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Karth M, Kinzig KP. Adolescent activity-based anorexia has a substantial and prolonged impact on social behavior in young adult female rats. Physiol Behav 2024; 279:114528. [PMID: 38531425 DOI: 10.1016/j.physbeh.2024.114528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/01/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
Activity-based anorexia (ABA) is a rodent model of anorexia nervosa (AN) that induces several key components of AN, including voluntary reduction in food intake, reduced body weight, hyperactivity, and alterations to the hypothalamic-pituitary-adrenal (HPA) axis. Previous research has demonstrated persistently increased anxiety-like behavior in the elevated plus maze (EPM), a test measuring avoidance of novel and open areas in adult female rats that experienced ABA during adolescence and are weight-restored in adulthood. Whether the same behavioral effects of two bouts of adolescent ABA emerge in response to different anxiety-provoking stimuli, however, has not been explored. We used the social partition (SP), novelty suppressed feeding (NSF), marble burying, and EPM tests to explore whether two bouts of adolescent ABA have persistent effects on anxiety-like behavior in weight restored young adult female rats. One-way ANOVA analyses revealed that female rats that experienced two bouts of ABA during adolescence had increased anxiety-like behavior in the EPM and SP tests in young adulthood following weight restoration compared with controls. These data demonstrate that the enduring behavioral effects of two bouts of adolescent ABA are specific to particular anxiety-provoking stimuli and suggest that adolescent ABA has enduring effects on social relationships.
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Affiliation(s)
- Melinda Karth
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Kimberly P Kinzig
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA; Purdue University Ingestive Behavior Research Center, Purdue University, West Lafayette, IN, USA.
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2
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Bertrand V, Tavolacci MP, Bargiacchi A, Leblanc V, Déchelotte P, Stordeur C, Bellaïche M. Analysis of feeding and eating disorders in 191 children according to psychiatric or gastroenterological recruitment: The PEDIAFED cohort study. EUROPEAN EATING DISORDERS REVIEW 2024; 32:589-605. [PMID: 38308450 DOI: 10.1002/erv.3063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/24/2023] [Accepted: 12/27/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE The DSM-5 classification introduced new Feeding and Eating Disorders (FED) diagnostic categories, notably Avoidant and Restrictive Food Intake Disorder (ARFID), which, like other FED, can present psychiatric and gastrointestinal symptoms. However, paediatric clinical research that focuses on children below the age of 12 years remains scarce. The aim of this study was first to investigate the clinical features of FED in a cohort of children, second to compare them according to their recruitment (gastroenterology or psychiatry unit). METHOD This non-interventional retrospective cohort study analysed 191 patients in a French paediatric tertiary care centre (gastroenterology n = 100, psychiatry n = 91). The main outcome variables were clinical data (type of FED, BMI, nutritional support, chronic diseases, psychiatric comorbidities, sensory, sleep, language disorders, gastrointestinal complaints, adverse life events, family history). The outcome was defined by a Clinical Global Impression of Change-score. RESULTS FED diagnoses were ARFID (n = 100), Unspecified FED (UFED, n = 57), anorexia nervosa (AN, n = 33) and one pica/rumination. Mean follow-up was 3.28 years (SD 1.91). ARFID was associated with selective and sensory disorders (p < 0.001); they had more anxiety disorders than patients with UFED (p < 0.001). Patients with UFED had more chewing difficulties, language disorder (p < 0.001), and more FED related to chronic disease (p < 0.05) than patients with ARFID and AN. Patients with AN were female, underweight, referred exclusively to the psychiatrist, and had more depression than patients with ARFID and UFED (p < 0.001). The gastroenterology cohort included more UFED, while the psychiatry cohort included more psychiatric comorbidities (p < 0.001). A worse clinical outcome was associated with ARFID, a younger age at onset (p < 0.001), selective/sensory disorders and nutritional support (p < 0.05). CONCLUSION ARFID and UFED children were diagnosed either by gastroenterologists or psychiatrists. Due to frequently associated somatic and psychiatric comorbidities, children with FED should benefit from a multidisciplinary assessment and care.
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Affiliation(s)
- Valérie Bertrand
- Pediatric Unit, Le Havre Hospital, Le Havre Cedex, France
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France
| | - Marie-Pierre Tavolacci
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France
- CIC 1404, Rouen University Hospital, Rouen, France
| | - Anne Bargiacchi
- Child and Adolescent Psychiatry Department, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
| | - Véronique Leblanc
- Pediatric Digestive Diseases Unit, Robert Debré University Hospital, Paris, France
| | - Pierre Déchelotte
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France
- Department of Nutrition, Rouen University Hospital, Rouen, France
| | - Coline Stordeur
- Child and Adolescent Psychiatry Department, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
| | - Marc Bellaïche
- Pediatric Digestive Diseases Unit, Robert Debré University Hospital, Paris, France
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Tamura A, Minami K, Tsuda Y, Tsujimoto H, Ichikawa T, Mizumoto K, Suzuki H. Characteristics and outcomes of avoidant/restrictive food intake disorder in Japanese elementary-school students on total parenteral nutrition. Pediatr Investig 2021; 5:293-298. [PMID: 34938972 PMCID: PMC8666945 DOI: 10.1002/ped4.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/21/2021] [Indexed: 12/03/2022] Open
Abstract
The clinical outcomes of adolescents with avoidant/restrictive food intake disorder (ARFID) remain unclear. Furthermore, no report has compared the characteristics of ARFID and restricting-type anorexia nervosa (R-AN) in elementary-school students on total parenteral nutrition (TPN). This study retrospectively reviewed inpatients diagnosed with ARFID or R-AN between 2005 and 2019. Patients with ARFID (two boys and seven girls) and R-AN (13 girls) were hospitalized because of rapid physical deterioration, and nutrition therapy was continued without withdrawal. The ARFID group exhibited significantly lower body weights at admission than the R-AN group and gained an average of 6.5 kg during hospitalization; furthermore, the monthly weight gain during hospitalization was significantly higher, and no relapse was observed. Early physical improvement in ARFID resulted in good recovery. In conclusion, TPN can be easily introduced to patients with ARFID, in whom aversive eating is a concern, and is a suitable treatment for ARFID.
