Self-image of anorexic and bulimic female adolescents

The purpose of this study was to assess the self-concept using the Offer Self-Image Questionnaire (OSIQ) in groups of Finnish adolescent girls with anorexia nervosa and bulimia nervosa, and a normal control group without an eating disorder. A total of 135 adolescent girls aged 16-21 (10 with anorexia nervosa, 10 with bulimia nervosa and 115 normal controls) were investigated using the OSIQ. In comparisons, girls with bulimia nervosa differed significantly from both girls with anorexia nervosa and normal controls with regard to severity on almost all of the OSIQ scales. Girls with anorexia nervosa differed from normal controls only in Emotional Tone and Sexual Attitudes. The findings suggest that anorexia nervosa and bulimia nervosa should be handled as different groups in assessing self-image with the OSIQ.     

Core beliefs in anorexic and bulimic women

There is research evidence to suggest the presence of dysfunctional cognitions in anorexia nervosa and bulimia nervosa that are not related to food, weight, or shape. These maladaptive cognitions have not been addressed by the conventional cognitive behavioral models of etiology or therapy. This study aimed to assess the impact of unhealthy core beliefs on eating disorders and their symptoms. Twenty restricting anorexics, 10 bulimic anorexics, 27 bulimics, and 23 normal controls completed Young's Schema Questionnaire. Eating behaviors and attitudes were also measured. The results indicate that both anorexic and bulimic women had significantly higher levels of unhealthy core beliefs than comparison women, but the clinical groups only differed on one individual core belief (entitlement). However, there were different patterns of association between core beliefs and eating psychopathology in anorexic and bulimic women. It is suggested that future clinical practice should incorporate core beliefs as a potential element in the assessment and treatment of eating disorders.     

Are anorexic and bulimic patients depressed?

The presence of depression was assessed in 82 female outpatients with anorexia nervosa and bulimia by means of a structured interview. The Research Diagnostic Criteria for major depressive disorder were met by 55.6% of the anorexic patients and 23.6% of the bulimic patients. On the Extracted Hamilton Depression Rating Scale, 40.7% of the patients with anorexia and 23.6% of those with bulimia had scores in the moderately or severely depressed range.     

Predictive factors in social adaptation disorders in anorexic and bulimic patients

A lifetime diagnosis of at least one anxiety disorder has been found in 13% to 75% of women with BN (Herzog, Keller, Sacks, Yeh, & Lavori, 1992; Schwalberg, Barlow, Alger, & Howard, 1992), and in 20% to 55% of women with AN, (Herzog et al., 1992, Laessle et al., 1989). Wittchen et al., 1998) have observed that the frequency and degree of disabilities and impairments associated with mental disorders in adolescence are strongly related to comorbidity (notably with anxiety disorders). However, as noted by Wonderlich et al., 1997, no study has compared ED individuals with and without comorbid anxiety disorders in terms of clinical or general functioning. The current study was designed to determine whether social avoidance symptoms and/or comorbid lifetime anxiety disorders were predictive factors of social disability in subjects with ED (AN or BN). We focused on two main dimensions of social adaptation, regarding social and professional life. 63 subjects with anorexia nervosa or bulimia nervosa were assessed for lifetime diagnoses of anxiety disorders, childhood history of separation anxiety disorder, social avoidance symptoms, and social disability. Sociodemographic characteristics, lifetime diagnoses of ED and anxiety disorders, and ages at onset of each disorder present, were assessed using the French version of the Composite International Diagnostic Interview (CIDI) (Robins et al., 1988; WHO, 1990). In addition, childhood history of separation anxiety disorder, not included in the CIDI, was assessed using the appropriate section of the Schedule for Schizophrenia and Affective Disorders Lifetime Version--Modified for the study of Anxiety Disorders (SADS-LA-R) (Endicott, Spitzer, 1978; Mannuzza, Fyer, Klein, 1985). Social anxiety symptoms were measured on Liebowitz Social Phobia Scale (Liebowitz, 1987). Social adjustment was assessed using a semi-structured interview, the Groningen Social Disabilities Schedule-Second version (GSDS-II) (Wiersma, De Jong, Ormel, & Kraaij Kamp, 1990). For each of the two outcome variables regarding disability, the Social role and the Occupational role, all subsets logistic regression analysis was performed in accordance to Hosmer and Lemeshow's guidelines (Hosmer and Lemeshow, 1989). Our total sample of 63 subjects included 29 subjects with AN restricting type (27 women, 2 men; 7% with a past history of BN) and 34 subjects with BN purging type (all women; 53% with history of a previous episode of AN). On the Groningen Social Disabilities Schedule, 86% of the anorexics and 65% of the bulimics had disability regarding the "social role", and 86% and 61%, respectively, disability regarding the "occupational role". Using all subsets logistic regression analyses, predictive factors of disability were: 1) for the social role, social avoidance symptom score (p < 0.002) and diagnosis of separation anxiety disorder (p < 0.01); 2) for the occupational role, number of lifetime anxiety disorders (p < 0.01) and diagnosis of separation anxiety disorder (p < 0.06). The present study clearly demonstrates that social avoidance and anxiety disorders are common and important features in the clinical presentation of subjects with AN or BN, and that they can have a negative impact on both their social and their occupational adaptation. Chronicity is a major risk in the ED, in terms of medical and sometimes lethal complications, but also because of the social consequences of these disorders. It is therefore important, in subjects with ED, to identify comorbid conditions linked to social disability, in order to improve global outcome. Recognizing and treating comorbid anxiety disorders in subjects with AN or BN could give better results than treating only the ED, in terms of social as well as global psychopathological outcome.     

