolescent longitudinal biomarker assessment study (ANABEL) is a 2-year longitudinal study. OBJECTIVE Evaluate several clinical, biochemical, immunological, psychological, and family variables and their interactions in adolescent onset eating disorders (EDs) patients and their 2-year clinical and biological outcome. This article illustrates the framework and the methodology behind the research questions, as well as describing general features of the sample. METHODS A longitudinal study of 114 adolescents with EDs seeking treatment was performed. Only adolescents were selected during 4 years (2009-2013). The variables were collected at different times: baseline, 6, 12, 18, and 24 months of the start of treatment. Diagnoses were completed through the semi-structured Kiddie-Schedule for Affective Disorders and Schizophrenia interview. RESULTS At baseline, the mean age was 15.11 (SD = 1.36). The mean ED duration was 10 months (SD = 5.75). The mean body mass index was 16.1 (SD = 1.8). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis at baseline for restrictive anorexia nervosa was 69.6%, 17.4% for purgative anorexia nervosa, and 24.3% for other specified feeding disorder. At 12 months, 19.4% were in partial remission, whereas at 24 months, 13.8% had fully recovered and 29.2% had partially recovered. CONCLUSIONS There was an acceptable physical and psychopathological improvement during the first year of treatment, with recovery being more evident during the first 6 months.
Collapse
Affiliation(s)
- Montserrat Graell
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)España
| | - Patricia de Andrés
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | | | - Alba Moreno
- School of PsychologyAutonomous University of MadridMadridSpain
| | - Ángel Villaseñor
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | - Mar Faya
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | - Carmen Martínez‐Cantarero
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | - Sonia Gómez‐Martínez
- Immunonutrition Research Group, Department of Metabolism and NutritionInstitute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC)MadridSpain
| | - Ascensión Marcos
- Immunonutrition Research Group, Department of Metabolism and NutritionInstitute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC)MadridSpain
| | - Gonzalo Morandé
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | - Esther Nova
- Immunonutrition Research Group, Department of Metabolism and NutritionInstitute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC)MadridSpain
| |
Collapse
|
3
|
Reijonen JH, Pratt HD, Patel DR, Greydanus DE. Eating Disorders in the Adolescent Population:. JOURNAL OF ADOLESCENT RESEARCH 2016. [DOI: 10.1177/0743558403018003002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although eating disorders often begin during adolescence, characteristics of this population can complicate early detection by clinicians. The purpose of this article is to selectively review the literature on the diagnostic criteria for eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder) as described in Diagnostic and Statistical Manual of Mental Disorders (4th ed.) and International Classification of Diseases (10th ed.). The prevalence and course of eating disorders, theories regarding their etiology, and issues of comorbidity and differential diagnosis are also discussed.
Collapse
|
4
|
Rigaud D, Pennacchio H, Bizeul C, Reveillard V, Vergès B. Outcome in AN adult patients: A 13-year follow-up in 484 patients. DIABETES & METABOLISM 2011; 37:305-11. [DOI: 10.1016/j.diabet.2010.11.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 10/27/2010] [Accepted: 11/03/2010] [Indexed: 10/18/2022]
|
5
|
Perfectionism as a transdiagnostic process: A clinical review. Clin Psychol Rev 2011; 31:203-12. [DOI: 10.1016/j.cpr.2010.04.009] [Citation(s) in RCA: 506] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 04/12/2010] [Accepted: 04/22/2010] [Indexed: 12/18/2022]
|
6
|
Björk T, Clinton D, Norring C. The impact of different outcome measures on estimates of remission in a 3-year follow-up of eating disorders. EUROPEAN EATING DISORDERS REVIEW 2010; 19:2-11. [DOI: 10.1002/erv.1031] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
Eisler I, Simic M, Russell GFM, Dare C. A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. J Child Psychol Psychiatry 2007; 48:552-60. [PMID: 17537071 DOI: 10.1111/j.1469-7610.2007.01726.x] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is growing evidence that family therapy is an effective treatment for adolescent anorexia nervosa. This study aimed to ascertain the long-term impact of two forms of outpatient family intervention previously evaluated in a randomised controlled trial (RCT). METHOD A five-year follow-up was conducted on a cohort of 40 patients who had received either 'conjoint family therapy' (CFT) or 'separated family therapy' (SFT). All patients were traced and 38 agreed to be reassessed (29 interviewed in person, 3 completed telephone interviews, 6 completed questionnaires and/or agreed for parents/GP to be interviewed). RESULTS Overall there was little to distinguish the two treatments at 5 years, with more than 75% of subjects having no eating disorder symptoms. There were no deaths in the cohort and only 8% of those who had achieved a healthy weight by the end of treatment reported any kind of relapse. Three patients developed bulimic symptoms but only one to a degree warranting a diagnosis of bulimia nervosa. The one difference between the treatments was in patients from families with raised levels of maternal criticism. This group of patients had done less well at the end of treatment if they had been offered conjoint family meetings. At follow-up this difference was still evident, as shown in the relative lack of weight gain since the end of outpatient treatment. CONCLUSIONS This study confirms the efficacy of family therapy for adolescent anorexia nervosa, showing that those who respond well to outpatient family intervention generally stay well. The study provides further support for avoiding the use of conjoint family meetings at least early on in treatment when raised levels of parental criticism are evident.
