Anorexia nervosa and obsessive-compulsive disorder in a prepubertal patient with bone dysplasia: a case report

OBJECTIVE: The current article describes the case of a 13-year-old girl with body dysplasia, anorexia nervosa, and obsessive-compulsive disorder (OCD). METHOD: She was given cognitive-behavioral therapy and pharmacologic treatment for the obsessive-compulsive symptomatology and exogenous growth hormone to increase her height. RESULTS: She experienced an adequate weight and height increase and remission of obsessive-compulsive symptomatology, and reestablished adequate social and academic functioning. CONCLUSION: After a follow-up of almost 2 years, she had had her menarche, continued her positive eating habits, and had not relapsed into OCD.     

Anorexia nervosa following sexual harassment on the internet: a case report

BACKGROUND: Sexual abuse may be a risk factor for the development of anorexia nervosa. No information is available on sexual abuse through the Internet and its connection to the development of eating disorders. METHOD: We report on a case of an adolescent female with the diagnosis of anorexia nervosa, whose symptomatology correlated significantly with an incident of sexual harassment experienced via the Internet. RESULTS: A case of on-line harassment suffered without off-line follow-up is reported to have led to a restrictive type of anorexia nervosa, where the symptomatology was connected to a "computer scatology" like persecution of our patient. DISCUSSION: A causal connection of the on-line sexual harassment suffered and development of eating disorder is reported.     

Body dysmorphic disorder in patients with anorexia nervosa: prevalence,clinical features,and delusionality of body image

OBJECTIVE: The prevalence of body dysmorphic disorder in patients with anorexia nervosa is unknown. We hypothesized that body dysmorphic disorder would be underdiagnosed in patients with anorexia nervosa and that comorbidity with body dysmorphic disorder would result in greater overall dysfunction. METHOD: Forty-one patients with DSM-IV anorexia nervosa completed the Body Dysmorphic Disorder Questionnaire, a self-report screen for body dysmorphic disorder. A follow-up interview was conducted using a reliable clinician-administered semistructured diagnostic instrument for DSM-IV body dysmorphic disorder. Delusionality about appearance was assessed using a validated semistructured interview. Comorbid DSM-IV diagnoses, number of hospitalizations and suicide attempts were obtained by means of a detailed diagnostic interview. RESULTS: Sixteen (39%) of the 41 patients with anorexia nervosa were diagnosed with comorbid body dysmorphic disorder unrelated to weight concerns. The anorexia nervosa patients with body dysmorphic disorder had significantly lower overall functioning and higher levels of delusionality than the anorexic patients without body dysmorphic disorder. DISCUSSION: These preliminary results suggest that body dysmorphic disorder may be relatively common among patients with anorexia nervosa. The presence of comorbid body dysmorphic disorder may indicate a more severe form of illness.     

Neuropsychological functioning pretreatment and posttreatment in an inpatient eating disorders program

OBJECTIVE: This study was conducted to determine whether neuropsychological dysfunction associated with anorexia nervosa resolves with inpatient treatment. METHOD: Subjects were 28 women being treated for anorexia nervosa. Main study variables included body mass index (BMI), Beck Depression Inventory-II, and neuropsychological test scores. Subjects were tested at admission and discharge. RESULTS: Neuropsychological functioning improved across the course of treatment, with significant changes on tests of memory and psychomotor speed. This improvement was not significantly associated with change in BMI or with the other variables that were studied. DISCUSSION: Patients with anorexia nervosa exhibit subtle neuropsychological dysfunction, which resolves at least partially during treatment. This improvement does not appear to be associated with an increase in BMI. However, it is possible that BMI is not a sufficiently sensitive indicator of nutritional status or that longer-term follow-up is necessary to reveal the nutrition-cognition relationship that we were seeking.     