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Affiliation(s)
- Akira Tamura
- Department of PediatricsWakayama Medical UniversityWakayama City, WakayamaJapan
- Department of Medical Safety PromotionWakayama Medical UniversityWakayama City, WakayamaJapan
| | - Koichi Minami
- Department of PediatricsWakayama Medical UniversityWakayama City, WakayamaJapan
| | - Yuko Tsuda
- Department of PediatricsWakayama Medical UniversityWakayama City, WakayamaJapan
| | - Hiroshi Tsujimoto
- Department of PediatricsWakayama Medical UniversityWakayama City, WakayamaJapan
| | - Takayuki Ichikawa
- Department of PediatricsWakayama Medical UniversityWakayama City, WakayamaJapan
| | - Kazuhiro Mizumoto
- Department of Medical Safety PromotionWakayama Medical UniversityWakayama City, WakayamaJapan
| | - Hiroyuki Suzuki
- Department of PediatricsWakayama Medical UniversityWakayama City, WakayamaJapan
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Keery H, LeMay-Russell S, Barnes TL, Eckhardt S, Peterson CB, Lesser J, Gorrell S, Le Grange D. Attributes of children and adolescents with avoidant/restrictive food intake disorder. J Eat Disord 2019; 7:31. [PMID: 31528341 PMCID: PMC6739995 DOI: 10.1186/s40337-019-0261-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/22/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Avoidant/Restrictive Food Intake Disorder (ARFID) is a comparatively new DSM-5 diagnosis. In an effort to better understand this heterogeneous patient group, this study aimed to describe the physical and psychological attributes of children and adolescents with ARFID, and to compare them to patients with full-threshold or atypical anorexia nervosa (AN). METHODS Children and adolescents aged 7-to-19 years (N = 193) were examined upon presenting at a pediatric eating disorder center between July 2015 and December 2017. Data included diagnosis assessed via the semi-structured Eating Disorder Examination interview along with measures of anthropometrics, depression, anxiety, self-esteem, perfectionism and clinical impairment. RESULTS Compared to AN and atypical AN (n = 87), patients with ARFID (n = 106) were significantly younger (12.4 vs. 15.1 years, p < .0001), male (41% vs. 15%, p < .0002), and were more likely to be diagnosed with at least one co-morbid DSM-5 diagnosis (75% vs. 61%, p = .04). Patients with ARFID were less likely to be bradycardic (4.7% vs. 24.1%, p < .0001), amenorrheic (11.1 and 34.7%, p = .001), admitted to the hospital (14.2% vs. 27.6%, p = .02), and have a diagnosis of depression (18.9% vs. 48.3%, p < .0001). Patients with ARFID were significantly less likely to experience acute weight loss vs. chronic weight loss as compared with those with AN or atypical AN (p = .0001). On self-report measures, patients with ARFID reported significantly fewer symptoms of depression, anxiety, perfectionism, clinical impairment, concerns about weight and shape, and higher self-esteem than patients with AN or atypical AN (all ps < .0001). No differences were observed by race, anxiety disorder, orthostatic instability, suicidal ideation, and history of eating disorder treatment. CONCLUSIONS Study results highlight the clinical significance of ARFID as a distinct DSM-5 diagnosis and the physical and psychological differences between ARFID and AN/atypical AN. The novel finding that ARFID patients are more likely than those diagnosed with AN to experience chronic, rather than acute, weight loss suggests important related treatment considerations.
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Affiliation(s)
- Helene Keery
- Center for the Treatment of Eating Disorders, Children’s Minnesota, Minneapolis, MN USA
| | - Sarah LeMay-Russell
- Center for the Treatment of Eating Disorders, Children’s Minnesota, Minneapolis, MN USA
| | - Timothy L. Barnes
- Center for the Treatment of Eating Disorders, Children’s Minnesota, Minneapolis, MN USA
- Children’s Minnesota Research Institute, Children’s Minnesota, Minneapolis, MN USA
| | - Sarah Eckhardt
- Center for the Treatment of Eating Disorders, Children’s Minnesota, Minneapolis, MN USA
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN USA
- The Emily Program, St. Paul, MN USA
| | - Julie Lesser
- Center for the Treatment of Eating Disorders, Children’s Minnesota, Minneapolis, MN USA
| | - Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, CA USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, CA USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL USA
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Herpertz-Dahlmann B, Dahmen B. Children in Need-Diagnostics, Epidemiology, Treatment and Outcome of Early Onset Anorexia Nervosa. Nutrients 2019; 11:E1932. [PMID: 31426409 PMCID: PMC6722835 DOI: 10.3390/nu11081932] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022] Open
Abstract
Knowledge of anorexia nervosa (AN) in childhood is scarce. This review gives a state-of-the-art overview on the definition, classification, epidemiology and etiology of this serious disorder. The typical features of childhood AN in comparison to adolescent AN and avoidant restrictive eating disorder (ARFID) are described. Other important issues discussed in this article are somatic and psychiatric comorbidity, differential diagnoses and medical and psychological assessment of young patients with AN. Special problems in the medical and psychological treatment of AN in children are listed, although very few studies have investigated age-specific treatment strategies. The physical and mental outcomes of childhood AN appear to be worse than those of adolescent AN, although the causes for these outcomes are unclear. There is an urgent need for ongoing intensive research to reduce the consequences of this debilitating disorder of childhood and to help patients recover.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany.
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany
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Becker KR, Keshishian AC, Liebman RE, Coniglio KA, Wang SB, Franko DL, Eddy KT, Thomas JJ. Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa. Int J Eat Disord 2019; 52:230-238. [PMID: 30578644 PMCID: PMC7191972 DOI: 10.1002/eat.22988] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are restrictive eating disorders. There is a proposal before the American Psychiatric Association to broaden the current DSM-5 criteria for ARFID, which currently require dietary intake that is inadequate to support energy or nutritional needs. We compared the clinical presentations of ARFID and AN in an outpatient sample to determine how a more inclusive definition of ARFID, heterogeneous for age and weight status, is distinct from AN. METHODS As part of standard care, 138 individuals with AN or ARFID completed an online assessment battery and agreed to include their responses in research. RESULTS Individuals with ARFID were younger, reported earlier age of onset, and had higher percent median BMI (%mBMI) than those with AN (all ps < .001). Individuals with ARFID scored lower on measures of eating pathology, depression, anxiety, and clinical impairment (all ps < .05), but did not differ from those with AN on restrictive eating (p = .52), and scored higher on food neophobia (p < .001). DISCUSSION Allowing psychosocial impairment to be sufficient for an ARFID diagnosis resulted in a clinical picture of ARFID such that %mBMI was higher (and in the normal range) compared with AN. Differences in gender distribution, age, and age of onset remained consistent with previous research. Both groups reported similar levels of dietary restriction, although ARFID can be distinguished by relatively higher levels of food neophobia. Currently available measures of eating pathology may capture certain ARFID symptoms, but highlight the need for measures of impairment relative to ARFID.