Collapse
Affiliation(s)
- Ivan Eisler
- South London and Maudsley NHS Trust, London, UK.
| | | | | | | |
Collapse
|
8
|
Bardone-Cone AM, Wonderlich SA, Frost RO, Bulik CM, Mitchell JE, Uppala S, Simonich H. Perfectionism and eating disorders: Current status and future directions. Clin Psychol Rev 2007; 27:384-405. [PMID: 17267086 DOI: 10.1016/j.cpr.2006.12.005] [Citation(s) in RCA: 298] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 12/19/2006] [Accepted: 12/21/2006] [Indexed: 11/15/2022]
Abstract
The literature examining the relation between perfectionism and eating disorders was reviewed and content and methodological comparisons were made with the perfectionism literature in anxiety disorders and depressive disorders. A PsychInfo search using the key words "perfectionism/perfect/perfectionistic," "anorexia," "bulimia," and "eating disorders" was performed and the generated list of papers was supplemented based on a review of reference lists in the papers. A total of 55 papers published between 1990 and 2005 were identified that assessed perfectionism among individuals with diagnosed eating disorders. The key research questions were distilled from these publications and empirical findings were summarized for each question, followed by a comparison with perfectionism papers in the anxiety and depressive disorder literatures. Also, key research design methodological parameters were identified and comparisons made across the three literatures: eating disorders, anxiety disorders, depressive disorders. The current review concludes with conceptual and methodological recommendations for researchers interested in perfectionism and eating disorders.
Collapse
Affiliation(s)
- Anna M Bardone-Cone
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO, USA.
| | | | | | | | | | | | | |
Collapse
|
9
|
Godart NT, Perdereau F, Rein Z, Berthoz S, Wallier J, Jeammet P, Flament MF. Comorbidity studies of eating disorders and mood disorders. Critical review of the literature. J Affect Disord 2007; 97:37-49. [PMID: 16926052 DOI: 10.1016/j.jad.2006.06.023] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 06/27/2006] [Accepted: 06/27/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We conducted a critical literature review of studies assessing the prevalence of mood disorders (MD) in subjects with eating disorders (ED; anorexia nervosa and bulimia nervosa). In the first part of this article, we discuss methodological issues relevant to comorbidity studies between ED and MD. In the second part, we summarize the findings of these studies in light of the methodological considerations raised. METHOD A manual computerised search (Medline) was performed for all published studies on comorbidity between ED and MD. In order to have sufficiently homogeneous diagnostic criteria for both categories of disorders, this search was limited to articles published between 1985 and 2006. RESULTS Too few studies include control groups, few studies compared diagnostic subgroups of ED subjects, and results are scarce or conflicting. DISCUSSION The results are discussed in the light of the methodological problems observed. The implications when reviewing the results of published studies and planning future research are set out.
Collapse
Affiliation(s)
- N T Godart
- Department of Psychiatry, Institut Mutualiste Montsouris (IMM), University, René Descartes-Paris V, France.