Group therapy with anorexic and bulimic patients: implications for therapeutic intervention

The incidence of anorexia nervosa and bulimia has increased markedly during the last decade. Although numerous studies have appeared regarding the dynamics of the eating-disordered patient, few have attempted to link the unique pathology of these patients to specific psychotherapeutic interventions. This paper is based on the authors' experience as co-therapists with a group of eating-disordered patients over an eight months' period. It addresses itself to therapeutic interventions related to the particular dynamics of bulimics and anorexics.     

Self-image and parental attachment among late adolescents in Belize

This study investigated the relationship of ethnicity, parental education, gender, and parental attachment to multiple dimensions of self-image among 285 (161 female and 124 male) late adolescent Belizean students. Student ratings of self-image were unrelated to paternal education and student ethnicity. For maternal education, ethnic identity was higher for students whose mothers were high school graduates than for those whose mothers had completed college or a graduate degree. Female students reported more positive self-images than males in vocational attitudes. Favourable self-images were associated with secure ratings of parental attachment.     

Self-image of adolescents with diabetes mellitus type-I and rheumatoid arthritis

The purpose of this research was to determine possible differences in the self-concept of chronically ill and healthy adolescents. A group of adolescents with diabetes mellitus type-I (DM) and a group with rheumatoid arthritis (RA) were chosen for the study, together with a control group without any chronic illness. The groups were matched for gender, age (DM 17.8, RA 17.9, control group 17.6 years) and social class. The Offer Self-Image Questionnaire (OSIQ) was used to estimate differences between the groups of 23 DM adolescents, 25 RA adolescents and 26 control group adolescents. The scores are reversed; thus the higher the score, the better the self-image. The results indicate that Body Image, and Vocational and Educational Goals were lower in the groups of chronically ill adolescents than in the control group; however, no statistically significant differences were found between the groups on the OSIQ scales. The self-image of adolescents with DM with good metabolic control and moderate and long-lasting RA is relatively well developed.     

Self-image,war psychotrauma and refugee status in adolescents

The aim of this study was to assess how war psychotrauma, refugee status and other factors relate to self-image. Psychotherapeutic-psychiatric interview, the Offer Self-Image Questionnaire (OSIQ), questionnaires for measuring war stressors, posttraumatic stress reactions (PTS-reactions), depression and general data were administered. A total of 322 adolescents from Bosnia-Herzegovina and Croatia were included in the study. In 60.32% of the examinees, more than four war stressors were encountered. In 13.68% of the examinees, high PTS-reactions occurred. The refugees had nearly four times higher odds (aOR=3.66; 95% CI=1.63-8.2; p<0.01) of having a higher Offer score for the sexual attitudes subscale. Lower war stress had 0.28 times lower odds (aOR=0.28; 95% CI=0.11-0.71; p<0.01) of having a higher Offer score for the sexual attitudes subscale. More severe PTS-reactions had six times higher odds (aOR=6.15; 95% CI=1.7-22.2; p<0.01) of reaching a higher Offer score for the emotional tone subscale. War psychotrauma and refugee status are related to poorer adjustment only in some of the OSIQ subscales. Practical measures of joined sexually preventive/therapeutic activities are proposed, as well as educational and preventive/therapeutic psychotrauma models.     