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Affiliation(s)
- Kendra R. Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Ani C. Keshishian
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital
| | - Rachel E. Liebman
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | | | - Shirley B. Wang
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychology, Harvard University, Boston, Massachusetts
| | - Debra L. Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Northeastern University, Boston, Massachusetts
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Lieberman M, Houser ME, Voyer AP, Grady S, Katzman DK. Children with avoidant/restrictive food intake disorder and anorexia nervosa in a tertiary care pediatric eating disorder program: A comparative study. Int J Eat Disord 2019; 52:239-245. [PMID: 30706952 DOI: 10.1002/eat.23027] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 12/11/2018] [Accepted: 12/14/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the medical and psychological characteristics of children under the age of 13 years with avoidant restrictive food intake disorder (ARFID) and anorexia nervosa (AN) from a Canadian tertiary care pediatric eating disorders program. METHOD Participants included 106 children assessed between 2013 and 2017 using the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5). Data were collected through clinical interviews, psychometric questionnaires, and chart review. Information collected included medical variables (e.g., weight, heart rate, need for inpatient admission, and duration of illness from symptom onset); medical comorbidities (e.g., history of food allergies, infection, and abdominal pain preceding the eating disorder); and psychological variables (e.g., psychiatric comorbidity, self-reported depression and anxiety, and eating disorder related behaviors and cognitions). RESULTS Children with ARFID had a longer length of illness, while those with AN had lower heart rates and were more likely to be admitted as inpatients. Children with ARFID had a history of abdominal pain and infections preceding their diagnoses and were more likely to be diagnosed with a comorbid anxiety disorder. Children with AN had a higher drive for thinness, lower self-esteem, and scored higher on depression. DISCUSSION This is the first study to look at DSM-5 diagnosis at assessment and include psychometric and interview data with younger children with AN and ARFID. Understanding the medical and psychological profiles of children with AN and ARFID can result in a more timely and accurate diagnosis of eating disorders in younger children.
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Affiliation(s)
- Melissa Lieberman
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa E Houser
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne-Pier Voyer
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shelley Grady
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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8
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Herpertz-Dahlmann B, Dempfle A, Egberts KM, Kappel V, Konrad K, Vloet JA, Bühren K. Outcome of childhood anorexia nervosa-The results of a five- to ten-year follow-up study. Int J Eat Disord 2018; 51:295-304. [PMID: 29451957 DOI: 10.1002/eat.22840] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Although admissions of children with anorexia nervosa (AN) are increasing, there remains a dearth of up-to-date knowledge of the course and outcome of early-onset AN. The aim of the present study was to investigate the outcomes of patients with AN onset before the age of 14. METHOD Sixty-eight consecutive former patients who met the DSM-IV criteria for AN and who had been treated at one of three German university hospitals were asked to participate in a follow-up study. Body mass index, body height, outcome of the eating disorder (ED), psychiatric morbidity, and health related quality of life (HRQoL) were assessed through a personal examination after an average time span of 7.5 years (range: 4.5-11.5 years) after admission. RESULTS One patient had died. Fifty-two subjects with a mean age of 12.5 (SD 1.0) years at admission and of 20.2 (SD 2.0) years at follow-up agreed to participate in the follow-up assessment, aggregating to 77.9% of the original sample. Approximately 41% of the participants had a good outcome, while 35% and 24% had intermediate and poor outcomes, respectively. Twenty-eight percent of the sample met the DSM-IV criteria for a current non-ED psychiatric disorder, and 64% met the criteria for a past non-ED psychiatric disorder. Mental HRQoL and ED-specific psychopathology was strongly associated with the outcome of AN. Average body height was below the normal range. A higher weight at admission was the only significant positive indicator of outcome. DISCUSSION Childhood AN is a serious disorder with an unfavorable course in many patients and high rates of chronicity and psychiatric comorbidity in young adulthood. Early detection and intervention are urgently needed.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Astrid Dempfle
- Institute of Medical Biometry and Statistics, Christian Albrecht-University Kiel, Kiel, Germany
| | - Karin Maria Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Viola Kappel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité University Hospital Berlin, Berlin, Germany
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Jennifer Anne Vloet
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Katharina Bühren
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
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Kurz S, van Dyck Z, Dremmel D, Munsch S, Hilbert A. Variants of early-onset restrictive eating disturbances in middle childhood. Int J Eat Disord 2016; 49:102-6. [PMID: 26356990 DOI: 10.1002/eat.22461] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 06/29/2015] [Accepted: 07/08/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study sought to determine the factor structure of the newly developed self-report screening questionnaire Eating Disturbances in Youth-Questionnaire (EDY-Q) as well as to report the distribution of variants of early-onset restrictive eating disturbances characteristic of avoidant/restrictive food intake disorder (ARFID) in a middle childhood population sample. METHOD Using the EDY-Q, a total of 1,444 children aged 8-13 years were screened in elementary schools in Switzerland via self-report. The factor analysis of the 12 items covering ARFID related symptoms was performed using a principal component analysis (PCA). RESULTS The PCA showed a four factor solution, with clear allocation to the scales covering three variants of early-onset restrictive eating disturbances and weight problems. Inadequate overall food intake was reported by 19.3% of the children, a limited accepted amount of food by 26.1%, and food avoidance based on a specific underlying fear by 5.0%. DISCUSSION The postulated factor structure of the EDY-Q was confirmed, further supporting the existence of distinct variants of early-onset restrictive eating disturbances. Avoidant/restrictive eating behavior seems to be a common experience in middle childhood, but results have to be confirmed using validated interviews.
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Affiliation(s)
- Susanne Kurz
- Department of Psychology, University of Fribourg, Rue P.-a. De Faucigny 2, Fribourg, Switzerland.,Integrated Research and Treatment Center AdiposityDiseases, University of Leipzig, Medical Center, Philipp-Rosenthal-Strasse 27, Leipzig, Germany.,Department of Medical Psychology and Medical Sociology, University of Leipzig, Medical Center, Leipzig, Germany
| | - Zoé van Dyck
- Institute for Health and Behavior, Research Unit inside, University of Luxembourg, Campus Walferdange, Esch-sur-Alzette, Luxemburg
| | - Daniela Dremmel
- Department of Psychology, University of Fribourg, Rue P.-a. De Faucigny 2, Fribourg, Switzerland
| | - Simone Munsch
- Department of Psychology, University of Fribourg, Rue P.-a. De Faucigny 2, Fribourg, Switzerland
| | - Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, University of Leipzig, Medical Center, Philipp-Rosenthal-Strasse 27, Leipzig, Germany.,Department of Medical Psychology and Medical Sociology, University of Leipzig, Medical Center, Leipzig, Germany
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10
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Williams KE, Hendy HM, Field DG, Belousov Y, Riegel K, Harclerode W. Implications of Avoidant/Restrictive Food Intake Disorder (ARFID) on Children with Feeding Problems. CHILDRENS HEALTH CARE 2014. [DOI: 10.1080/02739615.2014.921789] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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A case of choking phobia: towards a conceptual approach. Eat Weight Disord 2014; 19:125-31. [PMID: 23888402 DOI: 10.1007/s40519-013-0048-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022] Open
Abstract
Choking phobia, also known as phagophobia or swallowing phobia is an uncommon clinical entity that has been underappreciated and is included in the new DSM-5 and upcoming ICD-11 diagnostic category of avoidant/restrictive food intake disorder. Phenomenologically distinct from other eating disorders, it is characterized by the phobic stimulus of swallowing that results in the avoidance of food or drinks, and ultimately to low weight, social withdrawal, anxiety and depression states. Its prevalence and long-term course on the general population still needs to be determined, probably reflecting years of indefiniteness regarding its nosology and by the absence of a clear set of diagnostic criteria. We present a clinical case of choking phobia in a 32-year-old male patient after an episode of choke when eating chicken. An early diagnosis and distinction from other eating disorders is important for proper treatment and fundamental for prognosis. We also make a thorough revision on literature in clinical features, differential diagnosis and treatment approaches, suggesting a conceptual approach for choking phobia as a clinical spectrum settled by different degrees of phobic subtypes, which may depend on a varied number of clinical variables.
