Girls with anorexia nervosa as young adults: personality, self-esteem, and life satisfaction

OBJECTIVE: The current study evaluated personality, self-esteem, and life satisfaction in former patients with different outcomes of childhood and adolescent-onset anorexia nervosa (AN). METHODS: Forty-four female patients with AN were assessed 8.5 +/- SD 3.4 years after treatment start with a clinical interview and questionnaires including the Temperament and Character Inventory (TCI) and the Rosenberg Self-Esteem Scale. Self-esteem and general life satisfaction in former patients were compared with women in a large population study. RESULTS: Former AN patients with no eating disorder and normal eating attitudes at follow-up (n = 21 [48%]) had similar TCI profiles and self-esteem as samples from normal populations, whereas participants with poorer outcome had significantly lower TCI Self Directedness, self-esteem, and life satisfaction scores. Life satisfaction was reduced in all outcome groups and was strongly associated with self-esteem. CONCLUSION: Personality, self-esteem, and life satisfaction varied significantly between outcome groups. The results indicate that young patients with AN with a good outcome may have normal personality and self-esteem features in young adulthood.     

Specific and nonspecific comorbidity in anorexia nervosa

OBJECTIVE: This article reports lifetime Axis I and II comorbidity in women with anorexia nervosa (AN), and ascertains specific and nonspecific comorbidity in AN compared to clinical samples of women with bulimia nervosa (BN) or major depression (DEP). METHOD: Outpatient AN (n = 56), BN (n = 132), and DEP (n = 100) samples were assessed using Structured Clinical Interviews I and II for DSM-III-R. Baseline data were compared using univariate statistics and logistic regression. RESULTS: In the AN sample as a whole, specific elevations were found for prevalences of obsessive compulsive disorder. The AN-binge eating purging subtype (AN-BP) and the BN sample had elevated prevalences of Cluster B personality disorders. Cluster C prevalences were elevated across samples. CONCLUSION: Evidence of AN-specific, eating disorder-specific, and nonspecific comorbidity illustrates the heterogeneity in AN. Further research is need to examine the relative impact of specific and nonspecific comorbidity in AN subtypes and AN as a whole.     

Anxiety and psychoactive substance use disorder comorbidity in anorexia nervosa or depression

OBJECTIVE: This study considered whether the prevalence and type of anxiety and psychoactive substance use disorder (PSUD) diagnoses differ between women with spectrum anorexia nervosa (AN) (N=40) and women with major depressive disorder (N = 58) participating in outpatient clinical trials. METHOD: Anxiety and PSUD diagnoses (according to criteria in the 3rd Rev. ed. of the Diagnostic and Statistical Manual of Mental Disorders) were assessed using structured clinical interviews. Comparisons were made between AN subtypes (restricting or binge eating/purging) and by history of depression within the AN sample. RESULTS: A high prevalence of obsessive-compulsive disorder (OCD) was found in women with AN. However, social phobia, simple phobia, and PSUD were significantly elevated in both women with depression and women with AN. Prevalences were similar for anxiety and PSUD diagnoses between AN subtypes. DISCUSSION: Women with anorexia or depression were comparable in all respects, except for the elevated OCD prevalence in AN, emphasizing the need to use clinical comparison groups to avoid inadvertently attributing elevated prevalences of comorbid conditions to specific disorders.     

Coronary atherosclerosis in anorexia nervosa

BACKGROUND: Chest pain is a common complaint in patients with anorexia nervosa (AN). Of those who experience chest pain, about 20% meet the diagnostic criteria for typical or atypical angina. METHODS: We compared the intima-medial thickness (IMT) of the carotid artery measured by ultrasound in AN with controls and found no difference. RESULTS AND DISCUSSION: Although clinically relevant atherosclerosis can occur in patients with a normal IMT, there is a strong correlation between carotid IMT and coronary atherosclerosis. This suggests that an atherosclerotic origin of chest pain in AN patients is unlikely.     

Severe and enduring anorexia nervosa: No easy solutions

There is currently no evidence-based definition of severe and enduring anorexia nervosa (SE-AN) with which to reliably inform clinical practice and research. Indeed, data on the effect of AN severity and duration on treatment outcome are inconsistent. A large group of patients with SE-AN are repeatedly unsuccessfully managed with the available eating disorders treatments and have no access to adequate treatment for their illness. Cognitive behavioral therapy (CBT) adapted for SE-AN has been designed to enhance quality of life and reduce harm rather than promoting weight gain in such patients, and has had some success. However, a percentage of patients with SE-AN achieves remission, or at least returns to a normal weight range, with available evidence-based treatments for eating disorders, such as enhanced CBT (CBT-E). It would therefore be worth conducting a large-scale randomized controlled trial comparing CBT adapted for SE-AN with CBT-E to assess their relative acceptability; efficacy, including their effect on quality of life and medical stability; cost-effectiveness; and the treatment response moderators that might allow better matching of patients with SE-AN to a treatment oriented either to harm reduction or to change.     