Self-image of adolescents with diabetes mellitus type-I and rheumatoid arthritis

The purpose of this research was to determine possible differences in the self-concept of chronically ill and healthy adolescents. A group of adolescents with diabetes mellitus type-I (DM) and a group with rheumatoid arthritis (RA) were chosen for the study, together with a control group without any chronic illness. The groups were matched for gender, age (DM 17.8, RA 17.9, control group 17.6 years) and social class. The Offer Self-Image Questionnaire (OSIQ) was used to estimate differences between the groups of 23 DM adolescents, 25 RA adolescents and 26 control group adolescents. The scores are reversed; thus the higher the score, the better the self-image. The results indicate that Body Image, and Vocational and Educational Goals were lower in the groups of chronically ill adolescents than in the control group; however, no statistically significant differences were found between the groups on the OSIQ scales. The self-image of adolescents with DM with good metabolic control and moderate and long-lasting RA is relatively well developed.     

Self-image and depressive symptoms among adolescents in a non-clinical sample

The connection between self-image and depressive symptoms in non-clinical adolescent populations has not been well documented in large samples of teenagers. Our purpose was to investigate the correlation between self-image and depressive symptoms. To assess the adolescent's self-concept, we used the Offer Self-Image Questionnaire (OSIQ), and to study their depressive symptoms, we chose the Children's Depression Inventory (CDI). The sample consisted of 1054 eighth-grade students (465 boys, 589 girls) from normal comprehensive schools in one town with 200 000 inhabitants. The mean age of both gender groups was 14.5 years and they came from all social classes. The results showed a highly significant correlation between OSIQ scale scores and CDI scores. The more problems the adolescents had with their self-image, the greater the number of depressive symptoms. The correlation between the CDI total score and OSIQ scales scores was higher for girls than for boys except for the Superior Adjustment scale. The difference between sexes in the strengths of the correlations was highly significant (P<0.0001) except in the Sexuality scale. Since both the tests have shown to have predictive value for later psychiatric symptoms, further investigation of high-scoring CDI adolescents', and especially girls', self-image problems is important.     

Prevalency rate and personality comparisons of bulimic and normal adolescents

This study was designed to examine (1) the prevalency rate of bulimia in high school students and (2) the personality characteristics of bulimic studients when compared with a matched control group using the MMPI. The Bulimia Test and the Eating Disorder Inventory were used to screen for the disorder, followed by clinical interviews. A prevalency rate of 5.8% was established. A significant discriminate function was found using the Pa, Hy, Mf, and Sc scales to discriminate bulimics from controls.This project was funded by a research grant to the first two authors from General Electric.The authors would like to express their thanks to the principal, guidance counselors, and students at Ursuline Academy for their cooperation throughout this project.     

Difficulties and counter-attitudes in the face of female adolescent anorexic patients

Nurses can encounter difficulties when caring for anorexic teenage girls hospitalised in child psychiatric units. Knowing how to deal with the counter-attitudes specific to the pathology of these young patients enables hospitalisation to be maintained in the best conditions.     

Internalized anger, self-control, and mastery experience in inpatient anorexic adolescents

OBJECTIVES: To evaluate the implications of internalized anger, self-control and experience of mastery for adolescent girls with severe anorexia nervosa (AN). METHODS: Internalized and externalized anger, internal and external control, mastery, use of methods for self-control, and severity of anorexic symptoms were measured by self-report questionnaires in inpatient anorexic teenagers (N=26), inpatient female adolescent psychiatric patients (N=24), and a normal female comparison group (N=29). RESULTS: Internalized anger was significantly higher in both the anorexic and general psychiatric patients as compared to normal controls, but this difference was significant only for the anorexic patients. Anorexic and general psychiatric patients experienced significantly less mastery than normal controls, but again this difference was significant only in the anorexic group. Within the anorexic group, severity of symptoms correlated significantly with internalized anger, low mastery, and external locus of control, and negative significant correlations among control measures and anger were found. Total length of hospitalization correlated positively with internalized anger only for the anorexics. CONCLUSION: The findings support the notion that internalized anger and defective experience of self-control are important factors in the psychopathology of adolescent anorexic inpatient females The results may have implications for the clinical management of patients with severe AN.     