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Nicely TA, Lane-Loney S, Masciulli E, Hollenbeak CS, Ornstein RM. Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. J Eat Disord 2014; 2:21. [PMID: 25165558 PMCID: PMC4145233 DOI: 10.1186/s40337-014-0021-3] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Avoidant/Restrictive Food Intake Disorder (ARFID) is a "new" diagnosis in the recently published DSM-5, but there is very little literature on patients with ARFID. Our objectives were to determine the prevalence of ARFID in children and adolescents undergoing day treatment for an eating disorder, and to compare ARFID patients to other eating disorder patients in the same cohort. METHODS A retrospective chart review of 7-17 year olds admitted to a day program for younger patients with eating disorders between 2008 and 2012 was performed. Patients with ARFID were compared to those with anorexia nervosa, bulimia nervosa, and other specified feeding or eating disorder/unspecified feeding or eating disorder with respect to demographics, anthropometrics, clinical symptoms, and psychometric testing, using Chi-square, ANOVA, and post-hoc analysis. RESULTS 39/173 (22.5%) patients met ARFID criteria. The ARFID group was younger than the non-ARFID group and had a greater proportion of males. Similar degrees of weight loss and malnutrition were found between groups. Patients with ARFID reported greater fears of vomiting and/or choking and food texture issues than those with other eating disorders, as well as greater dependency on nutritional supplements at intake. Children's Eating Attitudes Test scores were lower for children with than without ARFID. A higher comorbidity of anxiety disorders, pervasive developmental disorder, and learning disorders, and a lower comorbidity of depression, were found in those with ARFID. CONCLUSIONS This study demonstrates that there are significant demographic and clinical characteristics that differentiate children with ARFID from those with other eating disorders in a day treatment program, and helps substantiate the recognition of ARFID as a distinct eating disorder diagnosis in the DSM-5.
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Affiliation(s)
- Terri A Nicely
- Penn State College of Medicine, 500 University Drive, 17033 Hershey, PA USA
| | - Susan Lane-Loney
- Division of Adolescent Medicine and Eating Disorders, Penn State Hershey Children's Hospital, 905 West Governor Road, Suite 250, 17033 Hershey, PA USA
| | - Emily Masciulli
- Division of Adolescent Medicine and Eating Disorders, Penn State Hershey Children's Hospital, 905 West Governor Road, Suite 250, 17033 Hershey, PA USA
| | - Christopher S Hollenbeak
- Departments of Surgery and Public Health Sciences, Penn State College of Medicine, 500 University Drive, 17033 Hershey, PA USA
| | - Rollyn M Ornstein
- Division of Adolescent Medicine and Eating Disorders, Penn State Hershey Children's Hospital, 905 West Governor Road, Suite 250, 17033 Hershey, PA USA
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13
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Murray SB, Thornton C, Wallis A. Selective eating in a 9-year-old boy: family therapy as a first-line treatment. Clin Child Psychol Psychiatry 2013; 18:270-5. [PMID: 22790718 DOI: 10.1177/1359104512452418] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Whilst empirical studies continue to demonstrate the efficacy of family-based therapy in the treatment of adolescent anorexia nervosa, less comprehensive evidence exists in guiding the treatment of pre-adolescent eating disorders, which are typically characterised by a greater variety of symptom presentation. We present the case of a pre-adolescent male who met criteria for selective eating who was treated into full remission with eating-disorder-focused family therapy. This family-based intervention deviated significantly from recently manualised family-based therapy interventions, and we suggest continued exploration of family therapy techniques in the treatment of pre-adolescent eating disorders.
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14
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Dyck ZV, Bellwald L, Kurz S, Dremmel D, Munsch S, Hilbert A. Essprobleme im Kindesalter. ACTA ACUST UNITED AC 2013. [DOI: 10.1026/0943-8149/a000091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Essstörungen im Kindes- und Jugendalter werden immer häufiger und eine frühzeitige Erkennung ist von großer Bedeutung. Neben den „klassischen” Essstörungen besteht eine Anzahl von Essproblemen im Kindesalter, die sich durch vermeidende oder restriktive Nahrungsaufnahme kennzeichnen und zurzeit nicht im DSM-IV Klassifikationssystem aufgeführt werden. Ziel der Untersuchung war es, das Vorkommen dieser Essprobleme in einer allgemeinen, schulbasierten Stichprobe in der Schweiz zu untersuchen und die psychometrischen Kennwerte eines kurzen Screeningfragebogens zur Erfassung vermeidend oder restriktiver Nahrungsaufnahme im Selbstbericht zu ermitteln. Es beantworteten 730 Kinder im Alter von 8 – 13 Jahren den Eating Disturbances in Childhood–Questionnaire (EDCh-Q). 29.8 % der Kinder gaben an, vermeidendes oder restriktives Essverhalten aufzuzeigen. Der EDCh-Q zeigte insgesamt gute Itemcharakteristika. Die vierfaktorielle Struktur konnte bestätigt werden, allerdings mit geringen internen Konsistenzen der Subskalen. Untergewichtige Kinder gaben häufiger an, Symptome einer Nahrungsvermeidung mit emotionaler Störung aufzuzeigen. Vermeidendes oder restriktives Essverhalten ist nicht unüblich bei Kindern im Schulalter. Der EDCh-Q ist ein diagnostisch orientierter Screeningfragebogen zur Identifizierung dieser Essprobleme in der mittleren Kindheit. Weitere Forschung ist wünschenswert zur Validierung des EDCh-Q in allgemeinen und klinischen Stichproben.