| | | | | | | | | | | | | |
Collapse
|
10
|
Godart NT, Perdereau F, Jeammet P, Flament MF. [Comorbidity between eating disorders and mood disorders: review]. Encephale 2006; 31:575-87. [PMID: 16598962 DOI: 10.1016/s0013-7006(05)82417-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Comorbidity between eating disorders (ED) and mood disorders is a major issue when evaluating and treating patients with anorexia nervosa (AN) or bulimia nervosa (BN). In the literature, estimated comorbidity rates of mood disorders in subjects with ED differ widely across studies. Obviously, it is difficult to compare results from various sources because of differences in methods of assessment of depressive symptoms and in diagnostic criteria for both ED and mood disorders. Furthermore, few studies have included control groups, and, since mood disorders are among the most frequent psychiatric disorders in women--with an average estimated lifetime prevalence of 23.9 % (Kessleret al., 1994)--, it is not clear, yet, whether mood disorders are more common among women with an ED (AN or BN) than among women from the community. The only review articles we found on the relationships between ED and mood disorders survey different types of arguments in favour of a link between both categories of disorders, including symptoms, personal and family comorbidity, overlap in biological findings, and treatment results, but do not review in detail available comorbidity data. The aim of this paper is to conduct a critical literature review on studies assessing the prevalence of mood disorders in subjects with an ED (AN or BN). In the first part, we will discuss methodological issues relevant to comorbidity studies between ED and mood disorders, and select the most reliable studies. In the second part, taking into account these methodological considerations raised, we summarize the findings of these studies. METHOD We performed a manual and computerized search (Medline) for all published studies on comorbidity between ED and AD, limiting our search to the 1985-2002 period, in order to get sufficiently homogeneous diagnostic criteria for both categories of disorders. RESULTS Too few studies include control groups and few studies have compared diagnostic subgroups of ED subjects, with scarce or conflicting results. DISCUSSION We reviewed numerous studies here and conclude simply that there are many arguments in favor of elevated rates of MD in ED subjects, but there is no convincing evidence yet. Many questions are left unanswered or have conflicting responses. Our review highlights the need for further studies, which should address several requisites: comorbidity studies should be designed with this as a specific goal, rather than as a secondary aim within other types of studies (such as treatment studies, follow-up studies, etc.). Kendler et al. (1991) state that individuals with two disorders are more likely to present for treatment than individuals with one, therefore, comorbidity rates (which are not in agreement with a special etiologic relationship between BN and depression) may be exaggerated in clinical population results. New studies should include control subjects, matched (at least) for sex and age with ED subjects. Studies should evaluate prevalence of all types of MD in order to yield comparable estimates of MD in general. Comorbidity studies should be conducted on both current and recovered patients, compared to subjects from the community. It is still necessary to demonstrate specificity of findings, i.e. that early onset MD are of specific etiological importance to ED and do not simply increase the risk of later psychopathology in general. Studies should be conducted on larger samples, and all diagnostic subgroups should be considered (restrictive and bulimic anorexics, bulimics with and without history of AN, with or without purging). Multivariate comparisons should be performed, taking into account subject age, sex (if men are included), in- and outpatient status, course of illness, and other possibly relevant variables. Thus, more reliable estimates of the frequency of MD in subjects with ED could provide us with valuable etiologic, therapeutic and prognostic information.
Collapse
Affiliation(s)
- N T Godart
- Département de Psychiatrie, Institut Mutualiste Montsouris, Paris, France
| | | | | | | |
Collapse
|
11
|
Abstract
OBJECTIVE The current study presents the long-term course of anorexia nervosa (AN) over 12 years in a large sample of 103 patients diagnosed according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). METHOD Assessments were made at the beginning of therapy, at the end of therapy, at the 2-year follow-up, at the 6-year follow-up, and at the 12-year follow-up. Self-rating and an expert-rating interview data were obtained. RESULTS The participation rate at the 12-year follow-up was 88% of those alive. There was substantial improvement during therapy, a moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 12 years posttreatment. Based on a global 12-year outcome score, 27.5% had a good outcome, 25.3% an intermediate outcome, 39.6% had a poor outcome, and 7 (7.7%) were deceased. At the 12-year follow-up 19.0% had AN, 9.5% had bulimia nervosa-purging type (BN-P), 19.0% were classified as eating disorder not otherwise specified (EDNOS). A total of 52.4% showed no major DSM-IV eating disorder and 0% had binge eating disorder (BED). Systematic-strictly empirically based-model building resulted in a parsimonious model including four predictors of unfavorable 12-year outcome explaining 45% of the variance, that is, sexual problems, impulsivity, long duration of inpatient treatment, and long duration of an eating disorder. CONCLUSION Mortality was high and symptomatic recovery protracted. Impulsivity, symptom severity, and chronicity were the important factors for predicting the 12-year outcome.