Evaluation of family treatments in adolescent anorexia nervosa: A pilot study

In the search for more effective methods of psychological treatment in anorexia nervosa, there are a number of controlled trials evaluating the efficacy of different forms of treatment. Previous studies have shown that family therapy is the superior treatment for patients with an early onset and short duration of illness. In order to assess the impact and the effective components of family therapy, we conducted a pilot trial in which consecutive referrals of anorexia nervosa patients were randomly assigned to one of two forms of family treatment: family therapy (conjoint family sessions) or family counselling (separate supportive sessions for the patient and counselling for the parents). Changes taking place within the patient and the family were evaluated at regular intervals, while within and between group comparisons were made. Although tentative, it was found that, in the short term, there were few differences in terms of symptomatic relief between the two treatment groups. © 1992 john Wiley & Sons, Inc.     

Family functioning in anorexia nervosa: British and Italian mothers' perceptions

This study tested the hypothesis that cultural differences would influence individuals' perceptions of family functioning. Mothers of British and Italian children and adolescents with anorexia nervosa completed the Family Assessment Device (FAD). British mothers perceived their families' communication and role definition as less healthy than did the Italian mothers. In contrast, the Italians perceived their families' behavior control methods as less healthy than did the British mothers. The findings might be explained by differences between British and Italian interpretations of the role of "family," particularly giving the British emphasis on independence and the Italian emphasis on family life. It is suggested that these culturally divergent attitudes towards family life might have different influences on anorexia nervosa. Finally, implications for family therapy are discussed, taking into account those characteristics that are more relevant for each cultural group.     

The long-term efficacy of three psychotherapies for anorexia nervosa: a randomized, controlled trial

Objective:

To evaluate the long‐term efficacy of three psychotherapies for anorexia nervosa.

Method:

Participants were women with broadly defined anorexia nervosa who had participated in a RCT comparing specialized psychotherapies (cognitive behavior therapy, CBT, and interpersonal psychotherapy, IPT) with a control condition (specialist supportive clinical management, SSCM), and attended long‐term follow‐up assessment (mean 6.7 years ± 1.2).

Results:

Forty three of the original sample of 56 women participated in long‐term follow‐up assessment (77%). No significant differences were found on any pre‐selected primary, secondary or tertiary outcome measures among the three psychotherapies at long‐term follow‐up assessment. Significantly different patterns of recovery were identified for the psychotherapies across time on the primary global outcome measure. Although SSCM was associated with a more rapid response than IPT, by follow‐up all three treatments were indistinguishable.

Discussion:

Potential implications for the timing of interventions to improve treatment response in anorexia nervosa are critically examined. © 2010 by Wiley Periodicals, Inc. Int J Eat Disord 2010     

Outpatient management of eating disorders in adults

Eating disorders are prevalent in the young adult female population. Given the serious medical, nutritional, and psychological risks associated with eating disorders, it is advisable that patients be seen within the framework of a multidisciplinary team. Psychotherapy is the most effective treatment modality for eating disorders and constitutes the core of mental health treatment. Although cognitive behavior therapy trials dominate the research literature on interventions for bulimia nervosa and binge-eating disorder, various modalities of psychotherapy have efficacy. Active weight management is also a key component of treatment for anorexia nervosa. Psychotropic medication therapy is not generally useful for the primary symptoms of anorexia nervosa, whereas it is moderately effective in the treatment of both bulimia nervosa and binge-eating disorder. Given the patient population at Massachusetts General Hospital, to which patients often present with serious and chronic symptoms, comorbid medical and psychiatric illness, and history of poor response to treatment, we have found a flexible and eclectic treatment approach most useful clinically.     

A consideration of developmental egocentrism in anorexia nervosa

Recent research has suggested that normal adolescent processes are important in understanding psychosis, and that young adult individuals with psychosis are often struggling to develop an individual and autonomous self (the “fundamental task” of adolescence). The current paper explores the utility of considering normative adolescent developmental processes in understanding anorexia nervosa. Data were collected from 31 female young-adults with symptoms of anorexia nervosa, 26 female comparison young-adults and 71 female adolescents on measures of adolescent egocentrism. A one-way ANOVA indicated that individuals with symptoms of anorexia nervosa scored more highly than both their peers and the adolescents on several dimensions of egocentric developmental beliefs. Correlations also showed that egocentrism was positively associated with eating concern in participants with symptoms of anorexia. The results suggest that young-adult women with symptoms of anorexia nervosa tended to feel physically invulnerable while also feeling both psychologically vulnerable to others and special or different. Together with the finding of excessive self-consciousness, this supports a notion that they may be experiencing exaggerated versions of normal self-developmental phenomena. Clinically, offering alternative ways of feeling unique other than dieting may be important in therapeutic approaches to anorexia nervosa. Similarly, strategies aimed at normalisation, such as facilitating healthy attachment to peers, may be useful for individuals with anorexia nervosa.     