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Affiliation(s)
- Zoé van Dyck
- Forschungseinheit INSIDE, Universität Luxemburg, Campus Walferdange, Luxemburg
| | - Laura Bellwald
- Departement für Psychologie, Universität Freiburg, Schweiz
| | - Susanne Kurz
- Departement für Psychologie, Universität Freiburg, Schweiz
| | | | - Simone Munsch
- Departement für Psychologie, Universität Freiburg, Schweiz
| | - Anja Hilbert
- Integriertes Forschungs- und Behandlungszentrum AdipositasErkrankungen, Universitätsmedizin Leipzig
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16
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Abstract
Disorders related to ingesting adequate variety and amounts of food, often dichotomized into feeding or eating disorders, depending on the need for affected individuals to be fed or to eat on their own respectively, include a wide variety of conditions. This paper focuses on disorders that are not also associated with behaviors related to weight-control or self-concept strongly influenced by body weight or shape, as seen in anorexia nervosa or bulimia nervosa. In contrast to eating disorders, there is a relatively sparse body of literature, inconsistent and confusing set of terms and definitions, and conflicting classification schemes applied to feeding/eating disturbances. A new scheme is proposed to improve clinical utility and include individuals who experience morbidities that could benefit from diagnosis and treatment, but are presently excluded from classification. Key research findings are highlighted, and core clinical features regarding diagnosis and treatment are detailed. Two illustrative cases frame the clinical aspects of these conditions.
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Affiliation(s)
- Richard E Kreipe
- Division of Adolescent Medicine, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, 601 Elmwood Avenue, Box 690, Rochester, NY 14642, USA.
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17
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Watkins B, Cooper PJ, Lask B. History of Eating Disorder in Mothers of Children with Early Onset Eating Disorder or Disturbance. EUROPEAN EATING DISORDERS REVIEW 2011; 20:121-5. [DOI: 10.1002/erv.1125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 02/28/2011] [Accepted: 03/27/2011] [Indexed: 11/11/2022]
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18
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Sacrato L, Pellicciari A, Franzoni E. Emergent factors in eating disorders in childhood and preadolescence. Ital J Pediatr 2010; 36:49. [PMID: 20615223 PMCID: PMC2912312 DOI: 10.1186/1824-7288-36-49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 07/08/2010] [Indexed: 11/10/2022] Open
Abstract
We have reviewed the literature related to the current advances in comprehension of Eating Disorders (ED) in childhood and preadolescence. The state of art regarding the psychodynamic models concerning the onset of ED are explained. DSM-IV and ICD-10 criteria are discussed, pointing out their little value in the characterization of early eating difficulties. Historic and new diagnostic classifications are displayed in detail. We provided a clearer description of subclinical patterns. Finally we focus on the key role of the paediatrician in detecting and managing parental concerns regarding feeding.
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Affiliation(s)
- Leonardo Sacrato
- Child Neuropsychiatry Unit, Sant'Orsola Malpighi Hospital, University of Bologna, Italy
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19
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Abstract
OBJECTIVE To review the literature related to the current DSM-IV-TR diagnostic criteria for feeding disorder of infancy or early childhood; pica; rumination disorder; and other childhood presentations that are characterized by avoidance of food or restricted food intake, with the purpose of informing options for DSM-V. METHOD Articles were identified by computerized and manual searches and reviewed to evaluate the evidence supporting possible options for revision of criteria. RESULTS The study of childhood feeding and eating disturbances has been hampered by inconsistencies in classification and use of terminology. Greater clarity around subtypes of feeding and eating problems in children would benefit clinicians and patients alike. DISCUSSION A number of suggestions supported by existing evidence are made that provide clearer descriptions of subtypes to improve clinical utility and to promote research.
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Affiliation(s)
- Rachel Bryant-Waugh
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
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20
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Thomas JJ, Vartanian LR, Brownell KD. The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM. Psychol Bull 2009; 135:407-33. [PMID: 19379023 DOI: 10.1037/a0015326] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Eating disorder not otherwise specified (EDNOS) is the most prevalent eating disorder (ED) diagnosis. In this meta-analysis, the authors aimed to inform Diagnostic and Statistical Manual of Mental Disorders revisions by comparing the psychopathology of EDNOS with that of the officially recognized EDs: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). A comprehensive literature search identified 125 eligible studies (published and unpublished) appearing in the literature from 1987 to 2007. Random effects analyses indicated that whereas EDNOS did not differ significantly from AN and BED on eating pathology or general psychopathology, BN exhibited greater eating and general psychopathology than EDNOS. Moderator analyses indicated that EDNOS groups who met all diagnostic criteria for AN except for amenorrhea did not differ significantly from full syndrome cases. Similarly, EDNOS groups who met all criteria for BN or BED except for binge frequency did not differ significantly from full syndrome cases. Results suggest that EDNOS represents a set of disorders associated with substantial psychological and physiological morbidity. Although certain EDNOS subtypes could be incorporated into existing Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) categories, others-such as purging disorder and non-fat-phobic AN-may be best conceptualized as distinct syndromes. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
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21
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Rhodes P, Prunty M, Madden S. Life-threatening food refusal in two nine-year-old girls: re-thinking the Maudsley model. Clin Child Psychol Psychiatry 2009; 14:63-70. [PMID: 19103705 DOI: 10.1177/1359104508100136] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While there is growing evidence for the efficacy of the Maudsley model of family-based treatment for anorexia nervosa, little is known concerning the most effective treatment for pre-adolescents with Eating Disorders Not Otherwise Specified (EDNOS). The presentation of case studies of children with EDNOS is important. Large-scale studies are difficult due to low incidence and the application of homogenous manualized approaches may be unsuitable to the wide range of potential disorders. The aim of this article is to present two detailed case studies of children with food avoidant emotional disorder, both presenting with life threatening food refusal. A flexible and individualized approach to family therapy was taken, resulting in the resumption of eating in less than seven weeks and four months respectively.
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Affiliation(s)
- Paul Rhodes
- Sydney University and The Children's Hospital at Westmead, Australia.
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22
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Nicholls D, Bryant-Waugh R. Eating disorders of infancy and childhood: definition, symptomatology, epidemiology, and comorbidity. Child Adolesc Psychiatr Clin N Am 2009; 18:17-30. [PMID: 19014855 DOI: 10.1016/j.chc.2008.07.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article describes a range of problem feeding and eating presentations seen in infants and children. In diagnostic terms some fall under the category of "feeding disorder," whereas others are childhood presentations of the eating disorders "anorexia nervosa," "bulimia nervosa," and atypical forms of these. Several other commonly occurring presentations that are difficult to fit into existing diagnostic categories are additionally described here, including "selective eating," "food avoidance emotional disorder," "food phobias," "functional dysphagia," and "food refusal."