Collapse
|
12
|
Rodríguez Martín A, Novalbos Ruiz JP, Martinez Nieto JM, Escobar Jiménez L, Castro de Haro AL. Characteristics of eating disorders in a university hospital-based Spanish population. Eur J Clin Nutr 2005; 59:459-62. [PMID: 15674311 DOI: 10.1038/sj.ejcn.1602095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the personal and family antecedents and clinical characteristics of patients with eating disorders (EDs) in a population of the south of Spain; to analyse the influence of lifestyles, family functioning, socioeconomic status (SES), and psychological characteristics in these processes. DESIGN A university-based case-control study. SETTING University Hospital (Andalusia, Spain). SUBJECTS A total of 120 patients with EDs and 240 controls. INTERVENTIONS SCOFF, EDI, APGAR family, and SES questionnaires. RESULTS In all, 67.5% of patients presented anorexia (AN), 15% bulimia (BN), and 17.5% mixed forms. EDs emerged at around 18-20 y (95% CI 17.9-19.8). Factors associated with EDs are psychiatric conditions (depression OR: 4.16, anxiety OR: 4.59), more frequent use of medication (OR: 2.26), dietary fibre (OR: 2.59), and laxatives (OR: 3.47). Toxics consumption, sport activity, SES, and family antecedents of pathology are not associated with EDs. An inverse relationship was found between family functioning and the scores in various subscales of the EDI. CONCLUSIONS Eating disorders in Andalusia (Spain) are influenced significantly more by psychological, family, and cultural factors than by social factors.
Collapse
Affiliation(s)
- A Rodríguez Martín
- Area of Preventive Medicine and Public Health, University of Cádiz, Spain.
| | | | | | | | | |
Collapse
|
13
|
Roerig JL, Mitchell JE, Steffen KJ. New targets in the treatment of anorexia nervosa. Expert Opin Ther Targets 2005; 9:135-51. [PMID: 15757487 DOI: 10.1517/14728222.9.1.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The pathophysiology of anorexia nervosa (AN) is complex and involves alterations of serotonin, dopamine and histamine neurotransmitters. In addition, receptor activity is disturbed, presumably in response to the neurotransmitter changes. These alterations are reviewed in relation to symptomatology and outcome of AN. Neuropeptide and peripheral orexigenic and satiety peptide research is in its infancy but holds much promise to shed light on the pathophysiological mechanisms involved in this illness. Current drug therapies have not demonstrated the efficacy desired in the treatment of AN. Current therapies are reviewed and new drug targets are explored. Compounds that interact with serotonin, histamine and dopamine receptors may offer unique treatment opportunities. In the future, the manipulation of peptides may add to the therapeutic potential of pharmacotherapy.
Collapse
Affiliation(s)
- James L Roerig
- University of North Dakota, Department of Clinical Neuroscience, School of Medicine and Health Sciences, Grand Forks, USA.
| | | | | |
Collapse
|
14
|
Godart NT, Perdereau F, Jeammet P, Flament MF. Comorbidité des troubles du comportement alimentaire et des troubles anxieux. Encephale 2005; 31:152-61. [PMID: 15959442 DOI: 10.1016/s0013-7006(05)82382-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Taking into account the methodological problems underlined in the first part of this paper, the current review aims to answer three questions: 1) Is there convincing evidence that anxiety disorders (AD) are more frequent among women with eating disorders (ED) than among women from the community? 2) Is there convincing evidence that prevalence of AD differs across diagnostic types or subtypes of ED? 3) What is the chronology of appearance of the two disorders? We performed a manual and computerized search (Medline) for all published studies on comorbidity between ED and AD (1985-2002 period), and selected the most relevant studies. An increased risk for AD in subjects with ED has been shown in several community studies, but studies conducted in referred subjects have led to inconstant findings. The answer to the questions remains uncertain, because too few studies included control groups and few studies have compared diagnostic subgroups of ED subjects, with scarce or conflicting results.
