Impact of the media on adolescent body image.

The mass media have become a powerful force throughout the world and strongly influence how people see themselves and others. This is particularly true for adolescents. This article discusses how the media affect body image and self-esteem and why the media seem to have such strong effects on adolescents. The differences in responses to the media in adolescents of different ethnic, racial, and cultural backgrounds are discussed. Although this article focuses primarily on teenage girls, the data for adolescent boys is reviewed as well. Finally, this article discusses possible ways to help adolescents become more active viewers of the media and help prevent the decrease in body esteem that so often occurs during adolescence.

Smoking in adolescence: what a clinician can do to help.

Approximately 4400 adolescents try their first cigarette every day in the United States. Trying a few cigarettes or using tobacco more regularly as an adolescent significantly increases the risk of smoking in adulthood. Adolescents can develop nicotine dependency after smoking relatively few cigarettes. This article points out the prevalence and unique aspects of teenage tobacco use. In addition, current recommendations for treating nicotine dependence in adolescents are reviewed.

Use of nutritional supplements to increase the efficacy of fluoxetine in the treatment of anorexia nervosa.

OBJECTIVE: Selective serotonin reuptake inhibitor (SSRI) medication does not appear to be effective in ill, malnourished anorexia nervosa (AN) patients. However, it may be effective in preventing relapse after weight restoration. The purpose of this study was to determine whether nutritional supplements could potentiate the effects of fluoxetine in underweight AN subjects. METHOD: Twenty-six subjects with AN participated in a trial of fluoxetine. In a double-blind, placebo-controlled manner, subjects received either nutritional supplements or a nutritional placebo. The nutritional supplement included tryptophan (the precursor of serotonin), vitamins, minerals, and essential fatty acids believed to influence serotonin pathway function. RESULTS: There was no significant difference in weight gain between subjects treated with fluoxetine plus nutritional supplements versus fluoxetine plus a nutritional placebo. Moreover, there were no significant differences between groups on mean changes in anxiety or obsessive and compulsive symptoms. DISCUSSION: The results of this study suggest that supplement strategies are not a substitute for adequate nutrition and are ineffective in increasing the efficacy of fluoxetine in underweight AN subjects.

Primary prevention of eating disorders through attitude change: a two country comparison.

Primary prevention of eating disorders though increasing the knowledge base about eating disorders has been ineffectual, and in some cases has had a deleterious effect. The following study compared the efficacy of a classroom intervention using cognitive dissonance and repetition, in Italy and the U.S. In each country, health education classes of tenth grade students (U.S. n = 50, Italy n = 138) were randomly assigned to intervention and non-intervention sections. Subjects in the non-intervention sections received the standard health classes taught by their usual teacher. Students in the intervention sections received five classes taught by a psychologist (in the U.S.) or a psychiatrist (in Italy) specializing in eating disorders. Subjects in the intervention group also completed a cognitive dissonance essay designed to persuade a same sex friend that self-esteem should not be based solely on appearance. Intervention and non-intervention groups completed questionnaires before and after the intervention as well as at the end of the semester. The U.S. group had significantly higher Perfectionism scores and significantly lower Drive for Thinness scores (DT) than the Italian group. There was a significant decrease in DT for the intervention group in Italy. The intervention did not affect any other measures in the Italian group. There are clearly ethnic differences in comparing these two samples that may account for the baseline differences in eating attitudes. However, despite otherwise differing profiles, girls from each country had a desire to diet. This program appears to have made some impact in changing the attitudes away from a desire for thinness for Italian subjects. It is possible that many attitudes about weight, shape, and eating are established in this age group and a younger target audience would be more appropriate in the future.

Risk factors for eating disorders: surprising similarities between middle school boys and girls.

This study examined body dissatisfaction (BD), drive for thinness (DT), and self-esteem in middle school students. Participants were 40 girls and 36 boys aged 11-13. Students completed BD and DT Eating Disorder Inventory subscales and the Rosenberg self-esteem questionnaire. There were no significant differences on these measures. For boys and girls, self-esteem was negatively correlated with BD, and Body Mass Index (BMI) was positively correlated with BD. For boys, BMI was positively correlated with DT. DT was negatively correlated with self-esteem in girls. The relationship between body dissatisfaction and self-esteem is cause for concern and may be a higher risk for developing eating disorders.