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Affiliation(s)
- Dasha Nicholls
- Department of Child And Adolescent Mental Health, Great Ormond Street Hospital For Children NHS Trust, London WC1N 3JH, UK
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23
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Silva VGD, Papelbaum M. Fobia alimentar associada a magreza: um diagnóstico diferencial com anorexia nervosa. JORNAL BRASILEIRO DE PSIQUIATRIA 2009. [DOI: 10.1590/s0047-20852009000300011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A fobia alimentar (FA) ou fagofobia é um transtorno caracterizado pelo medo condicionado e excessivo de comer e engolir, muitas vezes precipitado por um evento de vômito ou engasgo. Existem poucos casos de FA descritos na literatura científica, o que dificulta a definição da sua prevalência. Apesar disso, a fagofobia apresenta importância clínica em função do risco de complicações clínicas e da possibilidade de erro diagnóstico por confusão com outras condições que acarretem restrição alimentar, como a anorexia nervosa. O objetivo deste artigo é apresentar um caso de FA e discutir a psicopatologia desse transtorno, as dificuldades diagnósticas e recomendações terapêuticas, tendo como base a evolução clínica do caso e as evidências científicas atuais.
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24
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Bravender T, Bryant-Waugh R, Herzog D, Katzman D, Kreipe RD, Lask B, Le Grange D, Lock J, Loeb K, Madden S, Nicholls D, O'Toole J, Pinhas L, Rome E, Sokol-Burger M, Wallen U, Zucker N. Classification of child and adolescent eating disturbances. Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA). Int J Eat Disord 2007; 40 Suppl:S117-22. [PMID: 17868122 DOI: 10.1002/eat.20458] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE : The purpose of this article is to summarize major conceptual and clinical variables related to age-appropriate and developmentally appropriate classification of eating problems and disorders in children and adolescents. METHOD A review of current classifications and related literature in child development is provided. Problems with current classification schemes are identified and discussed. RESULTS Current classifications are inadequate to address the clinical and research needs of children and adolescents with eating disturbances and disorders. CONCLUSION A range of possible changes in classification strategies for eating disorders in children and adolescents are described.
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Affiliation(s)
- T Bravender
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305, USA
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25
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Stein A, Woolley H, Cooper S, Winterbottom J, Fairburn CG, Cortina-Borja M. Eating habits and attitudes among 10-year-old children of mothers with eating disorders: longitudinal study. Br J Psychiatry 2006; 189:324-9. [PMID: 17012655 PMCID: PMC1888733 DOI: 10.1192/bjp.bp.105.014316] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Children of mothers with eating disorders are at increased risk of developmental disturbance, but there has been little research in middle childhood, when disturbed eating habits tend to emerge. AIMS To examine whether maternal eating disorders identified in the postnatal year are associated with the development of disturbed eating habits and attitudes in children at 10 years of age. METHOD Follow-up comparative study of 56 families (33 mothers with eating disorders and 23 controls). Psychopathology of children, mothers and fathers was assessed by interview, and mother-child interaction observed. RESULTS The index group of children scored higher than controls on three of four domains of eating disorder psychopathology and on a global score. Children's eating disturbance was associated with length of exposure to mothers' eating disorder and mother-child mealtime conflict at 5 years. There was some evidence of increased emotional problems in index children. CONCLUSIONS The children of mothers with eating disorders manifested disturbed eating habits and attitudes compared with controls, and may be at heightened risk of developing frank eating disorder psychopathology.
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Affiliation(s)
- Alan Stein
- Section of Child and Adolescent Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
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26
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Swenne I. Weight requirements for catch-up growth in girls with eating disorders and onset of weight loss before menarche. Int J Eat Disord 2005; 38:340-5. [PMID: 16231359 DOI: 10.1002/eat.20182] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The current study investigated catch-up in stature in girls with eating disorders and onset of weight loss and stunting of growth before menarche. METHOD Forty-six girls were followed with measurements of weight and stature for 2-5 years after presentation. RESULTS At presentation, the girls were stunted by 0.48 +/- 0.57 standard deviation scores (SDS) for height compared with their prepubertal growth track. Maximal stunting of 0.72 +/- 0.68 SDS was reached after 1 year of treatment despite weight gain. Catch-up growth, that is, increase in height SDS, was achieved during the second to fourth years. Thirty-four girls who reached menarche had normalized weight and reached their prepubertal growth track. In a regression analysis, growth in stature during a year of treatment could be predicted to 50% by age, the weight gain that year, the weight gain the preceding year, and by the weight level at the start of the year. Catch-up growth during a year could be predicted to 26% by the weight gain that year and the weight gain the preceding year. CONCLUSION Catch-up growth is possible in girls with eating disorders of premenarcheal onset. Weight gain is necessary for catch-up growth and must start before the ability to grow is lost with age. Once weight gain starts, the full effect on growth in stature takes several years to evolve.
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Affiliation(s)
- Ingemar Swenne
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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27
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Goëb JL, Azcona B, Troussier F, Malka J, Giniès JL, Duverger P. Évitement alimentaire et trouble affectif chez l'enfant. Arch Pediatr 2005; 12:1419-23. [PMID: 15979861 DOI: 10.1016/j.arcped.2005.02.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Accepted: 02/14/2005] [Indexed: 11/25/2022]
Abstract
We underline the clinical importance of a specific eating disorder in 3 to 10 years old children, when the majority of the works about the prepubertal eating disorders focus either on the period just preceding adolescence (often between 10 and 13 years), or on the second half of the first year of the baby. Within the eating disorders described in the literature, we compare the clinical presentation of most of these 3 to 10 years old children with the food avoidance emotional disorder described during adolescence. These problems of eating behaviour (various selective eating with or without provoked vomiting) are ignored for a long time in these young children because of quite a satisfactory growth, but these children are often seen in emergency rooms because of a brutally complete eating refusal. Therapeutic consultations allow these children to express their fears about diseases, poisoning and death, for themselves or for their close relations, in particular the mother, without endangering their body. The early recognition and care of these difficulties of conciliation between the body and the thoughts impose a narrow collaboration between paediatric and psychiatric staffs.
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Affiliation(s)
- J-L Goëb
- Service de pédopsychiatrie, CHRU, avenue Oscar Lambret, 59037 Lille cedex, France.
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28
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Watkins B, Frampton I, Lask B, Bryant-Waugh R. Reliability and validity of the child version of the Eating Disorder Examination: a preliminary investigation. Int J Eat Disord 2005; 38:183-7. [PMID: 16134106 DOI: 10.1002/eat.20165] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The Eating Disorder Examination (EDE) is a reliable and valid semistructured interview that measures the specific psychopathology of anorexia nervosa (AN) and bulimia nervosa. The current study aims to investigate the psychometric properties of the child adaptation of the EDE (ChEDE 12.0). METHOD The ChEDE was administered to 15 children with AN, 15 children with other clinical eating disturbances, and two groups of 15 age-matched controls. The groups were compared using a two-sample matched groups design. RESULTS Alpha coefficients for each of the ChEDE subscales indicated a high degree of internal consistency, and interrater reliability was found to be high (r = .91 to r = 1.00). The subscale scores of the AN group were significantly higher than those of the other groups, whereas the other eating disturbance group did not differ from its control group. DISCUSSION The ChEDE differentiates children with AN from children with other forms of clinical eating disturbance and control children.