Collapse
Affiliation(s)
- N T Godart
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | | | | | | |
Collapse
|
15
|
Godart NT, Perdereau F, Jeammet P, Flament MF. Comorbidité entre les troubles du comportement alimentaire et les troubles anxieux Première partie : revue méthodologique. Encephale 2005; 31:44-55. [PMID: 15971639 DOI: 10.1016/s0013-7006(05)82371-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED The objective of our work is to conduct a critical literature review on studies assessing the prevalence of anxiety disorders (AD) in subjects with eating disorders (ED) (anorexia nervosa and bulimia nervosa). In the first part (this paper), we will discuss methodological issues relevant to comorbidity studies between ED and AD. METHOD We performed a manual and computerised search (Medline) for all published studies on comorbidity between ED and AD, limiting our search to the 1985-2002 period, in order to get sufficiently homogeneous diagnostic criteria for both categories of disorders (most often RDC, DSM III, DSM Ill-R, or DSM IV criteria). RESULTS We review methodological issues regarding population sources, general methodological procedures, diagnostic criteria for ED and AD, diagnostic instruments, age of subjects and course of the eating disorder. DISCUSSION We give implications for reviewing the results of published studies and planing future research.
Collapse
Affiliation(s)
- N T Godart
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | | | | | | |
Collapse
|
16
|
Abstract
In this article, we review the clinical research on the implications of comorbid personality disorders (PDs), pathological personality traits, and the expression and response to treatment of those with eating disorders (EDs) (i.e., anorexia and bulimia nervosa, and binge eating disorder). Obsessive-compulsive PDs and related traits, such as perfectionism and rigidity, appear to be clear-cut risk and maintenance factors for anorexia nervosa. In bulimia nervosa, trait impulsivity seems to be related to early termination from therapy and, according to at least some indices, poorer responses to treatment. Dramatic-Erratic PD features, generally more characteristic of binge-purge ED variants, clearly predict a protracted course for general psychiatric symptoms, but may have less prognostic value for eating symptoms. Recent guidelines from two influential bodies--the American Psychiatric Association (APA, 2000) and the United Kingdom's National Institute for Clinical Excellence (NICE, 2004)--both include the concept that "trait-oriented" interventions, targeting personality-linked components like perfectionism, affective instability, impulsivity, and interpersonal disturbances, may optimize treatment effects. In general, the literature supports the recommendation that clinicians should apply well-validated, symptom-focused therapies for the EDs; in addition, clinicians may wish to incorporate trait-focused interventions in patients in whom personality pathology contributes to suboptimal response.
Collapse
|
17
|
González-Pinto A, Inmaculada F, Cristina R, de Corres Blanca F, Sonsoles E, Fernando R, Purificacion L. Purging behaviors and comorbidity as predictive factors of quality of life in anorexia nervosa. Int J Eat Disord 2004; 36:445-50. [PMID: 15558646 DOI: 10.1002/eat.20058] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study examined the predictive factors for the physical and mental summary components (PCS and MCS) of quality of life (SF-36) in patients with anorexia nervosa. METHOD Forty-seven patients with anorexia nervosa were studied. Assessment comprised psychiatric diagnosis by a clinical structured interview for Axis I disorders (SCID-I) and personality disorders (SCID-II), Clinical Global Impression (CGI), and Quality of Life (SF-36). RESULTS Anorexia nervosa, restrictive type, was diagnosed in 73.9% of the patients and 51% of the patients presented with comorbidity on Axis I or Axis II or both. The predictive variables for the PCS were poor outcome in previous year, comorbidity on Axes I and II, and female gender. The predictive variables for the MCS were the presence of comorbidity in one or the other of the Axis I or II disorders and purging behaviors. DISCUSSION The current study suggests the importance of comorbidity and purging behaviors in the quality of life of these patients with anorexia nervosa.
Collapse
Affiliation(s)
- Ana González-Pinto
- Department of Psychiatry, Santiago Apóstol Hospital, Osakidetza Mental Health System, Olaguibel 29, 01004 Vitoria, Spain.
| | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
OBJECTIVE The study was carried out to test whether time to remission varies for different eating disorder symptoms. METHOD Sixty-five patients (35 anorexic patients and 30 bulimic patients) treated with psychotherapy were interviewed 2 1/2 years after initial assessment. RESULTS The anorexic physical symptoms remitted before the psychological symptoms of anorexia and bulimia nervosa, as did the bulimic behaviors: binging and purging. Nonpurging compensatory behavior and obsession with weight and shape were the last symptoms to remit. Differences between the anorexic and bulimic groups were found between the remission order of psychological symptoms. DISCUSSION In spite of different treatments and symptoms between patients, the results support the notion of a common pattern in the process of change including a long and stepwise course. The results detail a template of the course to recovery for eating disorders.
