Childhood and adolescence are critical periods of neural development and physical growth. The malnutrition and related medical complications resulting from eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth than during other age periods. The consensus opinion of an international workgroup of experts on the diagnosis and treatment of child and adolescent eating disorders is that (a) lower and more developmentally sensitive thresholds of symptom severity (e.g. lower frequency of purging behaviours, significant deviations from growth curves as indicators of clinical severity) be used as diagnostic boundaries for children and adolescents, (b) behavioural indicators of psychological features of eating disorders be considered even in the absence of direct self-report of such symptoms and (c) multiple informants (e.g. parents) be used to ascertain symptom profiles. Collectively, these recommendations will permit earlier identification and intervention to prevent the exacerbation of eating disorder symptoms.
Medical students' attitudes towards suicide and suicidal patients were studied. The aim was also to determine whether attitudes differ between students in the beginning and end of studies. A questionnaire including own attitudes on death and suicide and psychosocial circumstances was filled in by 63% of first and final year students (306 of 485). The calculation included a factor analysis on items describing the attitudes to suicidal patients. Attitudes towards patients became influenced by the knowledge of mental disorders and by biological aspects of behaviour during the education. Final year students more often consider suicide to be an expression of psychiatric disease and thought that people trying to commit suicide were not responsible for their own actions. Thirty-four percent and 44% (ns) in the first and last years, respectively, reported suicidal ideas some time in their lives. Students with such a history of suicide thoughts were less optimistic about the possibility to help. Ongoing depressive/anxious symptoms were prevalent in 36/305 (12%) of students, but did not seem to affect their attitudes to patients. Female students had sought psychological/psychiatric help more often than males (26% and 10%, P < 0.01).
Objective To compare long term outcome between childhood‐onset Anorexia Nervosa (AN) and low‐weight Avoidant/Restrictive Food Intake Disorder (ARFID) in regard to psychiatric diagnoses, social and occupational functioning. Method A consecutive series of 56 children originally treated for low‐weight restrictive eating disorder (ED) were followed up after a mean of 15.9 years. ARFID‐diagnoses were assigned retrospectively. Results Thirty‐seven patients originally had AN and 19 patients were diagnosed retrospectively with ARFID. At follow‐up, in the AN‐group 21.6% had a current ED, 24.3% had another psychiatric diagnosis, and 54.1% did not have any psychiatric diagnosis. In the ARFID‐group, 26.3% had a current ED, 26.3% had another psychiatric diagnosis, and 47.4% had no psychiatric diagnosis. In the ARFID‐group ED diagnoses at follow‐up were all ARFID, whereas the AN‐group showed heterogeneity. Morgan Russell Outcome Assessment Schedule indicated similar outcome in the AN‐ and ARFID‐group. Occupational functioning did not differ significantly between the AN‐ and ARFID‐group. Discussion The AN‐group showed high rate of ED at follow up. The ARFID‐group had a similar outcome to AN. In the ARFID‐group, all ED‐cases at follow up had ARFID, possibly indicating symptomatic stability. Low‐weight ARFID should be treated as seriously as childhood onset AN.
Family therapy has emerged as the treatment of choice for young patients with anorexia nervosa, yet there is insufficient knowledge about what actually happens within the family unit in these cases. The purpose of the present study was to investigate how a family undergoing treatment due to an anorectic child changes their mode of functioning. Twenty-six families were studied. The concepts chosen in the study were closely linked to fundamental principles advocated by the therapeutic model used in the treatment, using a multi-method approach with both observer ratings and self-rating questionnaires. According to observer ratings, the families had changed towards a more functional pattern on all dimensions rated. They had a clearer hierarchy and a higher degree of competency. Cohesion and Adaptability had changed towards a more balanced pattern, away from enmeshment and rigidity. According to self-ratings, the families changed toward more expressiveness. Families where the patient had recovered were less enmeshed at follow-up. We also found a tendency towards higher degree of competence in these families.
Objective: To evaluate the effect of Body Awareness Therapy (BAT), a speci®c treatment method for dealing with body-image disturbances, in anorexia nervosa in the young patient.Methods: A consecutive group of patients receiving family therapy was randomly assigned to Body Awareness Therapy. The patients were examined at treatment start and at 2-year follow-up. The eating disorder symptoms were evaluated with the Global Clinical Score, Ch-EAT and EDI. The body-image disturbances were examined with the Visual Size Estimation technique.Results: We found no differences in the overall treatment results between the patients that received BAT compared with the patients who only received family therapy. The patients who received BAT, and had a disturbance in estimated body size, improved in their body image.Discussion: Body Awareness Therapy did not have an effect on the overall outcome of anorexia nervosa, but had a normalizing effect on the distorted body image.
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