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Affiliation(s)
- Beth Watkins
- Department of Mental Health, St. George's Hospital Medical School, London, United Kingdom.
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29
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Honjo S, Sasaki Y, Murase S, Kaneko H, Nomura K. Transient eating disorder in early childhood--a case report. Eur Child Adolesc Psychiatry 2005; 14:52-4. [PMID: 15756516 DOI: 10.1007/s00787-005-0413-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2004] [Indexed: 10/25/2022]
Abstract
Although children in infancy present eating problems of multifarious nature, the diagnostic classification of infant eating disorders remains markedly deficient. The authors present a case exhibiting transient eating disorder in early childhood, alongside discussion of some considerations relevant to this age group. The subject was a boy aged 5 years 6 months at first presentation. Starting with an inability to swallow "sushi" at dinner, he was brought to the clinic for inability to ingest food or liquids. Treatment was planned as play therapy for the patient, and psychological interviews for the mother. The child's symptoms were improved in five sessions, but interviews of the mother revealed eating disorders such as bulimia and vomiting, and sexual problems in the marital relationship, necessitating long-term therapy.
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Affiliation(s)
- Shuji Honjo
- Department of Child Psychiatry, Nagoya University Center for Developmental Clinical Psychology and Psychiatry, Chikusa-ku, Nagoya 464-8601, Japan.
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30
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Abstract
This update on anorexia nervosa among children and adolescents focuses on the current diagnostic criteria for the disorder, its history, epidemiology, and etiology. Consideration is given to the required medical evaluation and differential diagnosis. The medical complications, morbidity, and mortality that may ensue are described, and the corresponding pathophysiology explained. The review concludes with information on treatment and prognosis and a proposal on the appropriate role for the pediatrician in the management of anorexia nervosa.
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Affiliation(s)
- Tomas Jose Silber
- Adolescent Medicine Fellowship Program, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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31
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Tanofsky-Kraff M, Yanovski SZ, Wilfley DE, Marmarosh C, Morgan CM, Yanovski JA. Eating-disordered behaviors, body fat, and psychopathology in overweight and normal-weight children. J Consult Clin Psychol 2004; 72:53-61. [PMID: 14756614 PMCID: PMC2630209 DOI: 10.1037/0022-006x.72.1.53] [Citation(s) in RCA: 239] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined eating-disordered pathology in relation to psychopathology and adiposity in 162 non-treatment-seeking overweight (OW) and normal weight (NW) children, ages 6-13 years. Participants experienced objective or subjective binge eating (S/OBE; loss-of-control eating), objective overeating (OO), or no episodes (NE). OW children experienced significantly higher eating-disordered cognitions and behaviors than NW children and more behavior problems than NW children: 9.3% endorsed S/OBEs, 20.4% reported OOs, and 70.4% reported NEs. OW children reported S/OBEs more frequently than did NW children (p =.01), but similar percentages endorsed OOs. S/OBE children experienced greater eating-disordered cognitions (ps from <.05 to <.01) and had higher body fat (p <.05) than OOs or NEs. OOs are common in childhood, but S/OBEs are more prevalent in OW children and associated with increased adiposity and eating-disordered cognitions.
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Affiliation(s)
- Marian Tanofsky-Kraff
- Unit on Growth & Obesity, Developmental Endocrinology Branch, National Institite of Child Health & Human Development, National Institutes of Health, Bethesda, MD 20892, USA
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32
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Tanofsky-Kraff M, Morgan CM, Yanovski SZ, Marmarosh C, Wilfley DE, Yanovski JA. Comparison of assessments of children's eating-disordered behaviors by interview and questionnaire. Int J Eat Disord 2003; 33:213-24. [PMID: 12616588 DOI: 10.1002/eat.10128] [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: 11/06/2022]
Abstract
OBJECTIVE In adults, interview methods may detect eating-disordered behaviors more accurately than self-report methods. However, no studies have investigated the relationships between interview and self-report assessments in children. We compared results from the Eating Disorder Examination adapted for Children (ChEDE) with the Adolescent version of the Questionnaire on Eating and Weight Patterns (QEWP-A) and with the Children's Eating Attitude Test (ChEAT) in a nontreatment sample of overweight and normal weight children. METHOD The ChEDE, QEWP-A, and ChEAT were administered to 46 overweight (body mass index [BMI] at or above the 85th percentile) and 42 normal weight (BMI at the 15th-85th percentile) children, 10 +/- 1.8 years, recruited from the community. RESULTS The ChEDE and QEWP-A were not concordant for the number or type of eating episodes that occurred in the past month. Compared with the ChEDE, the QEWP-A was reasonably specific, but it was not sensitive for the presence of objective (17 % sensitivity, 91% specificity) or subjective bulimic episodes (0 % sensitivity, 89 % specificity) during the past month. ChEDE and ChEAT global scores were significantly related (Kendall's tau = 0.286, p <.001), but specific items assessing guilt in relation to eating and preoccupation with food were not. DISCUSSION Although self-report methods of eating disorder assessment in children may provide some general information regarding eating psychopathology in non-treatment-seeking children, they do not accurately reflect the results of a structured interview.
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Affiliation(s)
- Marian Tanofsky-Kraff
- Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, Bethesda, Maryland 20892-1862, USA
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33
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Nicholls D, Wells JC, Singhal A, Stanhope R. Body composition in early onset eating disorders. Eur J Clin Nutr 2002; 56:857-65. [PMID: 12209374 DOI: 10.1038/sj.ejcn.1601403] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2000] [Revised: 12/05/2001] [Accepted: 12/10/2001] [Indexed: 11/09/2022]
Abstract
BACKGROUND Body mass index (BMI) or equivalent weight for height indices are the most widely used measures of body composition in early onset and adolescent eating disorders. Although of value as screening instruments the limitation in disease states is their inability to discriminate fat and fat-free components of body weight. OBJECTIVE To compare height-adjusted fat and fat-free components of body composition in children and young adolescents with different types of eating disorders with those of age matched reference children. DESIGN Weight, height, triceps and subscapular skinfold thickness were measured in 172 children (aged 7-16 y) with eating disorders receiving specialist treatment. Fat mass index (FMI) and fat-free mass index (FFMI) were calculated using Slaughter's and Deurenberg's equations and normalisation for height. Using data from 157 normal children, representative of the UK 1990 growth reference data, reference curves for FMI and FFMI+/-2 s.d. were derived. Results for patient groups were superimposed on these reference curves. RESULTS FMI and FFMI were both reduced in eating disorders associated with malnutrition, including anorexia nervosa (AN). AN subjects did not differ from other subjects with comparable degrees of malnutrition. Children with eating disorders of normal weight, such as bulimia nervosa and selective eating, did not differ significantly from reference children in their relative FM and FFM. CONCLUSIONS FM and FFM merit independent consideration in disorders of malnutrition in children, rather than expressing data as percentage body fat or percentage BMI. The implications of loss of FFM on growth and development merit further investigation.