Collapse
Affiliation(s)
- Loa Clausen
- Department of Psychology, University of Aarhus, Riskov, Denmark.
| |
Collapse
|
19
|
Clausen L. Review of studies evaluating psychotherapy in bulimia nervosa: The influence of research methods. Scand J Psychol 2004; 45:247-52. [PMID: 15182243 DOI: 10.1111/j.1467-9450.2004.00401.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of the study was to test if design and research methods of studies predict outcome results of bulimia nervosa. Fifty-seven articles on outcome of bulimia nervosa were found through MEDLINE and PSYCHINFO databases and 25 were included in the statistical analysis. Percentages of patients with a good outcome ranged from 24% to 74% with a mean of 51.1%. The variables best predicting outcome were time to follow-up and number of symptoms evaluated in definition of good outcome whereas dropout, design of studies, treatments, and sample characteristics did not predict significantly. The implications of these findings are discussed.
Collapse
Affiliation(s)
- Loa Clausen
- Department of Psychology, Aarhus University, Denmark and Eating Disorder Centre, Aarhus University Hospital, Denmark.
| |
Collapse
|
20
|
Korndörfer SR, Lucas AR, Suman VJ, Crowson CS, Krahn LE, Melton LJ. Long-term survival of patients with anorexia nervosa: a population-based study in Rochester, Minn. Mayo Clin Proc 2003; 78:278-84. [PMID: 12630579 DOI: 10.4065/78.3.278] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To estimate long-term survival of unselected patients with anorexia nervosa from Rochester, Minn. PATIENTS AND METHODS In this population-based retrospective cohort study, all 208 Rochester residents who presented with anorexia nervosa (193 women and 15 men) for the first time from 1935 through 1989 were monitored for up to 63 years. Subsequent survival was compared with that expected for Minnesota white residents of similar age and sex, and standardized mortality ratios were determined on the basis of age- and sex-specific death rates for the US population in 1987. RESULTS Survival was not worse than expected in this cohort (P = .16). The estimated survival 30 years after the initial diagnosis of anorexia nervosa was 93% (95% confidence interval, 88%-97%) compared with an expected 94%. During 5646 person-years of follow-up (median, 22 years per patient), 17 deaths occurred (14 women and 3 men) compared with an expected 23.7 deaths (standardized mortality ratio, 0.71; 95% confidence interval, 0.42-1.09). One woman died of complications of anorexia nervosa, 2 women committed suicide, and 6 patients (5 women and 1 man) died of complications of alcoholism. Other causes of death were not increased. CONCLUSIONS Long-term survival of Rochester patients with anorexia nervosa did not differ from that expected. This finding suggests that overall mortality was not increased among the spectrum of cases representative of the community.
Collapse
Affiliation(s)
- Sergio R Korndörfer
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn 55905, USA
| | | | | | | | | | | |
Collapse
|
21
|
Godart NT, Flament MF, Perdereau F, Jeammet P. Comorbidity between eating disorders and anxiety disorders: a review. Int J Eat Disord 2002; 32:253-70. [PMID: 12210640 DOI: 10.1002/eat.10096] [Citation(s) in RCA: 226] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We conducted a critical literature review on studies assessing the prevalence of anxiety disorders (AD) in subjects with eating disorders (ED) (anorexia nervosa and bulimia nervosa). In the first part, we discuss methodological issues relevant to comorbidity studies between ED and AD. In the second part, taking into account these methodological considerations raised, we summarize the findings of these studies. METHOD We performed a manual and computerized search (Medline) for all published studies on comorbidity between ED and AD, limiting our search from 1985-2001 to get sufficiently homogeneous diagnostic criteria for both categories of disorders. RESULTS Too few studies include control groups and few studies have compared diagnostic subgroups of ED subjects, with scarce or conflicting results. DISCUSSION We discuss the results taking into account the methodological problems observed. We give guidelines for reviewing the results of published studies and planing future research.