Is anorexia nervosa associated with elevated rates of suicide?

OBJECTIVES: The purpose of this study was to ascertain whether individuals with anorexia nervosa are more likely to commit suicide, as suggested by previously noted associations between anorexia nervosa and mood disorders. METHODS: Data from death records representing over 5 million women were examined, yielding 571 cases in which anorexia nervosa was mentioned as an existing condition. The women with anorexia were compared with 1713 control subjects matched for age, sex, and race. RESULTS: The percentage of suicides among those listed as having anorexia nervosa was only 1.4%, compared with 4.1% for the controls. CONCLUSIONS: These findings suggest that the suicide rate is not elevated among individuals currently suffering from anorexia nervosa.     

The recognition of emotion in the faces and voice of anorexia nervosa

OBJECTIVE: The aim of this study was to examine emotional recognition (prosodic and visual) in anorexia nervosa. METHODS: Thirty people with anorexia nervosa and a comparison group of 30 healthy women were tested with facial and vocal stimuli that expressed specific emotions and they were given a neutral task. RESULTS: The group of women with anorexia nervosa was poor at emotional recognition. This was most marked for negative emotions in faces and for both positive and negative emotions in voices. This decreased ability to recognize negative affect in faces remained even after adjustment for confounding variables such as age, education, and depression. DISCUSSION: People with anorexia nervosa have difficulty recognizing emotions from facial expression and vocal tone. This may contribute to poor interpersonal communication and a lack of empathy, both of which are associated with anorexia nervosa patients.     

Anorexia nervosa and gender identity disorder in biologic males: a report of two cases

Gender identity disorder is a rare disorder of uncertain etiology. The emphasis on body shape in this disorder suggests that there may be an association with anorexia nervosa.METHOD: We report two cases of anorexia nervosa and gender identity disorder in biologic males who presented to an eating disorders service. RESULTS: One was treated successfully as an outpatient and subsequently underwent gender reassignment surgery. The other patient required admission and prolonged psychotherapy. DISCUSSION: Differences between the two cases are discussed. Issues of gender identity should be considered in the assessment of male patients presenting with anorexia nervosa.     

Anorexia nervosa. A review

Anorexia nervosa is an illness characterized by significant weight loss, amenorrhea, distorted body image and a relentless pursuit of thinness. The disorder affects primarily young women between the ages of 13 and 20, and is more commonly seen in westernized countries. Although the incidence is relatively rare, affecting approximately 0.5 to 1.0% of younger women in the United States, medical complications can be severe, and long-term mortality rates may approach 20%. Recent studies indicate that subclinical eating disorders occur in at least 5% of women and up to 1/3 of females among special populations such as athletes and insulin-dependent diabetics. The etiology of eating disorders is not known, but there are psychosocial and biological influences. Malnutrition associated with anorexia nervosa can affect nearly every organ system in the body, with cardiac complications responsible for 50% of the deaths in anorexia nervosa. More recent brain studies suggest that grey matter volume deficits may persist after refeeding. Subclinical anorexia nervosa in athletes is associated with premature fractures and long-term osteopenia. Early complications, such as retinopathy, are increasingly seen in female diabetics who have disordered eating patterns. Well-designed empirical trials of treatment with psychotherapy and psychopharmacology are very limited. There is some evidence that family therapy may be more effective than individual therapy in younger anorectics who have been ill less than 3 years. The most promising finding in medication treatment suggests that fluoxetine may help prevent relapse in the weight restored anorectic.     