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Affiliation(s)
- D Nicholls
- Brain and Behavioural Sciences Unit, Institute of Child Health, London, UK.
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Abstract
It is widely accepted that eating disorders do occur in children. There is a growing literature on childhood-onset AN, and it seems that the core behavioral, psychologic, and physical features are similar to those in adults. The differences between children and adults also must be taken into account, however. Because children have lower levels of body fat, they tend to become emaciated and suffer the effects of starvation for more quickly than adults, which must be taken into account when considering treatment. Although cases of childhood-onset BN have been reported, they are so rare that empirical research is difficult. Clinical features reported regarding the atypical childhood-onset eating disorders generally concur, although empirical testing of these features has yet to be developed. Theories as to why children develop these disorders need further development. The general consensus is that all childhood-onset eating disorders must be considered using a multidimensional model that takes into account physical, psychologic, social, and family factors in origin, assessment, and treatment.
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Affiliation(s)
- Beth Watkins
- Department of General Psychiatry, St. George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK.
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Abstract
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.
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Abstract
BACKGROUND Although weight and shape concerns are considered to be integral to the psychopathology of anorexia and bulimia nervosa, uncertainties remain about developmental aspects of the aetiology of these concerns and their relationship to eating disorders. AIMS To review the recent literature on weight and shape concern, with particular emphasis on aetiology, to identify a possible developmental pathway from weight concern through abnormal eating behaviour to disorder. METHOD Literature review of Medline and Psychlit databases using the keywords 'eating disorder', 'weight concern', 'shape concern' and 'aetiology'. Inclusion criteria were based on the strength of quantitative research findings, originality of ideas and recent publication. RESULTS Weight and shape concerns follow a developmental pathway arising before the typical age for the development of eating disorders. The origins are multifactorial, with biological, family and sociocultural features predominating. CONCLUSIONS Although weight and shape concern seems commonly to underlie the development of eating disorders, an alternative pathway appears to exist through impulsivity and fear of loss of control. Prevention strategies may usefully focus on the attitudes and concerns that lead to dieting behaviour.
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Affiliation(s)
- S G Gowers
- Section of Adolescent Psychiatry, University of Liverpool, UK
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37
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Abstract
Although considerable progress has been made over the past 2 decades in the field of eating-disorder epidemiology, there is room for improvement. Eating disorder diagnoses for children, need assessment, prospective longitudinal studies, studies of natural cause, treatment dose-effect studies, and bias are all areas that need careful consideration. Clinicians should consider establishing a Cochrane database for eating disorders. The mortality studies reviewed in this article are dominated by small, sparse, unbalanced data sets, and publication bias and bias caused by loss to follow-up limits the validity of the reported findings. Some methodologic advice is given in the hope that some of the more obvious pitfalls can be avoided in future research.
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Affiliation(s)
- S Nielsen
- Department of Child and Adolescent Psychiatry, Bispebjerg Hospital, University of Copenhagen, Denmark.
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Manley RS, Smye V, Srikameswaran S. Addressing complex ethical issues in the treatment of children and adolescents with eating disorders: application of a framework for ethical decision-making. EUROPEAN EATING DISORDERS REVIEW 2001. [DOI: 10.1002/erv.413] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Nicholls D, Chater R, Lask B. Children into DSM don't go: a comparison of classification systems for eating disorders in childhood and early adolescence. Int J Eat Disord 2000; 28:317-24. [PMID: 10942918 DOI: 10.1002/1098-108x(200011)28:3<317::aid-eat9>3.0.co;2-#] [Citation(s) in RCA: 176] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the reliability of diagnostic classification systems for eating disorders when applied to children and young adolescents. METHOD Eighty-one patients were randomly selected from a population of 226 children (age 7-16) presenting with eating difficulties to a specialist clinic. Diagnoses were assigned according to three classification systems: the 10th edition of the International Classification of Diseases (ICD 10), the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and Great Ormond Street (GOS) criteria. Ratings were performed by two clinicians blind to the diagnosis of the other. RESULTS Interrater reliability values (kappa) for the three systems were 0.357 (ICD 10), 0.636 (DSM-IV), and 0.879 (GOS). Using DSM criteria, more than 50% of children were classified as eating disorder not otherwise classified (EDNOS) or could not be classified. DISCUSSION DSM-IV and ICD 10 criteria are of little value in the classification of the eating difficulties of children. The GOS criteria, which were developed for this age range, are more reliable. The classification of eating disorders in childhood needs reevaluation.
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Affiliation(s)
- D Nicholls
- Behavioural Sciences Unit, Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
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Affiliation(s)
- B Lask
- Great Ormond Street Hospital for Children, London, United Kingdom.
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44
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Abstract
The literature on children who present with selective eating is limited to single case studies. This study aims to provide a descriptive clinical profile for these children. Case notes of 33 patients between 4 and 14 years of age, seen in two clinics over a 4-year-period were studied. Over two-thirds of the cases were boys. A significant minority had poor growth or weight gain. The children suffered from anxiety, obsessive compulsive symptoms, both food and non-food related and often had social and school difficulties. Mealtimes caused immense anxiety for family members and frequent mealtime battles was reported by the parents of the younger selective eaters, whereas parents of older children seemed to have given up trying to change their child's eating habits. A history of depression in at least one parent was found in a third of the parental couples.
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Affiliation(s)
- S Timimi
- Department of Psychological Medicine, Great Ormond Street Hospital For Sick Children, London, UK
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45
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Affiliation(s)
- H C Steinhausen
- Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland
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46
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Casper RC, Jabine LN. An eight-year follow-up: Outcome from adolescent compared to adult onset anorexia nervosa. J Youth Adolesc 1996. [DOI: 10.1007/bf01537545] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Theander S. Anorexia nervosa with an early onset: Selection, gender, outcome, and results of a long-term follow-up study. J Youth Adolesc 1996. [DOI: 10.1007/bf01537539] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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49
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Affiliation(s)
- R Bryant-Waugh
- Department of Psychological Medicine, Great Ormond Street Hospital for Children NHS Trust, London, U.K
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50
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Abstract
Accurate data are not available for the prevalence of eating disorders amongst the Asian population in Britain. Only a handful of cases have been reported in the literature [Bhadrinath (1990). British Journal of Psychiatry, 156, 565-568.] suggested that it is an uncommon phenomenon despite Dolan's recent finding [Dolan, Lacey, & Evans (1990). British Journal of Psychiatry, 157, 523-528.] that there were elevated Eating Attitudes Test (EAT) scores in a sample of young Asian adults compared with Caucasians. We report a case of an Asian girl with a rare inborn error of metabolism and an eating disorder.
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Affiliation(s)
- C G Ballard
- Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Mindelsohn Way, United Kingdom
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