Collapse
Affiliation(s)
- N T Godart
- Department of Psychiatry, Institut Mutualiste Montsouris, Paris, France.
| | | | | | | |
Collapse
|
22
|
Miotto P, De Coppi M, Frezza M, Rossi M, Preti A. Social desirability and eating disorders. A community study of an Italian school-aged sample. Acta Psychiatr Scand 2002; 105:372-7. [PMID: 11942944 DOI: 10.1034/j.1600-0447.2002.1o186.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore the links between social desirability and eating disorders in a sample of adolescents in a north-east area of Italy. METHOD A mixed male-female sample of 1000 school-aged adolescents, corresponding to 10% of the young population aged 15-19 years living in the district, were investigated with self-reported questionnaires, including the Eating Attitudes Test (EAT), the Bulimic Investigatory Test of Edinburgh (BITE), the Body Attitudes Questionnaire (BAT), and an Italian version of the Marlowe-Crowne Social Desirability Scale (MC-SDS). RESULTS Females scored higher than males at all eating disorder inventories. In both genders there was a negative relationship (in all cases P < 0.01) between scores at the eating disorder inventories and those at the MC-SDS. When analysing eating disorder "caseness", as measured by cut-off, "cases" reported significantly lower scores than "non-cases" at the MC-SDS in both genders. CONCLUSION Personality traits measured by the MC-SDS, such as defensiveness, self-esteem, and dependence from approval, might contribute to the development of abnormal eating patterns at risk of eating disorders.
Collapse
Affiliation(s)
- P Miotto
- Department of Drugs and Alcohol Dependence, ULSS 7, Conegliano, TV, Italy
| | | | | | | | | |
Collapse
|
23
|
Moraleda Barba S, González Alonso N, Casado Viñas J, Carmona De La Morena J, Gómez-Calcerrada Gómez R, Aguilera Sánchez M, Orueta Sánchez R. [Eating disorders among secondary students in a health area]. Aten Primaria 2001; 28:463-7. [PMID: 11718641 PMCID: PMC7675943 DOI: 10.1016/s0212-6567(01)70422-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES To study the prevalence of eating disorders among adolescent in a health area. Design. Cross-sectional descriptive study.Setting. The primary care centres of secondary education. PARTICIPANTS Students with age between 13-16 years. MEASUREMENTS The validation of the Spanish translation of the Eating Attitudes Test-40 was administered to students, previous authorization of their parents. In the positive cases, we reported with a letter to their parents. The date were incorporate to a data base and in order to their treatment tools of analytic and descriptive statistic they were used. RESULTS There were 503 valid questionnaires (95% students of the health area). The absolute mean score was 13.42 points (CI, 12.57-14.28), in women 14.71 points and in man 11.82 points. According to age groups, the mean score for 13, 14.15 and 16 years was 14.05, 13.85, 13.08 and 12.60 points respectively. 16.97% presented >= 20 points (sensitivity, 91%; specificity, 69.2%) and 16.97% of the sample >= 30 points (sensitivity, 67,9%; specificity, 85.9%). There were more positive cases in women than men (2 = 22.4; p < 0.001). The age variable did not show statistically significant differences (2 = 3.379; p > 0.05). CONCLUSIONS There is a high prevalence of eating disorders among secondary students, being more frequently among women. We think it is necessary to make preventive services task in these problems and seek positive cases.
Collapse
|
24
|
De Filippo E, Signorini A, Bracale R, Pasanisi F, Contaldo F. Hospital admission and mortality rates in anorexia nervosa: experience from an integrated medical-psychiatric outpatient treatment. Eat Weight Disord 2000; 5:211-6. [PMID: 11216129 DOI: 10.1007/bf03354448] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of an integrated medical-psychiatric treatment of major eating disorders. DESIGN Historical cohort study. SETTING Outpatient Unit for Protein Energy Malnutrition of the Department of Clinical and Experimental Medicine, "Federico II" University of Naples, time of study: January 1994 to December 1997 PARTICIPANTS: 147 female patients with restrictive or bulimic anorexia nervosa (mean age 19.8 +/- 13.7, BMI 14.7 +/- 2.1 Kg/m2) consecutively attending the outpatient unit between January 1994 and December 1997. MAIN OUTCOME MEASURES Hospitalization and mortality rates were evaluated up to Jan 1999 with a minimum follow-up of 18 months. RESULTS There were 23 admissions to the Clinical Nutrition ward for 19 patients (i.e. 12.9%) mostly due to severe protein energy malnutrition, and 2 deaths, only 1 strictly related to anorexia (mortality rate 0.7%). CONCLUSIONS Integrated outpatient medical-psychiatric treatment for major eating disorders is an effective and inexpensive procedure that reduces mortality and admissions due to medical complications in the medium term.
Collapse
Affiliation(s)
- E De Filippo
- CISRO, Clinical Nutrition, Department of Clinical and Experimental Medicine, Federico II Hospital University, Naples, Italy
| | | | | | | | | |
Collapse
|