A multidimensional psychotherapy for anorexia nervosa

A multidimensional psychotherapy is described which selectively integrates existing approaches with those which we have found to be useful in the management of patients with anorexia nervosa. General principles for facilitating the development of trust in the therapeutic relationship as well as factors contributing to the patient's ambivalence toward treatment are outlined. The interaction between psychopathology and starvation symptoms or other sequelae is emphasized. Specific clinical strategies for promoting cognitive, affective and behavioral change within the individual are proposed. Recommendations are made for dealing with issues such as weight, eating, body-image misperception, bulimia, self-concept deficiencies and the development of autonomy commonly encountered with the anorexic patient. Family therapy is advised for some patients.     

Family therapy in the treatment of anorexia nervosa

There have been a number of enthusiastic reports advocating the use of family therapy in the treatment of anorexia nervosa. Although the authors support the role of family therapy, they caution against its exclusive use in a condition that is clearly multidetermined. Case reports illustrating some of the problems experienced with families of patients with anorexia nervosa are provided.     

Anorexia nervosa in the Kibbutz: Factors influencing the development of a monoideistic fixation

Among the diverse psychiatric entities with stagnating monothematic thoughts, anorexia nervosa occupies a significant place as a typical example of a “monoideistic” illness. The dominant idea (about food, dieting, weight loss, and body shape), repeated mentally over and over again and deeply rooted in family and other interpersonal transactions, can engender an hyponotic-like state. Our interest in anorexia nervosa as one of the most typical monoideistic diseases gained in strength as we noted that in the course of the past 15 years there was an ever-growing stream of referrals to the Kibbutz Clinic of adolescent girls with anorexia nervosa. For this reason we opened an anorexia nervosa treatment unit and have been able to carry out prospective followups on 66 kibbutz anorectic patients (40 restricters and 26 bulimics) over periods from 4 to 10 years. We were particularly interested in the answer to the question of whether the nosogenesis of the monoideistic pattern, the family and sociocultural factors, and the course and the outcome of the illness are different in the kibbutz population as compared with other settings.     

Group psychotherapy in anorexia nervosa

The author's personal experience as a cotherapist in a psychotherapy group with anorexic patients is discussed. There appears to be mounting evidence that group therapy could be an effective adjunctive treatment in anorexia nervosa, and guidelines for setting up a research project to look at this treatment are consequently presented. These guidelines emphasize the need for careful methodology and outcome assessment but also note the difficulty of accurately monitoring any psychotherapy group.     

家庭治疗技术在护理儿童神经性厌食患者中的应用研究

目的探讨家庭治疗技术在护理儿童神经性厌食患者中的应用。方法回顾性分析我院从2009年12月至2011年12月在我院就诊的86名儿童神经性厌食患者的资料,86例进行家庭治疗技术的患者设置为A组,同时,82名不进行家庭治疗的儿童神经性厌食患者设置为B组。结果通过对A组和B组的比较发现,通过家庭治疗技术治疗的A组儿童康复较快(t=5.528,P<0.05),两组间差异有统计学意义。结论家庭治疗技术在护理儿童神经性厌食患者中具有重要的作用,值得推广。     

The current status of treatment for anorexia nervosa and bulimia nervosa

A survey investigating the current status of treatment for anorexia nervosa and bulimia nervosa was distributed at the International Conference on Eating Disorders in 7988 and again in 1990. Respondents answered questions regarding treatments they had endorsed for their last patient with anorexia nervosa and for bulimia nervosa. One hundred and seven medical doctors and psychologists completed the survey in 1988 and 115 in 1990. The results indicate that: (1) less than 50% of the respondents believe there is a consensus regarding the treatment of eating disorders; (2) talking therapy is overwhelmingly endorsed for the treatment of both anorexia and bulimia nervosa; (3)there is a trend in clinical practice towards using drug therapy more frequently in treating patients with bulimia nervosa than in treating patients with anorexia nervosa; (4)physicians are more likely than psychologists to endorse drug therapy when treating patients with anorexia and for bulimia nervosa; and (5) about one third of the respondents endorse drug therapy for treating anorexia nervosa. © 1992 John Wiley & Sons, Inc.