A systematic review of dropout from treatment in outpatients with anorexia nervosa

OBJECTIVE:

Dropout from treatment has serious implications for patients, clinicians, and researchers. The aim of this study was to examine rates of dropout from outpatient treatment for anorexia nervosa (AN) and critically examine the various definitions of dropout used.

METHOD:

A systematic review was conducted, including pharmacological and psychological interventions. All articles in PubMed, Web of Science, and the Cochrane Library were considered, and screened against a priori inclusion/exclusion criteria. Relationships between treatment outcome and dropout rate were examined across studies.

RESULTS:

Nineteen relevant studies were identified, with dropout rates ranging from 4.8% (family therapy) to 100% (dietary advice). In most cases, dropout was in the range of 20–40%. Definitions of dropout used varied widely. A significant negative correlation was found between rate of dropout and body mass index (BMI) at 1 year, but this did not remain significant when differences in BMI at baseline were taken into account.

DISCUSSION:

High rates of dropout from treatment for AN have serious implications for recovery, research, and the development of new treatments. A suggested reporting structure is proposed, with the aim of increasing the consistency of dropout reporting and facilitating greater understanding of this phenomenon. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2011)     

Severe and enduring anorexia nervosa: Update and observations about the current clinical reality

Several objectives underlie the current article. First, to review historical diagnostic issues and clinical strategies for treating SE-AN. Second, to provide an overview of recent evidence informed strategies and clinical innovations for the treatment of SE-AN. Third, based on the authors' collective clinical and research experience, we offer eight observations that we believe capture the current clinical experience of patients with SE-AN. Some of these observations represent empirically testable hypotheses, but all are designed to generate a meaningful discussion about the treatment of this group of individuals with eating disorders. Finally, we hope to call clinicians, scientists, professional organizations, advocates, and policy makers to action to attend to critical issues related to the care of individuals with SE-AN. We believe that an international discussion could clarify areas of need for these patients and identify opportunities for clinical innovation that would enhance the lives of individuals with SE-AN and their families.     

Body checking behaviors in anorexia nervosa

The study aimed to assess the trajectories of change in body checking over time and the change in eating disorder and general psychopathology in patients with anorexia nervosa treated with inpatient enhanced cognitive behavioral therapy (CBT‐E). Sixty‐six adult patients with anorexia nervosa were recruited from consecutive referrals to a community‐based eating disorder clinic. Body mass index, Eating Disorder Examination, Brief Symptom Inventory, and Body Checking Questionnaire (BCQ) scores were recorded at admission (T0), end of treatment (T1), and 6‐ and 12‐month follow‐ups (T2 and T3, respectively). The BCQ was also administered at a single time point to an age‐matched healthy female comparison participants group (N = 182). In comparison with comparison participants, patients had higher global BCQ scores at T0. However, mean patient scores for global BCQ administered at T1, T2, and T3 were significantly lower than that measured at baseline in the comparison participants group. The change in BCQ was significantly associated to short‐ and long‐term improvements in eating disorder and general psychopathology. The association between change in body checking and the trajectories of change of eating disorder psychopathology supports the potential usefulness of the CBT‐E strategy for reducing shape and weight concerns by addressing body checking.     

Personality pathology in purging disorder and bulimia nervosa

Objective:

To compare levels of personality pathology in women with purging disorder (PD), bulimia nervosa (BN), and controls and to compare women with PD and BN on associations between personality pathology and shared eating disorder features.

Method:

Women with BN (n = 73), PD (n = 48), and controls (n = 64) completed interviews and self‐report questionnaires.

Results:

BN and PD were associated with significantly greater personality pathology compared to controls. Cluster C symptoms and trait anxiety were greater in BN compared to PD, but groups did not differ on Cluster B symptoms or impulsivity. Subjective binge episodes were associated with anxious and impulsive personality traits in PD but not BN. Purging in PD was associated with trait anxiety, while purging in BN was associated with impulsivity.

Discussion:

Although BN and PD share eating disorder features and personality disturbance, some of the underlying associations between these eating disorder and personality features differ between groups. © 2011 by Wiley Periodicals, Inc.