A comparison of cognitive and behavioral symptoms between Mexican and American eating disorder patients.

OBJECTIVE: Mexican and U.S. patients with anorexia nervosa or bulimia (complete and partial syndromes) were compared on severity and types of preoccupations and rituals related to eating disorders and the motivation to change. METHOD: One hundred seventy-four patients who met DSM-IV criteria for anorexia nervosa, bulimia nervosa, or ED-NOS participated. Eighty-seven subjects entered treatment at the Instituto Nacional de Psiquiatría "Ramón de la Fuente" in Mexico City and were matched with 87 patients treated at the New York Presbyterian Hospital. Patients were interviewed with the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) (English or Spanish version). RESULTS: All YBC-EDS scores were higher for the Mexican group, which also had a greater number of current preoccupations and rituals. U.S. and Mexican patients were quite similar in their endorsement of current preoccupations, but the Mexican group was more likely to have rituals in all checklist categories, and the rituals were more egosyntonic. More U.S. patients had received previous treatment for their eating disorder. A negative correlation was obtained between the amount of previous treatment and motivation to change the preoccupations and rituals (higher scores indicating lower motivation). DISCUSSION: Cultural factors may influence characteristics of eating disorders. The previous treatment experiences of the U.S. patients seemed to positively influence their motivation for further treatment.

Obsessions and compulsions in anorexia nervosa subtypes.

OBJECTIVE: Obsession and compulsions in anorexia nervosa (AN) patients are often confused with the preoccupations and rituals that are characteristic of obsessive-compulsive disorder (OCD). We examined the type and frequency of characteristic OCD obsessions and compulsions in a large sample of AN patients. METHOD: In personal interviews with 324 AN patients, we assessed lifetime histories of eating disorder symptomatology and obsessive-compulsive behaviors with valid semistructured interviews. Checklist category sums on the Yale-Brown Obsessive Compulsive Scale were compared between AN and OCD subjects using generalized estimating equations. RESULTS: Lifetime obsessions and compulsions occurred in 68% of the AN restricting type and in 79.1% of the AN binge/purge type. The AN subgroups did not differ from OCD controls in frequency of obsessions in the symmetry and somatic categories or in the compulsion categories of ordering and hoarding. In all other categories, the AN subgroups had a significantly lower frequency compared with the OCD controls. DISCUSSION: Some common phenotype characteristics shared by most AN and OCD patients suggest these disorders may share common brain behavioral pathways. However, the lack of complete overlap indicates they most likely have different loci of pathology within those pathways.

Energy intake and body composition in anorexia and bulimia nervosa.

Energy intake during the weight gain phase and the weight maintenance phase was examined in three groups of inpatients: 64 anorectic restrictors (AN-R), 37 anorectic bulimics (AN-B), and 74 normal-weight bulimics (BN). The influence of body composition and other variables such as weight, exercise, and bingeing and purging frequencies on energy intake was analyzed. Eating disorder subgroups were found to differ in energy intakes to gain weight and to maintain weight within a target weight range. Anorectic restrictors consumed significantly more energy to gain weight than did the anorectic bulimics (a mean of 3055 kcals per day vs. a mean of 2788 kcal per day). Energy intake for weight gain was inversely related to admission body mass index (BMI) and to admission fat-free mass. Bingeing and purging frequencies did not predict caloric intake for either weight gain or maintenance for anorectics. Energy intake of the anorectic patients when they were maintaining weight within a target weight range did not differ between restrictors and anorectic bulimics (means of 2204 and 2134 kcal/day, respectively). Energy needed to maintain weight within a target weight range was predicted by the amount of fat-free mass at target weight and by the mean number of calories ingested per week during weight gain. Bulimics consumed fewer calories than either of the two anorectic groups during the weight maintenance phase (1538 kcal/day). Other than BMI at hospital admission, bulimics' energy intakes were unrelated to all demographic and eating disorder-related variables, including body composition.

Short-term group CBT versus psycho-education on an inpatient eating disorder unit.

The purpose of the current study was to compare, on an inpatient eating disorder unit, short-term cognitive behavior group therapy with a psycho-education group.