Distinguishing female borderline adolescents from normal and other disturbed female adolescents

PSYCHOANALYTIC theory would suggest that differentiating the borderline adolescent from his or her normal peers should be a difficult task. In many respects the developmental crises of adolescence dovetail with critical conflicts of Borderline Personality Disorder--e.g., identity formation and separation-individuation. Extensive semi-structured interviews (Gunderson's Diagnostic Interview for Borderlines) of normal, borderline and other disturbed adolescents provide a data base for examining the hallmarks of borderline pathology in adolescence. This paper focuses on the qualitative differences in patterns of impulsivity, affective lability, dissociative experience, and interpersonal relationships that distinguish borderline teenagers from other seriously disturbed and normal adolescents. The paper also outlines modifications in the Gunderson interview for an adolescent population.     

Frequency of bulimic behaviors and associated social maladjustment in female graduate students

A questionnaire survey of 550 female medical, business and law students revealed that 12% met criteria for bulimia. The bulimic students reported significantly more social maladjustment than their non-eating disordered peers. Frequency of binging and purging was associated with the degree of social impairment, with significant social dysfunction being noted on the overall scale at a minimum binging/purging frequency of once weekly. This finding suggests that the proposed DSM-III frequency criterion may be too restrictive.     

Self-love, self-control, and alexithymia: narcissistic features of two bulimic adolescents

The authors discuss two bulimic adolescent girls who also met the criteria for narcissistic personality disorder. The literature for both disorders is reviewed and three areas of common dynamics are elucidated. Bulimia appears to be part of a constellation of symptoms.     

The structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10 (SIAB-EX): reliability and validity.

OBJECTIVE: For reliable and valid assessment and diagnostic categorization of eating disorders, self-report measures have considerable limitations. A semi-structured interview - the SIAB-EX - was developed for a more reliable and valid assessment of eating disorders. METHODS: One study (videotapes of 31 inpatients, seven raters) was made to establish inter-rater reliability; in another study with 80 patients the SIAB-EX was compared to another semi-structured interview designed for comparable purposes (EDE). In a third study data was obtained on 377 eating disorder patients seeking treatment to explore discriminant and convergent (construct) validity using the following self-rating scales: EDI, TFEQ, SCL-90, BDI, and the PERI Demoralization Scale. RESULTS: Inter-rater reliability of dichotomous ratings was good with mean kappa values of.81 (current) and.85 (past). Comparison of the SIAB-EX with the EDE generally showed quite similar results and higher intercorrelation of the total scale (.77). There are, however, a number of differences between the two scales, which are discussed in detail. Construct validity of the SIAB-EX was established. CONCLUSION: Inter-rater reliability was good. Convergent and discriminant (construct) validity of the SIAB-EX was demonstrated. The constructs assessed by the SIAB and its subscales and items are discussed in the context of their correlations with other well-known scales.     

Development of sexuality in female children and adolescents

Female sexuality (meaning sexual desire, excitement and orgasm) has been of considerable interest in psychiatry. Women's efforts to define and legitimize their own experience of their sexuality have increased in the past 25 years. However, the integration of these new views into the body of psychiatric (especially psychoanalytic) theory has not occurred very actively or successfully. Very little is known about the development of sexuality in childhood and adolescence. This paper looks at various behaviours, interests and events in women's lives that might reveal something about the development of their sexuality. The literature on female masturbation is reviewed and some sex differences high-lighted. The literature on interest in babies, the wish to have babies, and menarche is explored for possible associations with sexuality. Rather than sexuality being a central organizer of experience, it seems quite possible that experience is an organizer of sexuality. Therefore, to better understand female sexuality we need to consider the impact of experiences during childhood and adolescence.